An internet CBT intervention for pediatric chronic pain and disability

针对儿科慢性疼痛和残疾的互联网 CBT 干预

• 批准号: 8715840
• 负责人: Tonya M Palermo
• 金额: $ 38.05万
• 依托单位: SEATTLE CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-25 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8715840
• 关键词: Abdominal Pain; Adolescent; Adult; Aftercare; Age; Anxiety; Attention; Attitude; Behavior Therapy; Behavioral; Canada; Child; Childhood; Cognitive Therapy; Communication; Community Services; Complement; Control Groups; Demographic Factors; Development; Distress; Economic Burden; Education; Educational Background; Employment; Evaluation; Evidence based treatment; Familiarity; Family; Future; Goals; Headache; Health; Health Services Accessibility; Individual; Insurance; Internet; Intervention; Measurable; Measures; Medical center; Mental Depression; Mental Health Services; Multicenter Trials; Musculoskeletal Pain; Online Systems; Outcome; Outcome Study; Outpatients; Pain; Pain Clinics; Pain intensity; Pain management; Parents; Participant; Patient Education; Patients; Population; Psychopathology; Psychotherapy; Randomized; Randomized Controlled Trials; Recruitment Activity; Recurrent pain; Reporting; Research; Research Design; Risk; Sampling; Self Management; Services; Site; Sleep; Social Impacts; Staging; Symptoms; Testing; Time; Tinnitus; Training; Treatment Efficacy; Treatment outcome; Uninsured Medical Expense; Visit; Waiting Lists; Work; Youth; chronic pain; cohort; cost; cost effective; daily functioning; depressive symptoms; design; disability; economic impact; effective therapy; experience; flexibility; follow-up; improved; innovation; prevent; programs; psychologic; public health relevance; response; satisfaction; secondary outcome; sex; success; treatment duration; treatment effect; treatment response

DESCRIPTION (provided by applicant): An estimated 15% to 30% of otherwise healthy children and adolescents suffer from recurrent or chronic pain such as headache, abdominal pain, and musculoskeletal pain. Chronic pain results in a measurable decline in children's functioning and produces economic burden on families. Effective treatment that targets these children may also lessen the risk of continued pain and disability into adulthood. There is recognition of the potential of psychological treatments, principally cognitive-behavioral therapies (CBT), for decreasing pain and disability in children. However, even where effective treatments have been developed, most children do not receive psychological intervention for chronic pain management due to barriers such as problems with access to treatment, lack of trained clinicians, expense, insurance limitations, or attitudes about psychotherapy. These problems have led to the consideration of alternative forms of treatment delivery such as through the Internet. We have already made significant progress in developing and conducting an initial evaluation of a psychological intervention delivered online called Web-based Management of Adolescent Pain (Web-MAP). Our findings indicated that children in families that received this intervention experienced significant reduction in activity limitations and pain intensity compared to children in a wait-list control group. The proposed project is designed to extend these findings and will determine (1) whether treatment effects can be maintained beyond the immediate post-treatment period, (2) whether findings generalize across individuals recruited from other medical centers, (3) whether other child outcomes such as pain-specific anxiety and sleep quality are impacted, and (4) how treatment results compare to online patient education. In this application, we plan to evaluate the efficacy of Web-MAP in a large multicenter sample of 300 children and adolescents (ages 11-16 years) with chronic pain and their parents recruited from pain centers across the U.S. and Canada. The study design is a 2 (group) x 4 (time point) randomized controlled trial. All participants will be receiving evaluation from a specialized pediatric pain clinic. In addition, participants will be randomly assigned to receive online access to either patient education (attention control condition) or CBT over an 8-week treatment period. The primary study outcomes are child activity limitations and pain measured at pre-treatment, immediately post- treatment, and at 6- and 12-month follow-ups. Secondary outcomes include child reported depression and anxiety symptoms, parental behaviors, treatment satisfaction, sleep quality, and service use. We will also evaluate demographic and individual factors that predict treatment response. This project represents a significant advance in the development and testing of innovative approaches to deliver psychological therapies for youth with chronic pain, which may guide future developments in CBT for pediatric chronic pain. The long- term goal of this research program is to develop effective and flexible treatments that can be delivered at low cost to reduce pediatric chronic pain and pain-related disability.

描述（由申请人提供）：估计有15％至30％的健康健康的儿童和青少年患有复发或慢性疼痛，例如头痛，腹痛和肌肉骨骼疼痛。慢性疼痛导致儿童功能可衡量的下降，并给家庭带来经济负担。针对这些儿童的有效治疗方法也可能会减少成年后持续疼痛和残疾的风险。人们认识到心理疗法的潜力，主要是认知行为疗法（CBT），以减轻儿童疼痛和残疾。但是，即使已经开发了有效的治疗，大多数儿童也不会因诸如获得治疗问题，缺乏训练的临床医生，费用，保险限制或对心理治疗的态度等障碍，因此也没有接受慢性疼痛管理的心理干预。这些问题导致考虑了替代形式的治疗交付，例如通过互联网。我们已经在开发和进行初步评估的心理干预措施中取得了重大进展，称为基于Web的青少年疼痛管理（Web-MAP）。我们的发现表明，与等待名单对照组的儿童相比，接受这种干预的家庭的儿童活动限制和疼痛强度显着降低。拟议的项目旨在扩展这些发现，并将确定（1）是否可以在直接治疗后期以外保持治疗效果，（2）（2）发现发现是否从其他医疗中心招募的个体中推广到（3）其他儿童结果（例如疼痛特异性焦虑和睡眠质量）是否受到影响，以及如何影响治疗与在线患者教育相比。在此应用程序中，我们计划评估300名儿童和青少年（11-16岁）的大型多中心样本中的Web Map的功效，其慢性疼痛及其父母从美国和加拿大的疼痛中心招募。研究设计是2（组）x 4（时间点）随机对照试验。所有参与者将接受专门的儿科疼痛诊所的评估。此外，在为期8周的治疗期内，将随机分配参与者在线访问患者教育（注意控制条件）或CBT。主要的研究结果是在治疗前，治疗后立即和6个月的随访中测量的儿童活动限制和疼痛。次要结果包括报告的抑郁症和焦虑症状，父母行为，治疗满意度，睡眠质量和服务使用。我们还将评估预测治疗反应的人口统计学和个人因素。该项目代表了创新方法开发和测试为慢性疼痛提供心理疗法的重要进步，这可能指导CBT的未来发展儿科慢性疼痛。该研究计划的长期目标是开发有效且灵活的治疗方法，这些治疗方法可以低成本以减少小儿慢性疼痛和与疼痛有关的残疾。

项目成果

Trajectories of change during a randomized controlled trial of internet-delivered psychological treatment for adolescent chronic pain: how does change in pain and function relate?

• DOI: 10.1097/01.j.pain.0000460355.17246.6c
• 发表时间: 2015-04-01
• 期刊: PAIN
• 影响因子: 7.4
• 作者: Palermo, Tonya M.;Law, Emily F.;Tai, Gabrielle
• 通讯作者: Tai, Gabrielle

Effect on Health Care Costs for Adolescents Receiving Adjunctive Internet-Delivered Cognitive-Behavioral Therapy: Results of a Randomized Controlled Trial.

对接受互联网辅助认知行为治疗的青少年医疗费用的影响：随机对照试验的结果。

• DOI: 10.1016/j.jpain.2018.03.004
• 发表时间: 2018
• 期刊: The journal of pain : official journal of the American Pain Society
• 作者: Law,EmilyF;Groenewald,CorneliusB;Zhou,Chuan;Palermo,TonyaM
• 通讯作者: Palermo,TonyaM

Components of Effective Cognitive-Behavioral Therapy for Pediatric Headache: A Mixed Methods Approach.

• DOI: 10.1037/cpp0000216
• 发表时间: 2017
• 期刊: Clinical practice in pediatric psychology
• 影响因子: 1.1
• 作者: Law EF;Beals-Erickson SE;Fisher E;Lang EA;Palermo TM
• 通讯作者: Palermo TM

Longitudinal change in parent and child functioning after internet-delivered cognitive-behavioral therapy for chronic pain.

• DOI: 10.1097/j.pain.0000000000000999
• 发表时间: 2017-10
• 期刊: Pain
• 影响因子: 7.4
• 作者: Law EF;Fisher E;Howard WJ;Levy R;Ritterband L;Palermo TM
• 通讯作者: Palermo TM

Treatment engagement in an internet-delivered cognitive behavioral program for pediatric chronic pain.

• DOI: 10.1016/j.invent.2018.07.005
• 发表时间: 2018-09
• 期刊: Internet interventions
• 作者: Alberts NM;Law EF;Chen AT;Ritterband LM;Palermo TM
• 通讯作者: Palermo TM