Longitudinal Assessment of Pain, Coping, and Daily Functioning in Children with Sickle Cell Disease Receiving Pain Management Skills Training
Objective. To conduct intensive pain management skills training (IST) in children with sickle cell disease (SCD) and their parents and to comprehensively evaluate pain, coping, and daily functioning in children pre, immediately post, and 3 months following treatment. Methods. Three children who received IST in nonpharmacological and pharmacological pain management strategies completed a Coping Strategies Questionnaire (CSQ) at pre, post, and follow-up assessments, and daily pain and activity diaries for 18 weeks, spanning from 1 week pretreatment to 11 weeks posttreatment. Results. From pre- to posttreatment, 1 child receiving IST indicated increased report of active coping attempts and all 3 children indicated decreased report of negative thinking on the CSQ. Participants in IST used coping skills on 90% of days with pain and reported the skills to be moderately helpful on the daily diaries. For daily activities such as eating dinner, playing with friends, and hours slept, children participated similarly on days with pain and days without pain during the posttreatment period. Given the small number of participants in this study, individual cases are discussed to highlight similarities and differences in how participants responded to the treatment and during the 3-month follow-up period. Conclusions. In this pilot study, each participant showed improvement in coping and daily functioning after completing the IST program. Individual differences in response to treatment indicate the need for more targeted intervention programs that incorporate pharmacological and nonpharmacological components. The results of this study highlight both the promise and the complications of conducting comprehensive pain intervention and functional outcome studies in children with SCD.
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ABSTRACT: The most common complication of sickle cell disease (SCD) is the acute painful episode. The effectiveness of nonpharmacologic pain interventions in decreasing reports of pain has been documented in other pediatric populations. However, there is a paucity of intervention research conducted with SCD populations. Thus, the goal of the present study was to implement a standardized, family-based cognitive-behavioral pain intervention for children with SCD. A three-session intervention involving guided imagery was used with 16 (8 in the intervention group, 8 in the waitlist group) school-aged children (Mean age = 14.00, SD = 2.68) with SCD. It was hypothesized that the intervention group would exhibit decreased medical contacts and report of pain, and improved quality of life when compared to the waitlist group. A repeated measures analysis of variance, however, revealed no significance for between group differences. There was a significant reduction in medical contacts and report of pain over time, regardless of group (intervention or waitlist). Quality of life was average for both groups and was stable over time. In addition, it was hypothesized that utilization and engagement in the guided imagery would be related to the outcome of the intervention. However, correlations showed no significance for the relationship between utilization and engagement in the intervention and the outcome measures. Treatment adherence was variable ; the overall adherence rate for participation in the intervention was 56%. When participants did practice, they gave high ratings of enjoyment and helpfulness. They were also able to engage in the guided imagery, which increased over time. In addition, caregiver participation was inconsistent, which may have contributed to the adherence issues. Follow-up analyses of treatment fidelity and psychosocial functioning suggest that the delivery of the intervention and family functioning and coping may have impacted the outcome of the intervention. Limitations of the present study included small sample size, recruitment issues, high dropout rates, and other methodological issues (i.e. measures, design of intervention), which all played a part in the outcome of the intervention. Information gained from this study is beneficial in addressing and developing pain interventions for children with sickle cell disease.
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ABSTRACT: Psychological interventions are an integral component of treatment programs for chronic pain in children and adolescents. However, the evidence base supporting their efficacy varies widely. Although strong and consistent evidence supports the efficacy of cognitive-behavioral interventions for relieving children’s headache, the evidence base supporting the use of cognitive and behavioral interventions for relieving other types of chronic pain is weak, as assessed by the number of controlled trials that have been conducted in children and by the few types of chronic pain that have been formally studied. Empirical support for most psychological interventions targeting nonheadache chronic pain derives from anecdotal reports and case studies. In this study we review this evidence, identify specific gaps in our knowledge base, and recommend practical strategies to obtain critical information about which therapies are best for which children and for which types of chronic pain.
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