Problem Solving Skills Training for Parent Caregivers of Youth with Chronic Pain

描述（由申请人提供）：慢性疼痛影响25-40%的儿童和青少年，并导致儿童整体生活质量的明显下降。父母不仅在孩子如何应对慢性疼痛方面发挥着重要作用，而且他们也可以体验到自己广泛的社会、关系、情感和经济影响。特别是，患有慢性疼痛的青少年的父母报告角色压力增加，抑郁症状增加，社会功能下降。不管压力增加的原因是什么，多项研究发现，父母的心理压力与孩子较差的适应能力有关。因此，迫切需要考虑减少父母痛苦的方法，以便更有效地管理儿童的慢性疼痛和残疾。迄今为止，尽管有需要，并且在其他基于证据的青少年疼痛治疗中取得了成功，但还没有开发出专门用于治疗儿童慢性疼痛的父母的干预措施。拟议的项目旨在评估解决问题技能培训（PSST），这是一种已被证明有效的干预措施，可减少有医疗条件的个人的其他照顾者群体的父母痛苦。我们的目的是评估PSST作为青少年慢性疼痛父母照顾者干预的可行性和可接受性，并对青少年慢性疼痛父母进行PSST的初步疗效试验。在本申请中，我们建议首先在5对亲子对中进行干预试验，然后在两家疼痛诊所招募的60名患有慢性疼痛的青少年（10-17岁）的父母照顾者中进行PSST的随机对照试验。所有儿童都将接受慢性疼痛的专科治疗。此外，随机分配到PSST干预组的父母将在8周的治疗期内接受8次解决问题技能的单独培训，而标准护理对照组的父母将继续接受疼痛诊所规定的治疗和慢性疼痛管理建议。主要的研究结果是父母的抑郁和焦虑，父母的压力，解决问题的能力和儿童的身体和情绪功能在治疗前，治疗后立即和3个月的随访中测量。次要结局包括父母对慢性疼痛的影响以及治疗的满意度和可接受性。我们提出有史以来第一个干预设计，并直接交付给父母照顾青少年慢性疼痛。研究结果将增进对父母和儿童功能之间相互关系的理解，特别是将提供如何有效地加强以儿童和父母为重点的干预措施的知识。这一治疗发展的创新将显著推进儿科疼痛管理的心理治疗，并最终可能提高受慢性疼痛影响的大量青少年及其家庭的生活质量。

DESCRIPTION (provided by applicant): Chronic pain affects 25-40% of children and adolescents, and results in a measurable decline in children's overall quality of life. Parents not only play a significant role in how their children cope with chronic pain but they also can experience their own widespread social, relational, emotional and financial impact. In particular, parents of youth with chronic pain report increased role stress, increased depressive symptoms, and reduced social functioning. Regardless of the reason for increased distress, multiple studies have found that parental psychological distress is associated with poorer child adjustment. Therefore, there is a critical need to consider methods of reducing parental distress in order to more effectively manage children's chronic pain and disability. To date, no intervention has been developed specifically to treat parents in the context of their child's chronic pain, despite need, and success in other evidence-based pain treatments in youth. The proposed project is designed to evaluate problem-solving skills training (PSST), an intervention proven effective for reducing parental distress in other caregiver populations of individuals with medical conditions. Our aims are to evaluate the feasibility and acceptability of PSST as an intervention in parent caregivers of youth with chronic pain, and to conduct a preliminary efficacy trial of PSST in parents of youth with chronic pain. In this application, we propose first testing the intervention with 5 parent-child dyads in a pilot phase and then carrying out a randomized controlled trial of PSST in 60 parent caregivers of youth (10-17 years) with chronic pain recruited from two pain clinics. All children will be receiving specialty care for chronic pain. Parents randomized to the PSST intervention will, in addition, receive 8 individual sessions of problem-solving skills training over an 8-week treatment period while parents in the Standard Care control group will continue with prescribed treatments and recommendations for chronic pain management from the pain clinics. The primary study outcomes are parental depression and anxiety, parenting stress, and problem-solving skills and child physical and emotional functioning measured at pre-treatment, immediately post-treatment, and at 3-month follow-up. Secondary outcomes include parental impact of chronic pain and treatment satisfaction and acceptability. We propose the first ever intervention designed for, and delivered directly to, parental caregivers of youth with chronic pain. Findings will increase understanding of the interrelationships among parental and child functioning, and specifically will provide knowledge of how to augment effectively child and parent focused interventions. This innovation in treatment development will significantly advance psychological therapies for pediatric pain management, and ultimately may enhance quality of life in the substantial population of youth and their families affected by chronic pain. PUBLIC HEALTH RELEVANCE: Reducing parental distress and negative affectivity may be critical to influencing children's abilities to manage chronic pain. Testing of interventions developed specifically for parents will increase understanding of how effectively to reduce parental distress, and how to complement child treatment with parental intervention strategies. The long-term goal of the research is to develop effective treatments to manage chronic pain and disability in youth through reducing parental distress and increasing their coping abilities.