Get moving, GET living: Graded exposure treatment for adolescents with chronic musculoskeletal pain.

行动起来，生活：针对患有慢性肌肉骨骼疼痛的青少年的分级暴露治疗。

• 批准号: 9980786
• 负责人: LAURA E SIMONS
• 金额: $ 13.82万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9980786
• 关键词: Address; Adherence; Adolescence; Adolescent; Adult; Affect; Age; Ambulatory Care; Assessment tool; Behavior; Behavioral Mechanisms; Biomechanics; Chronic; Clinical; Coupled; Data; Diagnosis; Distress; Fright; Functional disorder; Funding; Gender; Health; Health Care Costs; Impairment; Intervention; Joints; Kinetics; Life; Living Wills; Measurement; Measures; Mental Health; Monitor; Motion; Movement; Musculoskeletal; Outcome; Outpatients; Pain; Pain management; Parents; Participant; Patients; Physical activity; Physical therapy; Play; Psychologist; Psychology; Randomized Controlled Trials; Readiness; Recurrence; Reporting; Research; Risk; Risk Factors; Schedule; Site; Technology; Work; actigraphy; adherence rate; avoidance behavior; base; chronic musculoskeletal pain; chronic pain; diaries; disability; experience; follow-up; functional disability; functional improvement; in vivo; innovation; pain outcome; physical therapist; prevent; primary outcome; protective behavior; public health relevance; response; satisfaction; secondary outcome; societal costs; treatment response

With up to a third of adolescents reporting recurrent or chronic musculoskeletal pain, it is a critical national health problem. The experience of chronic pain in adolescence negatively impacts overall health during this important life period, and increases the risk of pain and mental health problems in adulthood. Pain-related fear is repeatedly identified as an important factor that increases the likelihood of poor outcomes among adolescents with pain, and yet pain-related fear is rarely targeted in typical pain management (TPM). Perhaps unsurprisingly, TPM yields no change in pain-related fear, and modest improvements in functional disability. To overcome limitations of TPM for pain-related fear, graded in-vivo exposure treatment (GET) was developed. While TPM focuses on pain control via pain management psychology and impairment-based physical therapy, GET is jointly delivered by a pain psychologist and physical therapist targeting functional improvement, through exposing patients to activities previously avoided due to fear of pain. GET is successful in adults with chronic musculoskeletal pain! and our pilot data of GET for adolescents with chronic pain (GET Living) is robust, with significant declines in patient fear, activity avoidance, and disability. Uniquely, GET Living also targets parent distress and behavior, and our pilot data demonstrate decreases in parent fear, avoidance, and protective behavior. GET Living also distinguishes itself with an innovative assessment approach to patient progress and clinical endpoints. In addition to standard assessment tools, GET Living utilizes electronic daily diary technology to identify exactly when improvements in outcomes are occurring/not occurring, and objective biomechanical assessment using motion analysis and physical activity monitoring via Actigraphy. Building from this work, the proposed research concerns an exploratory randomized controlled trial (RCT) of GET Living aimed at measuring changes in fear and function for adolescents with chronic musculoskeletal pain when compared to TPM. This study will provide necessary findings to support or refute a large multi-site RCT. Aim 1 compares changes in pain-related fear (primary outcome), disability, and parent behavior (secondary outcomes) between GET Living and TPM. Aim 2 characterizes feasibility and acceptability of GET Living to inform implementation of a large multi-site RCT. Treatment of adolescent chronic musculoskeletal pain is suboptimal. Significant breakthroughs require directly targeting mechanisms underlying pain-related dysfunction, such as pain-related fear. Implementing innovative interdisciplinary outpatient treatment that addresses pain-related fear and dysfunction, coupled with proof-of-concept electronic daily diaries and biomechanical assessment to determine clinical endpoints and treatment response, will lead to advancements in our understanding and treatment of adolescent chronic pain. These findings will directly inform the decision of whether to proceed with a large multi-site RCT of GET Living, serving as the basis for potential large-scale implementation of GET Living nationwide.

多达三分之一的青少年报告复发性或慢性肌肉骨骼疼痛，这是一个重要的全国性问题 健康问题。青春期慢性疼痛的经历会对在此期间的整体健康产生负面影响 生命的重要时期，并增加成年后疼痛和心理健康问题的风险。与疼痛有关的恐惧 被反复认为是增加不良结果可能性的一个重要因素 青少年患有疼痛，但与疼痛相关的恐惧很少成为典型疼痛管理（TPM）的目标。 也许并不令人意外的是，TPM 并没有改变与疼痛相关的恐惧，并且在功能方面略有改善。 残疾。为了克服 TPM 对疼痛相关恐惧的局限性，分级体内暴露治疗 (GET) 被开发出来。虽然 TPM 侧重于通过疼痛管理心理学和基于损伤的疼痛控制 物理治疗，GET由疼痛心理学家和物理治疗师共同提供，目标是功能性治疗 通过让患者进行以前因害怕疼痛而避免的活动来改善。获取成功 患有慢性肌肉骨骼疼痛的成年人！以及我们针对患有慢性疼痛的青少年的 GET 试点数据 (GET 生活）是稳健的，患者的恐惧、活动回避和残疾显着下降。独特的是，获取 生活还针对父母的痛苦和行为，我们的试点数据表明父母的恐惧有所减少， 回避和保护行为。 GET Living 还凭借创新的评估而脱颖而出 患者进展和临床终点的方法。除了标准评估工具外，GET Living 利用电子日记技术来准确识别结果何时出现/未出现改善 使用运动分析和身体活动监测进行客观的生物力学评估 体动记录仪。基于这项工作，拟议的研究涉及一项探索性随机对照试验 GET Living 的随机对照试验 (RCT) 旨在测量慢性病青少年的恐惧和功能变化 与 TPM 相比，肌肉骨骼疼痛。这项研究将提供必要的发现来支持或反驳 大型多中心随机对照试验。目标 1 比较与疼痛相关的恐惧（主要结果）、残疾和父母的变化 GET Living 和 TPM 之间的行为（次要结果）。目标 2 描述了可行性和 GET Living 的可接受性，为大型多站点 RCT 的实施提供信息。青少年慢性病的治疗 肌肉骨骼疼痛不理想。重大突破需要直接针对潜在机制 与疼痛相关的功能障碍，例如与疼痛相关的恐惧。实施创新型跨学科门诊 解决与疼痛相关的恐惧和功能障碍的治疗，加上概念验证电子日报 日记和生物力学评估以确定临床终点和治疗反应，将导致 我们对青少年慢性疼痛的理解和治疗取得了进展。这些发现将直接 告知决定是否继续进行 GET Living 的大型多站点 RCT，作为 GET Living 可能在全国范围内大规模实施。

项目成果

mHealth for pediatric chronic pain: state of the art and future directions.

• DOI: 10.1080/14737175.2020.1819792
• 发表时间: 2020-11
• 期刊: Expert review of neurotherapeutics
• 影响因子: 4.3
• 作者: Richardson PA;Harrison LE;Heathcote LC;Rush G;Shear D;Lalloo C;Hood K;Wicksell RK;Stinson J;Simons LE
• 通讯作者: Simons LE

Graded exposure treatment for adolescents with chronic pain (GET Living): Protocol for a randomized controlled trial enhanced with single case experimental design.

患有慢性疼痛的青少年的分级暴露治疗（GET Living）：通过单例实验设计增强的随机对照试验方案。

• DOI: 10.1016/j.conctc.2019.100448
• 发表时间: 2019
• 期刊: Contemporary clinical trials communications
• 影响因子: 1.5
• 作者: Simons,LauraE;Harrison,LaurenE;O'Brien,ShannonF;Heirich,MarissaS;Loecher,Nele;Boothroyd,DerekB;Vlaeyen,JohanWS;Wicksell,RikardK;Schofield,Deborah;Hood,KoreyK;Orendurff,Michael;Chan,Salinda;Lyons,Sam
• 通讯作者: Lyons,Sam