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

描述(申请人提供)：慢性疼痛影响25%-40%的儿童和青少年，并导致儿童总体生活质量的可衡量的下降。父母不仅在孩子如何应对慢性疼痛方面发挥着重要作用，而且他们还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说，角色压力增加，抑郁症状增加，社会功能降低。不管增加痛苦的原因是什么，多项研究发现，父母的心理痛苦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。到目前为止，还没有专门针对父母子女慢性疼痛的干预措施，尽管他们需要治疗，并在其他以证据为基础的青少年疼痛治疗中取得成功。拟议的项目旨在评估解决问题技能培训(Psst)，这一干预措施被证明对减少其他有疾病的照顾者群体的父母痛苦是有效的。我们的目的是评估Psst作为干预青少年慢性疼痛父母的可行性和可接受性，并在青少年慢性疼痛的父母中进行Psst的初步疗效试验。在这项应用中，我们建议首先在试点阶段测试5个亲子二元组的干预措施，然后对从两个疼痛诊所招募的60名患有慢性疼痛的青少年(10-17岁)的父母照顾者进行Psst的随机对照试验。所有儿童都将接受慢性疼痛的特殊护理。此外，随机参加Psst干预的父母将在8周的治疗期内接受8次个人问题解决技能培训，而标准护理对照组的父母将继续接受疼痛诊所对慢性疼痛管理的处方治疗和建议。主要研究结果是在治疗前、治疗后立即和3个月随访时测量父母的抑郁和焦虑、育儿压力、解决问题的技能以及儿童的身体和情绪功能。次要结果包括父母对慢性疼痛的影响以及治疗满意度和可接受性。我们建议首次为患有慢性疼痛的青少年的父母照顾者设计并直接提供干预措施。研究结果将增加对父母和儿童功能之间相互关系的理解，特别是将提供关于如何有效地加强以儿童和父母为重点的干预措施的知识。治疗开发方面的这一创新将大大推进儿科疼痛管理的心理疗法，并最终可能提高受慢性疼痛影响的大量青年及其家庭的生活质量。 公共卫生相关性：减少父母的痛苦和消极情感可能对影响儿童管理慢性疼痛的能力至关重要。对专门为父母制定的干预措施的测试将增加对如何有效减少父母痛苦以及如何用父母干预战略补充儿童治疗的理解。这项研究的长期目标是开发有效的治疗方法，通过减少父母的痛苦和提高他们的应对能力来管理青少年的慢性疼痛和残疾。

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.