T. Palermo, Ph.D.
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.
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.