Palermo Tonya M, Law Emily F, Zhou Chuan, Holley Amy Lewandowski, Logan Deirdre, Tai Gabrielle
Departments of Anesthesiology & Pain Medicine, and Pediatrics, University of Washington, Seattle, WA, USA, Center for Child Health Behavior and Development, Seattle Children's Hospital, Seattle, WA, USA, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA, Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Pain. 2015 Apr;156(4):626-634. doi: 10.1097/01.j.pain.0000460355.17246.6c.
Although pain and function improve at immediate posttreatment 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 to understand the temporal association of these changes during internet-delivered cognitive behavioral therapy (CBT). Weekly repeated assessments of pain and function were conducted during 8 weeks of treatment among 135 adolescents, aged 11 to 17 years, with chronic pain who were randomized to the cognitive behavioral intervention 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 and quadratic effects. Trajectories of change showed that some patients' pain and functional disability were 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 after treatment.
尽管接受慢性疼痛认知行为疗法的青少年在治疗后即刻疼痛和功能有所改善，但关于青少年在心理治疗期间变化的数据有限。我们试图描述疼痛和功能变化的不同轨迹模式，以了解在互联网提供的认知行为疗法（CBT）期间这些变化的时间关联。在一项正在进行的互联网提供的CBT试验（青少年疼痛的网络管理；Web-MAP2）的认知行为干预组中，对135名年龄在11至17岁、患有慢性疼痛的青少年进行了为期8周的治疗，期间每周重复评估疼痛和功能。使用随机效应生长混合模型，我们描述了疼痛和功能障碍轨迹，发现了不同的轨迹组，表明了线性和二次效应的模式。变化轨迹表明，一些患者的疼痛和功能障碍在改善，另一些则恶化或变化极小。配对t检验比较了疼痛和功能的受试者内相对变化率，结果显示治疗期间疼痛和功能的变化范围相似。没有证据支持一个领域的改善先于另一个领域的变化。这些发现可能有助于为未来关于儿童慢性疼痛心理社会治疗的研究提供信息，以考虑如何针对不同的患者反应概况制定治疗策略。这可能会导致开发出既能在治疗期间更有效地针对儿童的疼痛和功能，又能在治疗后带来持续变化的干预策略。
