Psychosocial and Family Risk in Pediatric Chronic Migraine

 描述（由申请人提供）：慢性偏头痛是一种常见的疼痛状况，在儿童与显着的疼痛，残疾和痛苦。越来越多的证据 支持将行为干预作为儿童慢性偏头痛的一线治疗。然而，许多青少年由于与获得和远离训练有素的专业人员有关的障碍而没有接受行为治疗。互联网干预为家庭提供了一种更容易接受行为干预的方式，但可能不足以支持某些儿童的行为改变。目前，没有可用的筛查工具来帮助临床医生确定哪些儿童需要行为干预以及干预的强度是必要的。这项研究计划的长期目标是将患有慢性偏头痛的青少年与正确剂量的行为治疗相匹配，以优化结果并降低医疗保健相关成本。本申请的目的是适应和验证慢性偏头痛青年的心理社会和家庭风险的筛选工具，并确定技术提供的行为疼痛治疗的可行性，可接受性[和初步疗效]。K23候选人是华盛顿大学麻醉学和疼痛医学系的[助理教授]，以及西雅图儿童医院慢性疼痛诊所的儿科心理学家。 候选人致力于以患者为导向的研究事业，并提出了一个为期五年的培训计划，由一个跨学科的教师导师团队提供支持，该团队具有心理社会风险评估，互联网干预，儿科头痛临床试验和生物统计学方面的专业知识。该奖项将为候选人提供专门的指导， 心理社会和家庭风险和弹性，研究方法，以制定可访问的和有针对性的干预措施，为儿科头痛，和必要的知识，进行和评估临床试验，在儿科头痛人群。研究计划的第一阶段涉及调整用于慢性偏头痛青少年的心理社会风险筛查工具，并在225名慢性偏头痛儿童及其父母中验证调整后的工具。在该队列的随访研究中，将在6个月时进行心理社会风险的重复评估，以检查风险状态作为头痛结局和医疗保健相关费用的纵向预测因素。在研究的第二阶段，两种互联网行为治疗将适用于患有慢性偏头痛的青少年，其强度各不相同（自我指导与人类支持）。随后，这些干预措施的可行性、可接受性[和初步疗效][与常规治疗相比]将在一项随机对照试点试验中进行评估，试验中有[60]名儿童在不同的心理社会风险水平下接受筛查。这项研究产生的数据将为计划中的R01提案提供信息，该提案侧重于评估针对慢性偏头痛儿童及其家庭心理社会风险状况的可获得行为干预措施。完成拟议的培训将为候选人在儿科头痛医学方面成功的独立研究生涯做好准备。

 DESCRIPTION (provided by applicant): Chronic migraine is a common pain condition in childhood associated with significant pain, disability, and suffering. There is growing evidence to support behavioral interventions as first-line treatment in pediatric chronic migraine. However, many youth do not receive behavioral treatment due to barriers related to access and distance from trained professionals. Internet interventions offer an easier way for families to receive behavioral intervention, but may not be intense enough to support behavioral changes for some children. At present, there are no screening tools available to help clinicians determine which children need behavioral intervention and what intensity of intervention is necessary. The long-term goal of this research program is to match youth with chronic migraine to the correct dose of behavioral treatment in order to optimize outcomes and reduce healthcare-related costs. The objective of this application is to adapt and validate a screening tool of psychosocial and family risk in youth with chronic migraine, and to determine feasibility, acceptability [and preliminary efficacy] of technology-delivered behavioral pain treatment. The K23 candidate is an [Assistant Professor] in the Department of Anesthesiology and Pain Medicine at the University of Washington, and a pediatric psychologist in the chronic pain clinic at Seattle Children's Hospital. The candidate is committed to a patient-oriented research career and proposes a five-year training plan supported by an interdisciplinary team of faculty mentors with expertise in psychosocial risk assessment, Internet interventions, clinical trials in pediatric headache, and biostatistics. This award will provide the candidate with specialized instruction in the evaluation of psychosocial and family risk and resiliency, research methods to develop accessible and targeted interventions for pediatric headache, and necessary knowledge to conduct and evaluate clinical trials in pediatric headache populations. The first phase the research plan involves adaptation of a psychosocial risk screening tool for use in youth with chronic migraine, and validation of the adapted tool in [a separate cohort] of 225 children with chronic migraine and their parents. Repeat assessment of psychosocial risk will be conducted at six-months in a follow-up study of this cohort to examine risk status as a longitudinal predictor of headache outcomes and healthcare-related costs. In the second phase of research, two Internet behavioral treatments will be adapted for youth with chronic migraine that vary in intensity (self-guided vs. human support). Subsequently, feasibility, acceptability [and preliminary efficacy] of these interventions [compared to treatment as usual] will be evaluated in a randomized controlled pilot trial with [60] children screened at different levels of psychosocial risk. Data generated from this research will inform a planned R01 proposal focused on the evaluation of accessible behavioral interventions targeted to the psychosocial risk status of children with chronic migraine and their families. Completion of the proposed training will prepare the candidate for a successful independent research career in pediatric headache medicine.