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，并导致儿童的整体生活质量明显下降。父母不仅在孩子如何科普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，父母的心理困扰与孩子适应能力较差有关。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，还没有专门针对儿童慢性疼痛的父母制定干预措施，尽管需要，并且在其他基于证据的青年疼痛治疗中取得了成功。拟议的项目旨在评估解决问题的技能培训（PSST），一种干预措施被证明有效地减少父母的痛苦，在其他照顾者人群的个人与医疗条件。我们的目的是评估PSST作为慢性疼痛青少年父母照顾者干预的可行性和可接受性，并在慢性疼痛青少年父母中进行PSST的初步疗效试验。在本申请中，我们建议首先在试点阶段测试5个亲子配对的干预措施，然后在60名从两个疼痛诊所招募的慢性疼痛青少年（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护理。此外，随机分配至PSST干预组的父母将在8周治疗期内接受8次单独的问题解决技能培训，而标准治疗对照组的父母将继续接受疼痛诊所的处方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，并在3个月的随访。次要结局包括父母对慢性疼痛的影响以及治疗满意度和可接受性。我们提出了有史以来第一次干预设计，并直接交付给，父母照顾的青年慢性疼痛。调查结果将增加父母和儿童功能之间的相互关系的理解，特别是将提供如何有效地增加儿童和父母为重点的干预措施的知识。这种治疗开发的创新将显著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少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是影响儿童管理慢性疼痛的能力的关键。专门为父母制定的干预措施的测试将增加了解如何有效地减少父母的痛苦，以及如何补充儿童治疗与父母的干预策略。这项研究的长期目标是通过减少父母的痛苦和提高他们的应对能力，开发有效的治疗方法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.