Predicting Treatment Response in Pediatric Functional Abdominal Pain

项目总结 在这项修订的应用中，我们研究的目标是确定儿科功能的个体差异 腹痛(FAP)，预测干预后不同的健康结果，可用于 进一步为FAP量身定做干预措施。FAP是儿童时期最常见的疼痛问题之一， 前瞻性地预测早期慢性疼痛、残疾和频繁使用医疗服务(HSU)的风险 成人期。因此，提供有效的FAP治疗是一个重要的公共卫生问题。认知 由训练有素的专业人员在面对面的会议中提供的行为治疗(CBT)已被发现 减轻一些FAP患者的疼痛，但大多数FAP通常不能获得如此密集的资源 病人。这项拟议的研究将评估治疗FAP的替代方法。这项研究综合了 延长了最近由儿科疼痛方面的主要调查人员所做的工作。在一项前瞻性的儿科自然历史研究中 发病的FAP患者跟踪到青春期晚期/成年期早期，Pi Walker和他的同事发现了三个 不同的患者特征(即低疼痛适应、高疼痛适应、高疼痛功能障碍)包括 在儿童时期最初进行FAP评估时，疼痛严重程度、疼痛认知和影响。这些痛苦 资料预测了近十年后的随访(FU)中的慢性疼痛和残疾。患有高度疼痛的患者 基线状态下的功能障碍患者的症状转归最差，而且也表现出前伤害性中枢神经系统 FU实验室疼痛测试中的疼痛调制。FAP疼痛特征组的异质性表明 他们可能在治疗需求和从行为干预中受益的程度上有所不同。共同-- 研究人员巴勒莫开发并测试了CBT干预(基于网络的青少年疼痛管理； 网络地图)，适用于患有各种慢性疼痛的青年。这种有效的、容易传播的治疗方法包括 在线向青少年和家长提供不同的模块。WebMAP在线CBT显著降低了年轻人的 疼痛和残疾与通常的护理相比，等待名单控制的情况。目前的提案合并了这些 将研究方向转变为创新研究，将首次：(目标1)管理采用的在线CBT 具体针对FAP，并与在线信息、注意力控制条件进行比较，评估其疗效； (目标2)评估治疗反应的基线调节因素，包括我们之前验证的FAP疼痛 简档、促伤害性中枢痛觉调制和父母特征(保护性、模拟疼痛 行为，对儿童痛苦的灾难性影响)；以及(目标3)评估影响儿童健康的潜在因素 关于健康结果的在线CBT。经过医学评估，FAP患者(n=300)年龄11-17岁和 他们的父母将随机接受在线CBT或在线信息。评估将在基线、年中进行 治疗后，基线后6个月和12个月。这项研究将产生可以 用于根据FAP患者的个人资料更有效地针对他们进行干预，从而 将循证护理扩展到更多的患者，并最终降低总体护理成本。

PROJECT SUMMARY The goal of our research in this revised application is to identify individual differences in pediatric functional abdominal pain (FAP) that predict differential health outcomes in response to an intervention and can be used to further tailor interventions for FAP. FAP is among the most common pain problems in childhood and prospectively predicts risk for chronic pain, disability, and frequent health service utilization (HSU) in early adulthood. Therefore, providing effective treatments of FAP is a critical public health concern. Cognitive behavior therapy (CBT) delivered by highly trained professionals in face-to-face sessions has been found to reduce pain in some FAP patients, but such intensive resources are not generally available to most FAP patients. The proposed study will evaluate an alternative approach to treating FAP. The study integrates and extends recent work by leading investigators in pediatric pain. In a prospective natural history study of pediatric onset FAP patients followed into late adolescence/early adulthood, PI Walker and colleagues identified three distinct patient profiles (i.e., Low Pain Adaptive, High Pain Adaptive, High Pain Dysfunctional) comprised of pain severity, pain cognitions, and affect at the time of the initial FAP evaluation in childhood. These pain profiles predicted chronic pain and disability at follow-up (FU) nearly a decade later. Patients with the High Pain Dysfunctional profile at baseline had the poorest symptom outcomes and also exhibited pro-nociceptive central pain modulation in laboratory pain tests at FU. The heterogeneity of the FAP pain profile groups suggests that they may differ in treatment needs and in the extent to which they benefit from behavioral interventions. Co- Investigator Palermo developed and tested a CBT intervention (Web-based Management of Adolescent Pain; Web-MAP) for youth with various chronic pain conditions. This efficient, easily disseminated treatment includes separate modules delivered online to youth and parents. WebMAP Online CBT significantly reduced youths' pain and disability in comparison to a usual care, wait-list control condition. The current proposal merges these lines of research into an innovative study that will, for the first time: (Aim 1) administer Online CBT adapted specifically for FAP and evaluate its efficacy compared to an Online Information, attention control condition; (Aim 2) evaluate baseline moderators of treatment response, including our previously validated FAP pain profiles, pro-nociceptive central pain modulation, and parent characteristics (protectiveness, modeling pain behavior, catastrophizing about the child's pain); and (Aim 3) evaluate potential mediators of the effect of Online CBT on health outcomes. Following medical evaluation, FAP patients (n = 300) ages 11-17 years and their parents will be randomized to Online CBT or Online Information. Assessments will be at baseline, mid- and post-treatment, and at 6- and 12-months post baseline. The study will produce knowledge that can be used to more efficiently target interventions to FAP patients according to their individual profiles and thereby extend evidence-based care to more patients and ultimately reduce overall costs of care.