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
Download full-text


Available from: Tonya M Palermo, Jan 02, 2014
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Jan 2015 · Pain
  • Source
    • "Systematic reviews of the randomized controlled trials of psychological interventions for children and adolescents with chronic pain indicate that psychological therapies (cognitive–behavioral therapy, relaxation therapy, and biofeedback) have a positive effect on pain intensity in headache, abdominal pain, and fibromyalgia populations (Eccleston et al., 2002; Palermo, Eccleston, Lewandowski, Williams, & Morley, 2010), suggesting that the skills learned in these therapies may mitigate negative outcomes related to pediatric chronic pain. Although these therapies promote pain reduction for many patients, they may not lead to improved functioning (Palermo, 2009). Functioning is a particularly important outcome variable when working with pediatric pain patients who have long-standing pain that has not been alleviated by typical pain management techniques and continue to experience symptoms that result in emotional distress and functional disability. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: The aims of this study were: (1) investigate relations between pain acceptance, depressive symptoms, catastrophizing, and functional disability in pediatric patients in an interdisciplinary chronic pain rehabilitation program, (2) examine changes in acceptance from pre- to posttreatment, and (3) test if changes in acceptance predict changes in depressive symptoms, catastrophizing, and functional disability from pre- to posttreatment. Methods: 112 participants, ages 11-18 years, completed the Chronic Pain Acceptance Questionnaire, Adolescent Version, Center for Epidemiological Studies-Depression-Children's Scale, Pain Catastrophizing Scale for Children, and Functional Disability Inventory on admission to and completion of the program. Results: Significant and strong relations between acceptance, depression, catastrophizing, and functional disability were demonstrated. Participants demonstrated significant increases in acceptance and decreases in depression, catastrophizing, and functional disability. Finally, changes in acceptance significantly predicted changes in depressive symptoms, catastrophizing, and functional disability. Conclusions: Pain acceptance is an important variable in the treatment of pediatric chronic pain.
    Full-text · Article · May 2013 · Journal of Pediatric Psychology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jun 2009 · European journal of pain (London, England)
Show more