Predicting Treatment Response in Pediatric Functional Abdominal Pain

描述（由申请人提供）：我们在这份修订后的申请中研究的目的是确定儿科功能性腹痛（FAP）的个体差异，预测干预后的不同健康结果，并可用于进一步定制FAP干预措施。FAP是儿童时期最常见的疼痛问题之一，可预测成年早期慢性疼痛、残疾和频繁使用卫生服务（HSU）的风险。因此，提供FAP的有效治疗是一个重要的公共卫生问题。认知行为疗法（CBT）由训练有素的专业人员在面对面的会议中提供，已被发现可以减轻一些FAP患者的疼痛，但这种密集的资源通常不适用于大多数FAP患者。拟议的研究将评估治疗FAP的另一种方法。该研究整合并扩展了儿科疼痛的主要研究人员最近的工作。在一项对儿童期发病的FAP患者进行的前瞻性自然史研究中，PI Walker及其同事确定了三种不同的患者特征（即低疼痛适应性、高疼痛适应性、高疼痛功能障碍），包括疼痛严重程度、疼痛认知和儿童期初始FAP评估时的影响。这些疼痛特征在近十年后的随访（FU）中预测了慢性疼痛和残疾。在基线时具有高疼痛功能障碍特征的患者具有最差的症状结果，并且在FU的实验室疼痛测试中也表现出前伤害性中枢性疼痛调节。FAP疼痛概况组的异质性表明，他们可能在治疗需求和从行为干预中获益的程度上有所不同。共同研究者Palermo为患有各种慢性疼痛的青少年开发并测试了CBT干预（基于网络的青少年疼痛管理；Web-MAP）。这种有效、易于传播的治疗包括在线向青年和家长提供的单独模块。与常规治疗相比，WebMAP在线CBT显著减少了青少年的疼痛和残疾。目前的提案将这些研究纳入

DESCRIPTION (provided by applicant): 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.