Effectiveness of a Cognitive-Behavioral Intervention to Improve Pain Outcomes Among Adolescents and Their Parents

• In Event: 2-199 - Cross-sectional and Longitudinal Factors Linked to Pain Experiences Across Child Development

Integrative Statement

Chronic pain in pediatrics is linked to significant physical, psychosocial, and psychological burdens for adolescents and families (Eccleston, Crombez, Scotford, Clinch, & Connell, 2004; Palermo, 2000) and places a significant burden on our healthcare system, ranking among the most expensive pediatric health problems in the United States (Groenewald, Essner, Wright, Fesinmeyer, & Palermo, 2014).
While there are various pathways that contribute to the onset of chronic pain, children with a wide range of pain-related conditions suffer in similar ways. Almost 70% of children with pain have problems with school, 50% have problems with sleep, and children with any type of ongoing pain are 35% more likely than those without pain to have anxiety or depression. These common pain-related comorbidities are known risk factors for the persistence of pain symptoms and remain vastly under-treated in pediatric pain. Cognitive behavioral therapy (CBT) is research-proven to help children and adolescents reduce pain and pain-related comorbidities (Coakley, Wihak, 2017; Palermo, 2014; Eccleston et al, 2014), however, few pediatric patients obtain services due to time, cost, and access barriers (Darnell et. Al, 2016; Simons, Logan, Chastain, Cerulla, 2010) as well as biomedical biases that inhibit engagement in services (Guite, Kim, Chen, Sherker, 2014).
The Comfort Ability (TCA) program is a 1-day, manualized, CBT intervention that was designed specifically to reduce barriers to care by enhancing access to psychological services for the management of pediatric pain. TCA is currently an established clinical intervention at 13 children’s hospitals in the US and Canada. This presentation will review parent and adolescent outcomes in a sample of parent-adolescent dyads (n=102; female 78%; mean age 14.0, Caucasian 80%). Duration of pain ranged from 3months to 13 years with a median duration of 18 months. Diagnoses within this sample primarily included musculoskeletal pain (29.5%), headache (21.0%) and abdominal pain (15.2%).
A key conceptual finding in this paper is that adolescent pain condition/diagnosis had minimal influence across all outcomes. This finding suggests that the core of pain education, introductory cognitive and behavioral skills, and treatment recommendations presented within this group intervention is widely applicable to adolescents with various presenting pain conditions and lends support to the idea that chronic pain can be treated within a primary pain disorder paradigm (Schechter, 2014). Linear mixed models within this nonrandomized design suggest that adolescents demonstrate improvement in functionality (p= .0012), depression symptoms (p < .0001), and pain catastrophizing (p < .0001) by 1-month posttreatment. Parents made significant changes in parenting practices (p-values <.01) and in their beliefs about their adolescent’s ability to manage pain (p < .001) by 1-week posttreatment. Additional outcome analyses suggest that after participation mother-father dyads converge in their thinking about pain (i.e., pain catastrophizing), suggesting a more unified approach to care. Additional research is currently being conducted to understand the program specific clinical contributions that adolescents and parents can expect, as well as the healthcare cost-utility associated with this treatment.

Author

• Rachael Coakley, Harvard Medical School and Boston Children’s Hospital
  Presenting Author