An internet CBT intervention for pediatric chronic pain and disability

描述(申请人提供)：估计有15%到30%的其他健康的儿童和青少年患有反复或慢性疼痛，如头痛、腹痛和肌肉骨骼疼痛。慢性疼痛导致儿童功能明显下降，并给家庭带来经济负担。针对这些儿童的有效治疗也可能减少成年后持续疼痛和残疾的风险。人们认识到心理治疗的潜力，主要是认知行为疗法(CBT)，用于减少儿童的疼痛和残疾。然而，即使已经开发出有效的治疗方法，大多数儿童也没有接受针对慢性疼痛管理的心理干预，原因是获得治疗的机会存在问题、缺乏训练有素的临床医生、费用、保险限制或对心理治疗的态度。这些问题促使人们考虑通过互联网等其他方式提供治疗。我们已经在开发和进行一项名为基于网络的青少年疼痛管理(Web-MAP)的在线心理干预的初步评估方面取得了重大进展。我们的研究结果表明，与等待名单控制组的儿童相比，接受这种干预的家庭中的儿童在活动限制和疼痛强度方面经历了显著的减少。拟议的项目旨在扩展这些发现，并将确定(1)治疗效果是否可以在治疗后立即保持，(2)研究结果是否适用于从其他医疗中心招募的个人，(3)其他儿童结果是否受到影响，如疼痛特有的焦虑和睡眠质量，以及(4)治疗结果与在线患者教育的比较。在这项应用中，我们计划对300名患有慢性疼痛的儿童和青少年(年龄在11-16岁)及其父母从美国和加拿大的疼痛中心招募的大型多中心样本中评估Web-MAP的有效性。研究设计为2(组)×4(时间点)随机对照试验。所有参与者都将接受一家专门的儿科疼痛诊所的评估。此外，参与者将被随机分配，在8周的治疗期内接受患者教育(注意力控制条件)或CBT的在线访问。主要研究结果是儿童活动受限和在治疗前、治疗后立即以及6个月和12个月随访时测量的疼痛。次要结果包括儿童报告的抑郁和焦虑症状、父母行为、治疗满意度、睡眠质量和服务使用情况。我们还将评估预测治疗反应的人口统计和个人因素。该项目代表着在为患有慢性疼痛的青年提供心理治疗的创新方法的开发和测试方面取得的重大进展，这可能会指导儿童慢性疼痛CBT的未来发展。这项研究计划的长期目标是开发能够以低成本提供的有效和灵活的治疗方法，以减少儿科慢性疼痛和疼痛相关残疾。 与公共卫生有关：利用互联网向患有慢性疼痛的儿童和青少年提供心理治疗，提供了一种灵活和具有成本效益的方式，接触到否则可能无法获得心理健康服务的家庭。长期目标是提供有效的治疗，以防止成人慢性疼痛、残疾和精神病理的发展。

DESCRIPTION (provided by applicant): An estimated 15% to 30% of otherwise healthy children and adolescents suffer from recurrent or chronic pain such as headache, abdominal pain, and musculoskeletal pain. Chronic pain results in a measurable decline in children's functioning and produces economic burden on families. Effective treatment that targets these children may also lessen the risk of continued pain and disability into adulthood. There is recognition of the potential of psychological treatments, principally cognitive-behavioral therapies (CBT), for decreasing pain and disability in children. However, even where effective treatments have been developed, most children do not receive psychological intervention for chronic pain management due to barriers such as problems with access to treatment, lack of trained clinicians, expense, insurance limitations, or attitudes about psychotherapy. These problems have led to the consideration of alternative forms of treatment delivery such as through the Internet. We have already made significant progress in developing and conducting an initial evaluation of a psychological intervention delivered online called Web-based Management of Adolescent Pain (Web-MAP). Our findings indicated that children in families that received this intervention experienced significant reduction in activity limitations and pain intensity compared to children in a wait-list control group. The proposed project is designed to extend these findings and will determine (1) whether treatment effects can be maintained beyond the immediate post-treatment period, (2) whether findings generalize across individuals recruited from other medical centers, (3) whether other child outcomes such as pain-specific anxiety and sleep quality are impacted, and (4) how treatment results compare to online patient education. In this application, we plan to evaluate the efficacy of Web-MAP in a large multicenter sample of 300 children and adolescents (ages 11-16 years) with chronic pain and their parents recruited from pain centers across the U.S. and Canada. The study design is a 2 (group) x 4 (time point) randomized controlled trial. All participants will be receiving evaluation from a specialized pediatric pain clinic. In addition, participants will be randomly assigned to receive online access to either patient education (attention control condition) or CBT over an 8-week treatment period. The primary study outcomes are child activity limitations and pain measured at pre-treatment, immediately post- treatment, and at 6- and 12-month follow-ups. Secondary outcomes include child reported depression and anxiety symptoms, parental behaviors, treatment satisfaction, sleep quality, and service use. We will also evaluate demographic and individual factors that predict treatment response. This project represents a significant advance in the development and testing of innovative approaches to deliver psychological therapies for youth with chronic pain, which may guide future developments in CBT for pediatric chronic pain. The long- term goal of this research program is to develop effective and flexible treatments that can be delivered at low cost to reduce pediatric chronic pain and pain-related disability. PUBLIC HEALTH RELEVANCE: Use of the Internet to deliver psychological treatment to children and adolescents with chronic pain provides a flexible and cost-effective way of reaching families who may not otherwise access mental health services. The long-term goal is provide effective treatment to prevent the development of adult chronic pain, disability, and psychopathology.