Predicting Treatment Response in Pediatric Functional Abdominal Pain

预测小儿功能性腹痛的治疗反应

基本信息

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
项目类别：
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

项目摘要

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）：我们在此修订的应用中研究的目的是确定小儿功能性腹痛（FAP）的个体差异，这些差异可以预测响应干预措施的差异健康结果，并可用于进一步调整FAP的干预措施。 FAP是儿童期最常见的疼痛问题之一，前瞻性地预测了成年初期慢性疼痛，残疾和频繁的健康服务利用（HSU）的风险。因此，提供有效的FAP治疗是一个关键的公共卫生问题。已经发现，训练有素的专业人员在面对面课程中提供的认知行为疗法（CBT）可减轻某些FAP患者的疼痛，但是大多数FAP患者通常无法使用这种大量资源。拟议的研究将评估一种治疗FAP的替代方法。该研究融合并扩展了小儿疼痛研究人员的最新工作。在一项针对青春期晚期/成年早期的小儿发作患者的前瞻性自然史研究中，Pi Walker及其同事确定了三种不同的患者概况（即低疼痛适应性，高疼痛适应性，高疼痛功能失调），由痛苦严重程度，止痛，认知和初始fap评估时影响。这些疼痛特征预测了近十年后的随访（FU）时的慢性疼痛和残疾。基线时疼痛功能障碍功能障碍的患者的症状结局最差，并且在FU的实验室疼痛测试中也表现出亲人的中枢性疼痛调节。 FAP疼痛概况组的异质性表明，它们在治疗需求上可能有所不同，并且在行为干预措施中受益的程度可能会有所不同。合作社Palermo为患有各种慢性疼痛状况的青年开发并测试了CBT干预（基于Web的青少年疼痛管理； Web Map）。这种高效，易于传播的治疗包括在线交付给青年和父母的单独模块。与通常的护理，候补名单控制条件相比，网络图在线CBT大大减轻了青年的疼痛和残疾。当前的提议将这些研究渠道合并为一项创新的研究将首次：（ AIM 1）在线管理CBT专门针对FAP，并评估其功效，与在线信息，注意力控制条件相比；（AIM 2）评估治疗反应的基线主持人，包括我们先前验证的FAP疼痛特征，亲人的中心疼痛调节和父母特征（保护性，对疼痛行为进行建模，对孩子的疼痛造成灾难）；（AIM 3）评估在线CBT对健康结果的影响的潜在介体。经过医学评估后，FAP患者（n = 300）年龄在11-17岁之间，他们的父母将被随机分为在线CBT或在线信息。评估将在基线，中和治疗后进行，以及基线后6个月和12个月。这项研究将产生可用于更有效地针对患者的知识，从而根据他们的个人概况进行FAP患者，从而将基于证据的护理扩展到更多的患者，并最终降低总体护理成本。