Predicting Treatment Response in Pediatric Functional Abdominal Pain

预测小儿功能性腹痛的治疗反应

• 批准号: 8693260
• 负责人: Lynn D. Walker
• 金额: $ 61.14万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8693260
• 关键词: Abdominal Pain; Adolescence; Adolescent; Affect; Aftercare; Age; Anxiety; Attention; Behavior Therapy; Biological; Biological Factors; Caring; Characteristics; Child; Childhood; Cognition; Cognitive Therapy; Diagnosis; Emotional; Environmental Wind; Evaluation; Exhibits; Family Characteristics; Goals; Health; Heterogeneity; Individual; Individual Differences; Internet; Intervention; Knowledge; Laboratories; Mediating; Mediator of activation protein; Medical; Mental Depression; Modeling; Natural History; Nociception; Online Systems; Outcome; Pain; Parents; Pathology; Patients; Prospective Studies; Public Health; Randomized; Research; Research Personnel; Resources; Risk; Sampling; Severities; Symptoms; Testing; Time; Training; Waiting Lists; Walkers; Work; Youth; base; biopsychosocial; central pain; chronic pain; comparative efficacy; coping; cost; disability; effective therapy; efficacy testing; emerging adult; evidence base; follow-up; gastrointestinal symptom; health care service utilization; innovation; pain behavior; pain inhibition; programs; prospective; psychologic; public health relevance; response; social; treatment as usual; treatment effect; treatment response; young adult

PROJECT SUMMARY The goal of our research in this revised application is to identify individual differences in pediatric functional abdominal pain (FAP) that predict differential health outcomes in response to an intervention and can be used to further tailor interventions for FAP. FAP is among the most common pain problems in childhood and prospectively predicts risk for chronic pain, disability, and frequent health service utilization (HSU) in early adulthood. Therefore, providing effective treatments of FAP is a critical public health concern. Cognitive behavior therapy (CBT) delivered by highly trained professionals in face-to-face sessions has been found to reduce pain in some FAP patients, but such intensive resources are not generally available to most FAP patients. The proposed study will evaluate an alternative approach to treating FAP. The study integrates and extends recent work by leading investigators in pediatric pain. In a prospective natural history study of pediatric onset FAP patients followed into late adolescence/early adulthood, PI Walker and colleagues identified three distinct patient profiles (i.e., Low Pain Adaptive, High Pain Adaptive, High Pain Dysfunctional) comprised of pain severity, pain cognitions, and affect at the time of the initial FAP evaluation in childhood. These pain profiles predicted chronic pain and disability at follow-up (FU) nearly a decade later. Patients with the High Pain Dysfunctional profile at baseline had the poorest symptom outcomes and also exhibited pro-nociceptive central pain modulation in laboratory pain tests at FU. The heterogeneity of the FAP pain profile groups suggests that they may differ in treatment needs and in the extent to which they benefit from behavioral interventions. Co- Investigator Palermo developed and tested a CBT intervention (Web-based Management of Adolescent Pain; Web-MAP) for youth with various chronic pain conditions. This efficient, easily disseminated treatment includes separate modules delivered online to youth and parents. WebMAP Online CBT significantly reduced youths' pain and disability in comparison to a usual care, wait-list control condition. The current proposal merges these lines of research into an innovative study that will, for the first time: (Aim 1) administer Online CBT adapted specifically for FAP and evaluate its efficacy compared to an Online Information, attention control condition; (Aim 2) evaluate baseline moderators of treatment response, including our previously validated FAP pain profiles, pro-nociceptive central pain modulation, and parent characteristics (protectiveness, modeling pain behavior, catastrophizing about the child's pain); and (Aim 3) evaluate potential mediators of the effect of Online CBT on health outcomes. Following medical evaluation, FAP patients (n = 300) ages 11-17 years and their parents will be randomized to Online CBT or Online Information. Assessments will be at baseline, mid- and post-treatment, and at 6- and 12-months post baseline. The study will produce knowledge that can be used to more efficiently target interventions to FAP patients according to their individual profiles and thereby extend evidence-based care to more patients and ultimately reduce overall costs of care.

项目摘要 我们在这个修订后的应用程序中的研究目标是确定儿童功能的个体差异， 腹痛（FAP），预测不同的健康结果，以响应干预，并可以使用 进一步针对FAP采取干预措施。FAP是儿童时期最常见的疼痛问题之一， 前瞻性预测早期慢性疼痛、残疾和频繁使用卫生服务（HSU）的风险。 成年因此，提供FAP的有效治疗是一个关键的公共卫生问题。认知 行为疗法（CBT）由训练有素的专业人员在面对面的会议上提供， 减轻一些FAP患者的疼痛，但大多数FAP患者通常无法获得这种密集的资源 患者拟议的研究将评估治疗FAP的替代方法。该研究整合了 扩展了儿科疼痛领域主要研究人员的近期工作。在一项前瞻性的儿科自然史研究中， PI步行者及其同事对一组FAP患者进行了青少年晚期/成年早期随访， 不同的患者概况（即，低疼痛适应性、高疼痛适应性、高疼痛功能障碍性），包括 疼痛的严重程度，疼痛认知，以及在儿童期进行初始FAP评估时的影响。这些痛 在近十年后的随访（FU）中，这些特征预测了慢性疼痛和残疾。高度疼痛的患者 基线时功能障碍的症状结局最差，并且还表现出促伤害性中枢神经系统功能障碍。 随访时实验室疼痛测试中的疼痛调节。FAP疼痛特征组的异质性表明， 他们在治疗需求和从行为干预中获益的程度上可能有所不同。共- 研究者巴勒莫开发并测试了CBT干预（基于网络的青少年疼痛管理; Web-MAP）用于患有各种慢性疼痛状况的青年。这种高效、易于传播的治疗方法包括 在线向青年和家长提供单独的模块。WebMAP在线CBT显著降低了青少年的 疼痛和残疾相比，通常的护理，等待名单控制条件。当前的提案将这些合并在一起 线的研究到一个创新的研究，将首次：（目标1）管理在线CBT适应 特别是FAP，并评估其疗效相比，在线信息，注意力控制条件; (Aim 2）评估治疗反应的基线调节因素，包括我们先前验证的FAP疼痛 特征、促伤害性中枢疼痛调节和母体特征（保护性、疼痛建模 行为，对孩子的痛苦灾难化）;和（目的3）评估的影响， 关于健康结果的在线CBT。在医学评估后，FAP患者（n = 300）年龄为11-17岁， 他们的父母将被随机分配到在线CBT或在线信息。评估将在基线、中期 治疗后以及基线后6个月和12个月。这项研究将产生的知识， 用于根据FAP患者的个体特征更有效地将干预措施定向于他们， 将循证护理扩展到更多患者，并最终降低护理的总体成本。