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.

项目概要 我们在此修订后的申请中的研究目标是确定儿科功能的个体差异 腹痛（FAP）可预测干预措施带来的不同健康结果，并可用于 进一步制定针对 FAP 的干预措施。 FAP 是儿童时期最常见的疼痛问题之一 前瞻性地预测早期慢性疼痛、残疾和频繁使用医疗服务 (HSU) 的风险 成年期。因此，提供 FAP 的有效治疗是一个重要的公共卫生问题。认知的 研究发现，由训练有素的专业人员在面对面课程中提供的行为疗法（CBT）可以 减轻一些 FAP 患者的疼痛，但大多数 FAP 通常无法获得如此密集的资源 患者。拟议的研究将评估治疗 FAP 的替代方法。该研究整合并 扩展了儿科疼痛领域主要研究人员最近的工作。在一项儿科前瞻性自然史研究中 PI Walker 及其同事将发病的 FAP 患者跟踪至青春期晚期/成年早期，确定了三 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）包括 儿童期初次 FAP 评估时的疼痛严重程度、疼痛认知和影响。这些痛苦 档案预测了近十年后随访时的慢性疼痛和残疾（FU）。高痛患者 基线时的功能障碍具有最差的症状结果，并且还表现出促伤害性中枢 FU 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 他们的治疗需求以及从行为干预中受益的程度可能有所不同。共同 研究者巴勒莫开发并测试了 CBT 干预措施（基于网络的青少年疼痛管理； Web-MAP）针对患有各种慢性疼痛的青少年。这种有效且易于传播的治疗方法包括 在线向青少年和家长提供单独的模块。 WebMAP 在线 CBT 显着降低了青少年的 与常规护理、候补名单控制条件相比的疼痛和残疾。当前的提案合并了这些 一项创新研究的研究方向，该研究将首次：（目标 1）管理适应的在线 CBT 专门针对 FAP，并与在线信息、注意力控制条件相比评估其功效； （目标 2）评估治疗反应的基线调节因素，包括我们之前验证的 FAP 疼痛 概况、促伤害性中枢疼痛调节和父母特征（保护性、模拟疼痛 行为，夸大孩子的痛苦）； （目标 3）评估影响的潜在中介因素 关于健康结果的在线 CBT。经过医学评估，FAP 患者 (n = 300) 年龄为 11-17 岁， 他们的父母将被随机分配接受在线 CBT 或在线信息。评估将在基线、中期进行 和治疗后，以及基线后 6 个月和 12 个月。该研究将产生可用于 用于根据 FAP 患者的个人情况更有效地采取针对性干预措施，从而 将循证护理扩展到更多患者，最终降低总体护理成本。