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: 9459932
• 负责人: Lynn D. Walker
• 金额: $ 57.15万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 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 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9459932
• 关键词: Abdominal Pain; Adolescent; Affect; Aftercare; Age; Anxiety; Behavior Therapy; Biological; Biological Factors; Caring; Characteristics; Child; Childhood; Cognition; Cognitive Therapy; Diagnosis; Environmental Wind; Evaluation; Exhibits; Family Characteristics; Goals; Health; Heterogeneity; Individual; Individual Differences; Internet; Intervention; Knowledge; Laboratories; Mediating; Mediator of activation protein; Medical; Mental Depression; Natural History; Nociception; Online Systems; Outcome; Pain; Parents; Pathology; Patient-Focused Outcomes; Patients; Prediction of Response to Therapy; Predictive Factor; Prospective Studies; Public Health; Randomized; Research; Research Personnel; Resources; Risk; Sampling; Severities; Symptoms; Testing; Therapeutic Intervention; Time; Training; Waiting Lists; Walkers; Work; Youth; attentional control; base; biopsychosocial; care costs; central pain; chronic pain; chronic painful condition; comparative efficacy; conditioned pain modulation; coping; disability; early adolescence; effective therapy; efficacy testing; emerging adult; emotional symptom; evidence base; follow-up; gastrointestinal symptom; health care service utilization; health service use; individualized medicine; innovation; pain behavior; pain catastrophizing; pain inhibition; pain model; pain outcome; pain patient; pain reduction; personalized intervention; profiles in patients; programs; prospective; psychologic; public health relevance; response; social; treatment as usual; treatment effect; treatment response; young adult

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：我们在此修订申请中的研究目标是确定儿童功能性腹痛（FAP）的个体差异，这些差异预测干预措施的不同健康结果，并可用于进一步定制FAP干预措施。FAP是儿童期最常见的疼痛问题之一，并可预测成年早期慢性疼痛、残疾和频繁使用卫生服务（HSU）的风险。因此，提供FAP的有效治疗是一个关键的公共卫生问题。由训练有素的专业人员在面对面的会议上提供的认知行为疗法（CBT）已被发现可以减轻一些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。拟议的研究将评估治疗FAP的替代方法。这项研究整合并扩展了儿科疼痛领域主要研究人员的最新工作。在一项对青少年晚期/成年早期的儿科发病FAP患者进行的前瞻性自然史研究中，PI步行者及其同事确定了三种不同的患者特征（即，低疼痛适应性、高疼痛适应性、高疼痛功能障碍性）包括疼痛严重程度、疼痛认知和儿童期初始FAP评估时的影响。这些疼痛特征预测了近十年后随访（FU）时的慢性疼痛和残疾。基线时具有高度疼痛功能障碍特征的患者的症状结局最差，并且在FU时的实验室疼痛测试中也表现出促伤害性中枢疼痛调节。FAP疼痛特征组的异质性表明，他们可能在治疗需求和从行为干预中获益的程度上有所不同。共同研究者巴勒莫开发并测试了针对患有各种慢性疼痛状况的青少年的CBT干预（基于网络的青少年疼痛管理; Web-MAP）。这种有效、易于传播的治疗方法包括在线向青少年和家长提供的单独模块。WebMAP在线CBT显着减少青少年的疼痛和残疾相比，通常的照顾，等待名单控制条件。目前的建议将这些研究方向合并为 一项创新的研究，将首次：（目的1）管理专门适用于FAP的在线CBT，并评估其与在线信息相比的功效，注意力控制条件;（目的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制和父母特征（保护性，模拟疼痛行为，对儿童疼痛的灾难化）;和（目的3）评估在线CBT对健康结果影响的潜在介质。在医学评估后，年龄11-17岁的FAP患者（n = 300）及其父母将被随机分配到在线CBT或在线信息组。将在基线、治疗中期和治疗后以及基线后6个月和12个月进行评估。该研究将产生可用于根据FAP患者的个人资料更有效地针对FAP患者进行干预的知识，从而将循证护理扩展到更多患者，并最终降低整体护理成本。