Enhancing daily functioning with exposure and acceptance strategies: An important stride in the development of psychological therapies for pediatric chronic pain

Division of Clinical Pain & Regional Anesthesia Research, Dept. of Anesthesiology & Peri-Operative Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., UHN-2, Portland, OR 97239, USA.
Pain (Impact Factor: 5.21). 02/2009; 141(3):189-90. DOI: 10.1016/j.pain.2008.12.012
Source: PubMed
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Available from: Tonya M Palermo, Jan 02, 2014
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    • "Cognitive-behavioral therapy (CBT) for pediatric chronic pain produces significant and large effects for pain reduction and small effects in improving function at post-treatment [7]. However, in clinical practice using a rehabilitative approach, the primary focus of treatment is on increasing function [15]. Clinical anecdotes suggest improvements in function may occur in the absence of changes in pain or that pain reduction may subsequently follow. "
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    ABSTRACT: Although pain and function improve at immediate post-treatment for youth receiving cognitive-behavioral therapy for chronic pain, limited data are available to understand changes that youth make during psychological treatment. We sought to characterize distinct trajectory patterns of change in pain and function in order to understand the temporal association of these changes during internet-delivered cognitive-behavioral treatment. Weekly repeated assessments of pain and function were conducted during eight weeks of treatment among 135 adolescents, ages 11 to 17 years, with chronic pain who were randomized to the cognitive-behavioral intervention (CBT) arm of an ongoing trial of internet-delivered CBT (Web-Based Management of Adolescent Pain; Web-MAP2). Using random effects growth mixture models we characterized pain and functional disability trajectories finding distinct trajectory groups indicating patterns of both linear as well as quadratic effects. Trajectories of change showed that some patients' pain and functional disability was improving, others worsened, or changed minimally. Paired t-tests compared the within-subject relative change rate in pain and function demonstrating similar change range for pain and function during the treatment period. There was no support for improvements in either pain or function to precede changes in the other domain. Findings may be useful in informing future studies of psychosocial treatments for pediatric chronic pain to consider how to target treatment strategies to distinct patient response profiles. This may lead to the development of intervention strategies that can both more effectively target children's pain and function during treatment, and lead to sustained changes following treatment.
    Pain 01/2015; 156(4). DOI:10.1097/01.j.pain.0000460355.17246.6c · 5.21 Impact Factor
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    ABSTRACT: It is important to understand the processes that contribute to disability and distress in adolescents with chronic pain. For example, research has identified that when adolescents can positively adapt to the consequences of health condition, rather than attempt to change the condition itself, they also function better and experience less distress. This pattern of behavior is similar to what is referred to as "acceptance" of pain in the adult literature. Although acceptance is consistently associated with positive outcomes in adult studies, there has been less investigation of acceptance in adolescents. This study aimed to examine the reliability and validity of an adolescent-adapted version of the Chronic Pain Acceptance Questionnaire (CPAQ-A), and, using this instrument, to carry out a preliminary investigation of acceptance in adolescents with chronic pain. A sample of 122 highly disabled adolescents with chronic pain attending a specialty service completed the adapted CPAQ-A. They also completed standardized measures of their pain and daily functioning. Results supported the reliability and validity of the CPAQ-A. Correlation analyses showed that higher levels of acceptance were associated with lower levels of distress and disability, but not with lower pain intensity. Regression analyses were carried out to assess the independent contribution of acceptance after pain intensity and demographic variables were taken into account. In these analyses acceptance accounted for significant variance in disability, psychological distress, and developmental and family functioning. We discuss developmental aspects of acceptance in adolescents and clinical implications of these findings.
    European journal of pain (London, England) 06/2009; 14(3):316-20. DOI:10.1016/j.ejpain.2009.05.002 · 2.93 Impact Factor
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    ABSTRACT: The purpose of this meta-analytic review was to quantify the effects of psychological therapies for the management of chronic pain in youth. Specifically, in this review we updated previous systematic reviews of randomized controlled trials by including new trials, and by adding disability and emotional functioning to pain as treatment outcomes. Electronic searches of the Cochrane Register of Randomised Controlled Trials, MEDLINE, PsycLIT, EMBASE, and the Social Sciences Citation Index were conducted from inception through August 2008. Methodological quality of the studies was assessed, and data extracted on the three primary outcomes of interest. Twenty-five trials including 1247 young people met inclusion criteria and were included in the meta-analysis. Meta-analytic findings demonstrated a large positive effect of psychological intervention on pain reduction at immediate post-treatment and follow-up in youth with headache, abdominal pain, and fibromyalgia. Small and non-significant effects were found for improvements in disability and emotional functioning, although there were limited data on these outcomes available in the included studies. Omnibus cognitive-behavioral therapy, relaxation therapy, and biofeedback all produced significant and positive effects on pain reduction. Studies directly comparing the effects of self-administered versus therapist-administered interventions found similar effects on pain reduction. Psychological therapies result in improvement in pain relief across several different pain conditions in children. Future trials are needed that incorporate non-pain outcome domains, that focus significant therapeutic content on reductions in disability, and that include extended follow-up to better understand maintenance of treatment effects.
    Pain 11/2009; 148(3):387-97. DOI:10.1016/j.pain.2009.10.004 · 5.21 Impact Factor
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