A Pilot Randomized Controlled Trial of Resilience Coaching for Adolescents with Chronic Musculoskeletal Pain

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PROJECT SUMMARY Chronic musculoskeletal pain (CMP) affects as many as 4 in 10 children, mostly adolescents, and accounts for the majority of new referrals to pediatric rheumatology. Long-term physical and psychosocial outcomes for adolescents with CMP are poor with increased healthcare utilization and psychological co-morbidities. Additionally, current treatment regimens for CMP have limited accessibility. Resilience is a dynamic process of positive adaptation or development in the context of significant adversity, such as living with excessive chronic pain. Promoting Resilience in Stress Management (PRISM) is a successful resilience-training intervention for adolescents and young adults with serious illness. Preliminary data for this proposal demonstrate a moderate correlation between self-perceived resilience and symptom severity among adolescents as well as high feasibility and acceptability of PRISM delivery among youth with CMP. Qualitative feedback was universally positive with the consistent recommendation to add a patient group session to the intervention. With an added patient group session to the intervention, we now aim to ascertain the impact of the adapted intervention (Promoting Resilience in Stress Management (PRISM) for adolescent Chronic musculoskeletal pain [PRISM-C]) on pain-related clinical outcomes in a randomized controlled trial. The overall objectives of the proposed project are to (1) determine the efficacy of PRISM-C in a population of youth with CMP, (2) explore moderators of the intervention to identify youth most likely to benefit from resilience coaching, and (3) assess implementation outcomes and identify barriers and facilitators to engagement in PRISM-C. Findings from this work will further our understanding of psychosocial factors important in adolescent CMP in order to reduce disease burden and improve long-term outcomes. Study results will serve as preliminary data for an R01 application to perform a multicenter randomized controlled trial of PRISM-C for adolescents with CMP. The proposed Career Development Award addresses how to improve access to and efficacy of interdisciplinary treatments for CMP. The exceptional resources and institutional support at Children’s Hospital of Philadelphia and the University of Pennsylvania, outstanding multidisciplinary mentorship team, and proposed career development activities will allow the candidate to achieve her long-term goal of becoming an independent investigator and nationally recognized pediatric rheumatologist with expertise in pediatric chronic pain, resilience, and behavioral health interventions with the goal of improving the long-term physical and psychosocial outcomes for adolescents with CMP.