Psychosocial and Family Risk in Pediatric Chronic Migraine

 描述(由申请人提供)：慢性偏头痛是一种常见的儿童疼痛状况，与显著的疼痛、残疾和痛苦有关。有越来越多的证据表明 支持行为干预作为儿童慢性偏头痛的一线治疗。然而，由于与训练有素的专业人员的接触和距离有关的障碍，许多青年没有得到行为治疗。互联网干预为家庭提供了一种更容易接受行为干预的方式，但力度可能不足以支持一些儿童的行为变化。目前，还没有可用的筛查工具来帮助临床医生确定哪些儿童需要行为干预，以及需要进行何种程度的干预。这项研究计划的长期目标是将患有慢性偏头痛的青年与正确剂量的行为治疗相匹配，以优化结果并降低与医疗保健相关的成本。这项应用的目的是适应和验证慢性偏头痛青年心理社会和家庭风险的筛查工具，并确定技术提供的行为疼痛治疗的可行性、可接受性和初步疗效。K23候选人是华盛顿大学麻醉学和疼痛医学系的[助理教授]，也是西雅图儿童医院慢性疼痛诊所的儿科心理学家。 这位候选人致力于以患者为中心的研究生涯，并提出了一项为期五年的培训计划，该计划由一个由教师组成的跨学科团队提供支持，该团队拥有心理社会风险评估、互联网干预、儿科头痛临床试验和生物统计学方面的专业知识。该奖项将为候选人提供评估方面的专门指导 研究内容包括：了解儿童头痛的心理社会和家庭风险及恢复力，制定可获得的、有针对性的儿童头痛干预措施的研究方法，以及在儿童头痛人群中开展和评估临床试验所需的知识。研究计划的第一阶段包括调整一种用于青少年慢性偏头痛的心理社会风险筛查工具，并在225名慢性偏头痛儿童及其父母的[单独队列]中验证调整后的工具。在对这一队列的后续研究中，将在6个月内对心理社会风险进行重复评估，以检查风险状况作为头痛结果和医疗保健相关成本的纵向预测因素。在第二阶段的研究中，两种互联网行为疗法将适用于强度不同的慢性偏头痛青年(自我指导与人工支持)。随后，将在一项随机对照试点试验中评估这些干预措施的可行性、可接受性[和初步疗效][与通常治疗相比]，[60]名儿童接受不同水平的心理社会风险筛查。这项研究产生的数据将为一项计划中的R01提案提供参考，该提案侧重于评估针对慢性偏头痛儿童及其家庭的心理社会风险状况的可获得行为干预。完成拟议的培训将为候选人在儿科头痛医学领域取得成功的独立研究生涯做好准备。

 DESCRIPTION (provided by applicant): Chronic migraine is a common pain condition in childhood associated with significant pain, disability, and suffering. There is growing evidence to support behavioral interventions as first-line treatment in pediatric chronic migraine. However, many youth do not receive behavioral treatment due to barriers related to access and distance from trained professionals. Internet interventions offer an easier way for families to receive behavioral intervention, but may not be intense enough to support behavioral changes for some children. At present, there are no screening tools available to help clinicians determine which children need behavioral intervention and what intensity of intervention is necessary. The long-term goal of this research program is to match youth with chronic migraine to the correct dose of behavioral treatment in order to optimize outcomes and reduce healthcare-related costs. The objective of this application is to adapt and validate a screening tool of psychosocial and family risk in youth with chronic migraine, and to determine feasibility, acceptability [and preliminary efficacy] of technology-delivered behavioral pain treatment. The K23 candidate is an [Assistant Professor] in the Department of Anesthesiology and Pain Medicine at the University of Washington, and a pediatric psychologist in the chronic pain clinic at Seattle Children's Hospital. The candidate is committed to a patient-oriented research career and proposes a five-year training plan supported by an interdisciplinary team of faculty mentors with expertise in psychosocial risk assessment, Internet interventions, clinical trials in pediatric headache, and biostatistics. This award will provide the candidate with specialized instruction in the evaluation of psychosocial and family risk and resiliency, research methods to develop accessible and targeted interventions for pediatric headache, and necessary knowledge to conduct and evaluate clinical trials in pediatric headache populations. The first phase the research plan involves adaptation of a psychosocial risk screening tool for use in youth with chronic migraine, and validation of the adapted tool in [a separate cohort] of 225 children with chronic migraine and their parents. Repeat assessment of psychosocial risk will be conducted at six-months in a follow-up study of this cohort to examine risk status as a longitudinal predictor of headache outcomes and healthcare-related costs. In the second phase of research, two Internet behavioral treatments will be adapted for youth with chronic migraine that vary in intensity (self-guided vs. human support). Subsequently, feasibility, acceptability [and preliminary efficacy] of these interventions [compared to treatment as usual] will be evaluated in a randomized controlled pilot trial with [60] children screened at different levels of psychosocial risk. Data generated from this research will inform a planned R01 proposal focused on the evaluation of accessible behavioral interventions targeted to the psychosocial risk status of children with chronic migraine and their families. Completion of the proposed training will prepare the candidate for a successful independent research career in pediatric headache medicine.