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(512) Functional improvement is observed before pain reduction in children treated for chronic pain
S104
The Journal of Pain
Abstracts
(512) Functional improvement is observed before pain reduction in children treated for chronic pain
(514) Influential factors in providers’ chronic pain treatment decisions
A Lynch-Jordan, S Kashikar-Zuck, S Sil, N Cunningham, D Wolf, H Stahlman, T Rogers, M Burke, K Barnett, J Peugh, J Rose, A Szabova, and K Goldschneider; Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
N Hollingshead, S Meints, S Middleton, C Free, and A Hirsh; Indiana University Purdue University Indianapolis, Indianapolis, IN
Patients presenting for treatment of chronic pain often believe that pain reduction must be achieved before returning to normal functioning. However, outpatient treatments typically focus on a rehabilitative approach with emphasis on first decreasing pain-related functional disability. A few case studies have shown functional disability improving more rapidly than pain intensity; however these findings have not been investigated on a larger scale. It was hypothesized that 1) functional disability and average pain intensity would improve (decrease) over the course of psychological treatment for chronic pain and 2) functional disability would improve (decrease) more quickly than average pain intensity. Participants were 94 youth with chronic pain between 8-18 years (74.5% female, 86.2% Caucasian) completing cognitive behavioral therapy (CBT) for pain management (M = 5.6 sessions, range = 3 to 9) in addition to standard medical care. Patients completed the Functional Disability Inventory (FDI) and a Numeric Rating Scale (NRS) of average pain intensity at every CBT session. Data were automatically entered into the patients’ electronic medical records and were collected retrospectively. Hierarchical linear modeling (HLM) was conducted separately for the FDI and NRS to investigate their longitudinal trajectories. HLM results for the FDI showed an overall significant decline in functional disability over time. No significant changes were found for the NRS, suggesting average pain intensity remained relatively constant. To test differences in rates of change between FDI and NRS, standardized estimates of their slopes were obtained. These estimates were used to construct 95% confidence intervals around the slopes. Results showed that the FDI’s rate of change differed significantly from that of the NRS. Our findings provide empirical support of the conventional wisdom that functioning improves before pain utilizing systematic data collection with a large clinical sample. Future research should investigate differential patterns of symptom improvement within specific pain populations.
Chronic pain is difficult to manage, and treatment guidelines are unclear and conflicting. Little is known about the factors providers use to make chronic pain treatment decisions. This study examined the factors that providers use to make treatment decisions and the extent to which these factors vary between physicians and medical students. We hypothesized that physicians and medical students would: prioritize objective over subjective factors and be particularly interested in information about patients’ substance use. We did not have specific hypotheses about differences between provider types; thus, these comparisons were exploratory in order to inform future research. Eighty-five providers (41% medical students, 59% physicians) viewed 16 computer-simulated patients; each included a picture with text describing the patients’ condition (i.e, chronic lower back pain, pain interfering with daily activity, open to all treatment options). After making treatment decisions, participants selected from separate lists the factors they used to make their treatment decisions and the factors they would have used if that information had been provided. Most providers reported being influenced by patients’ pain histories (97.6%) and pain descriptions (95.3%). Providers indicated they would have used information about patients’ previous treatments (97.6%), as well as average (96.5%) and current pain (96.5%) ratings had this information been available. Compared to physicians, medical students endorsed more often that they would have used patients’ employment and/or disability status (p<.01), and history of illicit drug (p=.09) and alcohol use (p=.08) to make treatment decisions. Consistent with hypotheses, we found providers prioritized objective factors. Exploratory analyses found medical students endorsed wanting more information about patients’ social history. Given the high prevalence of chronic pain and the abuse potential for certain pain treatments (e.g., opioids), future studies should examine the factors that influence decisions for specific treatment options.
(513) A mediation model of neuropathic pain and sleep quality: the role of depressed affect and pain interference
(515) Randomized controlled trial of a web-based behavioral treatment for pediatric headache
A Martin, A Heapy, B Moore, R Masheb, M Driscoll, and R Kerns; VA Connecticut Healthcare System, West Haven, CT
E Law, T Palermo, and R Claar; University of Washington, Seattle, WA
Poor sleep quality is a common problem among persons with chronic neuropathic pain. In contrast to a robust literature that has identified psychosocial factors associated with sleep disturbance among persons with chronic musculoskeletal pain, few investigators have focused on examining similar relationships in persons with neuropathic pain. We conducted secondary analyses of baseline data from a sample of veterans who participated in a randomized controlled trial of cognitive behavioral therapy for diabetic peripheral neuropathic pain (DPNP; 94% male; 70% white; mean age = 62.3; mean pain duration = 5.2 years). We tested whether depressive symptom severity and pain interference mediated the relationship between pain intensity and sleep quality. Patients completed the Neuropathic Pain Scale (total score, M =54.6, SD = 15.8), Pittsburgh Sleep Quality Index (M = 10.8, SD = 4.4), Pain Interference subscale of the Multidimensional Pain Inventory (M = 3.4, SD = 1.7), and the Depression-Dejection subscale of the Profile of Mood States (M = 12.4, SD = 13.8). Neuropathic pain intensity and sleep quality were strongly correlated (r(44) = .47, p < .01). Hierarchical regression analyses revealed that neuropathic pain intensity no longer predicted sleep quality when activity interference and depressed affect were taken into consideration (b = .25, t(42) = 1.67, ns). Mediation analyses revealed both of these factors to be important partial mediators of the relationship between neuropathic pain intensity and sleep quality. Results of the Sobel test revealed activity interference to be a particularly strong mediator (z’ = 2.81, p<0.01), with depressed affect being only marginally significant (z’ = 1.66, p<0.10). Further investigation of the temporal role of pain interference and mood sequela with regard to the potential development of sleep disorders in the context of neuropathic pain is needed. This research was supported by a merit review award (B6044R) from VA Rehab R&D.
Headache is among the most common pain complaints of childhood. Behavioral interventions are efficacious for improving pain among youth with headache. However, many youth do not receive psychological treatment for headache, which has led to consideration of alternative delivery modalities such as the Internet. We evaluated the efficacy of a family-based Internet behavioral treatment, called Web-Based Management of Adolescent Pain (Web-MAP), in 94 youth with headache (migraine, tension-type and other) receiving treatment in an interdisciplinary headache clinic. Adolescents were 11-17 years (M = 14.51) and 82% female, and were randomized to standard care (SMC; n = 42) or Web-MAP (n = 52). All participants completed pre-treatment assessments; 82% completed immediate post-treatment assessments (nSMC = 35; nWeb-MAP = 42). Primary treatment outcomes were pain intensity (0-10 NRS), headache days, and activity limitations (Child Activity Limitations Interview) completed via 7-day online diaries. In addition to standard care from the headache clinic, the Web-MAP group completed 8 weeks of online modules including relaxation training, cognitive strategies, parent operant techniques, communication strategies, and lifestyle interventions. The SMC group continued with standard headache care. Findings from baselineadjusted ANCOVAs showed no significant group differences at post-treatment on pain intensity, F(1, 74) = 0.17, p = 0.68, headache days, F(1, 74) = 0.10 p = 0.75, or activity limitations, F(1, 74) = 0.36, p = 0.55. Paired t-tests with Bonferroni correction (a = .008) were used to examine within-group changes from preto post-treatment. The Web-MAP group showed significant improvement on activity limitations, t(41) = 3.59, p = 0.001, but not pain intensity, t(41) = 2.58, p = .01, or headache days, t(41) = 2.32, p = 0.03. The SMC group did not show significant improvement on any outcomes. Initial findings suggest Web-MAP can lead to reductions in activity limitations among youth with headache.
The Journal of Pain
Abstracts
(512) Functional improvement is observed before pain reduction in children treated for chronic pain
(514) Influential factors in providers’ chronic pain treatment decisions
A Lynch-Jordan, S Kashikar-Zuck, S Sil, N Cunningham, D Wolf, H Stahlman, T Rogers, M Burke, K Barnett, J Peugh, J Rose, A Szabova, and K Goldschneider; Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
N Hollingshead, S Meints, S Middleton, C Free, and A Hirsh; Indiana University Purdue University Indianapolis, Indianapolis, IN
Patients presenting for treatment of chronic pain often believe that pain reduction must be achieved before returning to normal functioning. However, outpatient treatments typically focus on a rehabilitative approach with emphasis on first decreasing pain-related functional disability. A few case studies have shown functional disability improving more rapidly than pain intensity; however these findings have not been investigated on a larger scale. It was hypothesized that 1) functional disability and average pain intensity would improve (decrease) over the course of psychological treatment for chronic pain and 2) functional disability would improve (decrease) more quickly than average pain intensity. Participants were 94 youth with chronic pain between 8-18 years (74.5% female, 86.2% Caucasian) completing cognitive behavioral therapy (CBT) for pain management (M = 5.6 sessions, range = 3 to 9) in addition to standard medical care. Patients completed the Functional Disability Inventory (FDI) and a Numeric Rating Scale (NRS) of average pain intensity at every CBT session. Data were automatically entered into the patients’ electronic medical records and were collected retrospectively. Hierarchical linear modeling (HLM) was conducted separately for the FDI and NRS to investigate their longitudinal trajectories. HLM results for the FDI showed an overall significant decline in functional disability over time. No significant changes were found for the NRS, suggesting average pain intensity remained relatively constant. To test differences in rates of change between FDI and NRS, standardized estimates of their slopes were obtained. These estimates were used to construct 95% confidence intervals around the slopes. Results showed that the FDI’s rate of change differed significantly from that of the NRS. Our findings provide empirical support of the conventional wisdom that functioning improves before pain utilizing systematic data collection with a large clinical sample. Future research should investigate differential patterns of symptom improvement within specific pain populations.
Chronic pain is difficult to manage, and treatment guidelines are unclear and conflicting. Little is known about the factors providers use to make chronic pain treatment decisions. This study examined the factors that providers use to make treatment decisions and the extent to which these factors vary between physicians and medical students. We hypothesized that physicians and medical students would: prioritize objective over subjective factors and be particularly interested in information about patients’ substance use. We did not have specific hypotheses about differences between provider types; thus, these comparisons were exploratory in order to inform future research. Eighty-five providers (41% medical students, 59% physicians) viewed 16 computer-simulated patients; each included a picture with text describing the patients’ condition (i.e, chronic lower back pain, pain interfering with daily activity, open to all treatment options). After making treatment decisions, participants selected from separate lists the factors they used to make their treatment decisions and the factors they would have used if that information had been provided. Most providers reported being influenced by patients’ pain histories (97.6%) and pain descriptions (95.3%). Providers indicated they would have used information about patients’ previous treatments (97.6%), as well as average (96.5%) and current pain (96.5%) ratings had this information been available. Compared to physicians, medical students endorsed more often that they would have used patients’ employment and/or disability status (p<.01), and history of illicit drug (p=.09) and alcohol use (p=.08) to make treatment decisions. Consistent with hypotheses, we found providers prioritized objective factors. Exploratory analyses found medical students endorsed wanting more information about patients’ social history. Given the high prevalence of chronic pain and the abuse potential for certain pain treatments (e.g., opioids), future studies should examine the factors that influence decisions for specific treatment options.
(513) A mediation model of neuropathic pain and sleep quality: the role of depressed affect and pain interference
(515) Randomized controlled trial of a web-based behavioral treatment for pediatric headache
A Martin, A Heapy, B Moore, R Masheb, M Driscoll, and R Kerns; VA Connecticut Healthcare System, West Haven, CT
E Law, T Palermo, and R Claar; University of Washington, Seattle, WA
Poor sleep quality is a common problem among persons with chronic neuropathic pain. In contrast to a robust literature that has identified psychosocial factors associated with sleep disturbance among persons with chronic musculoskeletal pain, few investigators have focused on examining similar relationships in persons with neuropathic pain. We conducted secondary analyses of baseline data from a sample of veterans who participated in a randomized controlled trial of cognitive behavioral therapy for diabetic peripheral neuropathic pain (DPNP; 94% male; 70% white; mean age = 62.3; mean pain duration = 5.2 years). We tested whether depressive symptom severity and pain interference mediated the relationship between pain intensity and sleep quality. Patients completed the Neuropathic Pain Scale (total score, M =54.6, SD = 15.8), Pittsburgh Sleep Quality Index (M = 10.8, SD = 4.4), Pain Interference subscale of the Multidimensional Pain Inventory (M = 3.4, SD = 1.7), and the Depression-Dejection subscale of the Profile of Mood States (M = 12.4, SD = 13.8). Neuropathic pain intensity and sleep quality were strongly correlated (r(44) = .47, p < .01). Hierarchical regression analyses revealed that neuropathic pain intensity no longer predicted sleep quality when activity interference and depressed affect were taken into consideration (b = .25, t(42) = 1.67, ns). Mediation analyses revealed both of these factors to be important partial mediators of the relationship between neuropathic pain intensity and sleep quality. Results of the Sobel test revealed activity interference to be a particularly strong mediator (z’ = 2.81, p<0.01), with depressed affect being only marginally significant (z’ = 1.66, p<0.10). Further investigation of the temporal role of pain interference and mood sequela with regard to the potential development of sleep disorders in the context of neuropathic pain is needed. This research was supported by a merit review award (B6044R) from VA Rehab R&D.
Headache is among the most common pain complaints of childhood. Behavioral interventions are efficacious for improving pain among youth with headache. However, many youth do not receive psychological treatment for headache, which has led to consideration of alternative delivery modalities such as the Internet. We evaluated the efficacy of a family-based Internet behavioral treatment, called Web-Based Management of Adolescent Pain (Web-MAP), in 94 youth with headache (migraine, tension-type and other) receiving treatment in an interdisciplinary headache clinic. Adolescents were 11-17 years (M = 14.51) and 82% female, and were randomized to standard care (SMC; n = 42) or Web-MAP (n = 52). All participants completed pre-treatment assessments; 82% completed immediate post-treatment assessments (nSMC = 35; nWeb-MAP = 42). Primary treatment outcomes were pain intensity (0-10 NRS), headache days, and activity limitations (Child Activity Limitations Interview) completed via 7-day online diaries. In addition to standard care from the headache clinic, the Web-MAP group completed 8 weeks of online modules including relaxation training, cognitive strategies, parent operant techniques, communication strategies, and lifestyle interventions. The SMC group continued with standard headache care. Findings from baselineadjusted ANCOVAs showed no significant group differences at post-treatment on pain intensity, F(1, 74) = 0.17, p = 0.68, headache days, F(1, 74) = 0.10 p = 0.75, or activity limitations, F(1, 74) = 0.36, p = 0.55. Paired t-tests with Bonferroni correction (a = .008) were used to examine within-group changes from preto post-treatment. The Web-MAP group showed significant improvement on activity limitations, t(41) = 3.59, p = 0.001, but not pain intensity, t(41) = 2.58, p = .01, or headache days, t(41) = 2.32, p = 0.03. The SMC group did not show significant improvement on any outcomes. Initial findings suggest Web-MAP can lead to reductions in activity limitations among youth with headache.