An internet CBT intervention for pediatric chronic pain and disability

描述（由申请人提供）：估计有15%至30%的健康儿童和青少年患有复发性或慢性疼痛，如头痛、腹痛和肌肉骨骼疼痛。慢性疼痛会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），以减少儿童的疼痛和残疾。然而，即使在已经开发出有效的治疗方法的地方，由于诸如获得治疗的问题、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等障碍，大多数儿童没有接受慢性疼痛管理的心理干预。这些问题促使人们考虑通过互联网等其他形式提供治疗。我们已经在开发和实施一种心理干预的初步评估方面取得了重大进展，这种干预被称为基于网络的青少年疼痛管理（Web-MAP）。我们的研究结果表明，与等候名单对照组的儿童相比，接受这种干预的家庭的儿童在活动限制和疼痛强度方面显着减少。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维持，(2)研究结果是否适用于从其他医疗中心招募的个体，(3)其他儿童结局，如疼痛特异性焦虑和睡眠质量是否受到影响，以及(4)治疗结果如何与在线患者教育进行比较。在这项应用中，我们计划评估Web-MAP在美国和加拿大疼痛中心招募的300名患有慢性疼痛的儿童和青少年（11-16岁）及其父母的大型多中心样本中的疗效。研究设计为2（组）× 4（时间点）随机对照试验。所有参与者将接受来自儿科疼痛专科诊所的评估。此外，在为期8周的治疗期间，参与者将被随机分配接受在线患者教育（注意力控制条件）或CBT。主要研究结果是在治疗前、治疗后立即以及6个月和12个月随访时测量儿童活动限制和疼痛。次要结局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。我们还将评估预测治疗反应的人口统计学和个人因素。该项目代表了开发和测试创新方法的重大进步，为患有慢性疼痛的青少年提供心理治疗，这可能指导未来儿童慢性疼痛的CBT发展。这项研究计划的长期目标是开发有效和灵活的治疗方法，可以以低成本交付，以减少儿童慢性疼痛和与疼痛相关的残疾。

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.