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(527) An internet-based perioperative pain psychology treatment program: results of a randomized controlled trial in breast oncology surgery patients
S106
Abstracts
The Journal of Pain
sociocultural factors related to the doctor-patient relationship, such as feelings of trust, similarity, and liking, may mediate previously reported racial discordance effects. In the present study, we tested the effects of doctor-patient shared group membership and patient ratings of doctor similarity, trust and liking on patient reported pain during simulated clinical interactions. A mixed-ethnicity sample of 80 participants (40 male), age 19-54 years old, was divided into two groups ostensibly based on the similarity of their self-reported beliefs (actually random), and then randomly assigned the role of doctor or patient. Participants took part in two simulated clinical interactions in which patients rated pain from 16 thermal heat stimulations delivered by an ingroup or outgroup doctor. Patients reported greater trust, similarity, and liking of ingroup than outgroup doctors, and patients’ average ratings of their feelings towards their doctors predicted both continuous pain intensity rating during each heat stimulation and overall pain intensity rating completed after each heat stimulation. These results suggest that interventions aimed at increasing patient feelings of trust, similarity, and liking to their doctors may decrease patient reported pain during medical care regardless of racial and ethnic discordance. Such interventions may help mitigate the negative impact of doctor-patient racial and ethnic discordance in pain treatment.
G04 Interdisciplinary Approaches
(526) A brief psychological intervention targeting persistent pain prevention following mastectomy or lumpectomy: a pilot investigation
(528) Development and usability testing of an iPad and desktop psycho-educational game for children with Juvenile Idiopathic Arthritis and their parents
K Hadlandsmyth, L Dindo, S Sugg, R Wajid, M Zimmerman, and B Rakel;
J Stinson, M Connelly, A Huber, N Luca, L Spiegel, A Tsimicalis, S Luca, N Tajuddin, R Berard, J Barsalou, S Campillo, P Dancey, C Duffy, B Feldman, N Johnson, P McGrath, N Shiff, S Tse, L Tucker, and J Victor; The Hospital for Sick Children, Toronto, Ontario, Canada
University of Iowa, Iowa City, IA
Chronic pain following breast cancer treatment is prevalent, affecting 25-60% of patients. Psychological variables including depression, anxiety, and pain catastrophizing have been implicated in the development of persistent post-treatment pain. The current study is a pilot Randomized Control Trial of a single session psychological intervention (Acceptance and Commitment Therapy: ACT) compared to Treatment as Usual (TAU). Participants are identified preoperatively as being at risk for developing persistent pain based on elevated depressive symptoms (PHQ-8 $ 10); anxious symptoms (GAD-7 $ 10); pain catastrophizing (PCS $ 30); or pre-existing chronic pain conditions. Data collection is still underway; the current n = 13 with a target N = 60. Out of a possible 34 patients, 65% (22) were interested in participating and 38% (13) screened in and enrolled. Of these, 6 (46%) screened in on depression, 8 (62%) on anxiety, 5 (38%) on preexistent chronic pain condition(s), and 0 on pain catastrophizing. About half the participants (46%) screened in on more than one criteria. Of those reporting a chronic pain condition, 67% reported taking NSAIDS regularly for pain and their Brief Pain Inventory pain intensity composite sub-score M = 3.75 (SD = 2.61) on a 0 – 10 scale. Initial qualitative responses indicate that mindfulness exercises are particularly valued. Quantitative analyses will use t-tests to compare pain, anxiety, and depression between treatment groups. It is hypothesized that the ACT group will report reduced pain, depression, and anxiety compared to TAU. Findings from this study have the potential to inform a larger trial. This study is supported by a grant from the Holden Comprehensive Cancer Center at the University of Iowa.
(527) An internet-based perioperative pain psychology treatment program: results of a randomized controlled trial in breast oncology surgery patients B Darnall, A Wheeler, C Taub, I Mackey, I Wapnir, C Schultz, T Rico, and P Flood; Stanford University, Palo Alto, CA Pain catastrophizing is a deleterious pattern of cognitive and emotional responses actual or anticipated pain. Pain catastrophizing has particular salience in the perioperative context given its negative impacts on post-surgical outcomes, including pain intensity (Papaioannou, 2009), opioid use (Helmerhorst, 2014), duration of hospital stay and the development of post-surgical chronic pain (Pinto, 2012). Pain catastrophizing has been shown to be a greater predictor of surgical outcomes than disease characteristics, the surgeon, or the surgery (Wertli, 2013; Abbott, 2011). Accordingly, we developed an internet-based treatment (My Surgical Success) that builds on prior work (Darnall, 2014) and targets pain catastrophizing perioperatively. The website contains a 90-min skills-based education video, a personalized action plan, and a 20-minute binaural audio file. The study was approved by the Stanford IRB; design
was a randomized controlled clinical trial. Participants were mastectomy candidates ages $18 with a Pain Catastrophizing Scale (PCS) score $20 and a surgery date >7 days from consent. Participants were randomized to a health education control group (website with information on nutrition and surgical recovery) or to My Surgical Success. Data were collected via chart review, prospective electronic surveys, and by verbal report (phone). Data included demographics, medical and surgical characteristics, opioid use, PCS, PROMIS short-form measures (depression, anxiety, anger, sleep disturbance, social support, pain intensity, pain interference, function), and cancer quality of life. Time points: baseline, 48-24 hours before surgery (PCS only), monthly after surgery for 3 months, and twice weekly post-surgically for pain intensity and opioid use only. Primary outcomes were post-surgical time to pain resolution, function, and catastrophizing. Secondary outcomes were opioid use and psychosocial measures. Preliminary results were presented at the AAPM 2016 annual conference. Supported by the National Institutes of Health NCCIH P01AT006651S1 (BDD) and from the Chris Redlich Pain Research Endowment.
Juvenile Idiopathic Arthritis (JIA) is a common chronic childhood illness that causes inflamed and painful joints and can negatively impact health-related quality of life (HRQL). Engaging children in their treatment early on is important so that they are better prepared to more independently manage the disease as they become adolescents and young adults. While educational and self-management programs exist for adolescents and adults with JIA, there are no such programs for younger children. The aim of this study was to develop and assess the usability of a bilingual (English and French) interactive psycho-educational videogame for 8 to 11 year old children with JIA. The game modules played within 8-weeks on an iPad or desktop computer aims to help children and parents learn disease management and develop coping skills (e.g., dealing with physical symptoms and feelings of stress or strong emotions) using gamification mechanics. Core game concepts were developed in collaboration with various stakeholders. Four cycles of game usability testing have been conducted with 16 English-speaking children (average age=10.1 years; 10 female, 6 male) and 11 parents. Participants interacted with the game in a step-wise manner and errors and efficiencies were documented. Participants also provided feedback through a semi-structured interview. Data were analyzed using content analyses. Children and parents responded positively to the game. Suggestions have been minor (e.g., changing specific graphics) and no changes were made to core game mechanics. Also documented were minor errors related to navigation and visual presentation. Children with JIA may benefit from educational games to teach self-management strategies in order to improve pain and HRQL. Based upon user suggestions, prototype changes will be implemented, translated and tested. Feasibility and effectiveness of the game will be evaluated using a pilot randomized control trial. Supported by a grant from the Canadian Institutes of Health Research (CIHR).
(529) A multidisciplinary approach to pediatric back pain: characteristics and outcomes A Lynch-Jordan, J Trygier, K Barnett, O Ayala, and A Szabova; Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
Youth seeking treatment for chronic back pain are often significantly disabled—with physical, behavioral, and emotional impairments. Multidisciplinary care is recommended to minimize functional disability and pain intensity, but can be time-intensive and therefore less likely to occur. This study describes the treatment and clinical outcomes for a group of optimally compliant patients with chronic back pain. Participants (n=19) (Mage=14.8) presented to a pediatric pain management clinic with a primary complaint of
Abstracts
The Journal of Pain
sociocultural factors related to the doctor-patient relationship, such as feelings of trust, similarity, and liking, may mediate previously reported racial discordance effects. In the present study, we tested the effects of doctor-patient shared group membership and patient ratings of doctor similarity, trust and liking on patient reported pain during simulated clinical interactions. A mixed-ethnicity sample of 80 participants (40 male), age 19-54 years old, was divided into two groups ostensibly based on the similarity of their self-reported beliefs (actually random), and then randomly assigned the role of doctor or patient. Participants took part in two simulated clinical interactions in which patients rated pain from 16 thermal heat stimulations delivered by an ingroup or outgroup doctor. Patients reported greater trust, similarity, and liking of ingroup than outgroup doctors, and patients’ average ratings of their feelings towards their doctors predicted both continuous pain intensity rating during each heat stimulation and overall pain intensity rating completed after each heat stimulation. These results suggest that interventions aimed at increasing patient feelings of trust, similarity, and liking to their doctors may decrease patient reported pain during medical care regardless of racial and ethnic discordance. Such interventions may help mitigate the negative impact of doctor-patient racial and ethnic discordance in pain treatment.
G04 Interdisciplinary Approaches
(526) A brief psychological intervention targeting persistent pain prevention following mastectomy or lumpectomy: a pilot investigation
(528) Development and usability testing of an iPad and desktop psycho-educational game for children with Juvenile Idiopathic Arthritis and their parents
K Hadlandsmyth, L Dindo, S Sugg, R Wajid, M Zimmerman, and B Rakel;
J Stinson, M Connelly, A Huber, N Luca, L Spiegel, A Tsimicalis, S Luca, N Tajuddin, R Berard, J Barsalou, S Campillo, P Dancey, C Duffy, B Feldman, N Johnson, P McGrath, N Shiff, S Tse, L Tucker, and J Victor; The Hospital for Sick Children, Toronto, Ontario, Canada
University of Iowa, Iowa City, IA
Chronic pain following breast cancer treatment is prevalent, affecting 25-60% of patients. Psychological variables including depression, anxiety, and pain catastrophizing have been implicated in the development of persistent post-treatment pain. The current study is a pilot Randomized Control Trial of a single session psychological intervention (Acceptance and Commitment Therapy: ACT) compared to Treatment as Usual (TAU). Participants are identified preoperatively as being at risk for developing persistent pain based on elevated depressive symptoms (PHQ-8 $ 10); anxious symptoms (GAD-7 $ 10); pain catastrophizing (PCS $ 30); or pre-existing chronic pain conditions. Data collection is still underway; the current n = 13 with a target N = 60. Out of a possible 34 patients, 65% (22) were interested in participating and 38% (13) screened in and enrolled. Of these, 6 (46%) screened in on depression, 8 (62%) on anxiety, 5 (38%) on preexistent chronic pain condition(s), and 0 on pain catastrophizing. About half the participants (46%) screened in on more than one criteria. Of those reporting a chronic pain condition, 67% reported taking NSAIDS regularly for pain and their Brief Pain Inventory pain intensity composite sub-score M = 3.75 (SD = 2.61) on a 0 – 10 scale. Initial qualitative responses indicate that mindfulness exercises are particularly valued. Quantitative analyses will use t-tests to compare pain, anxiety, and depression between treatment groups. It is hypothesized that the ACT group will report reduced pain, depression, and anxiety compared to TAU. Findings from this study have the potential to inform a larger trial. This study is supported by a grant from the Holden Comprehensive Cancer Center at the University of Iowa.
(527) An internet-based perioperative pain psychology treatment program: results of a randomized controlled trial in breast oncology surgery patients B Darnall, A Wheeler, C Taub, I Mackey, I Wapnir, C Schultz, T Rico, and P Flood; Stanford University, Palo Alto, CA Pain catastrophizing is a deleterious pattern of cognitive and emotional responses actual or anticipated pain. Pain catastrophizing has particular salience in the perioperative context given its negative impacts on post-surgical outcomes, including pain intensity (Papaioannou, 2009), opioid use (Helmerhorst, 2014), duration of hospital stay and the development of post-surgical chronic pain (Pinto, 2012). Pain catastrophizing has been shown to be a greater predictor of surgical outcomes than disease characteristics, the surgeon, or the surgery (Wertli, 2013; Abbott, 2011). Accordingly, we developed an internet-based treatment (My Surgical Success) that builds on prior work (Darnall, 2014) and targets pain catastrophizing perioperatively. The website contains a 90-min skills-based education video, a personalized action plan, and a 20-minute binaural audio file. The study was approved by the Stanford IRB; design
was a randomized controlled clinical trial. Participants were mastectomy candidates ages $18 with a Pain Catastrophizing Scale (PCS) score $20 and a surgery date >7 days from consent. Participants were randomized to a health education control group (website with information on nutrition and surgical recovery) or to My Surgical Success. Data were collected via chart review, prospective electronic surveys, and by verbal report (phone). Data included demographics, medical and surgical characteristics, opioid use, PCS, PROMIS short-form measures (depression, anxiety, anger, sleep disturbance, social support, pain intensity, pain interference, function), and cancer quality of life. Time points: baseline, 48-24 hours before surgery (PCS only), monthly after surgery for 3 months, and twice weekly post-surgically for pain intensity and opioid use only. Primary outcomes were post-surgical time to pain resolution, function, and catastrophizing. Secondary outcomes were opioid use and psychosocial measures. Preliminary results were presented at the AAPM 2016 annual conference. Supported by the National Institutes of Health NCCIH P01AT006651S1 (BDD) and from the Chris Redlich Pain Research Endowment.
Juvenile Idiopathic Arthritis (JIA) is a common chronic childhood illness that causes inflamed and painful joints and can negatively impact health-related quality of life (HRQL). Engaging children in their treatment early on is important so that they are better prepared to more independently manage the disease as they become adolescents and young adults. While educational and self-management programs exist for adolescents and adults with JIA, there are no such programs for younger children. The aim of this study was to develop and assess the usability of a bilingual (English and French) interactive psycho-educational videogame for 8 to 11 year old children with JIA. The game modules played within 8-weeks on an iPad or desktop computer aims to help children and parents learn disease management and develop coping skills (e.g., dealing with physical symptoms and feelings of stress or strong emotions) using gamification mechanics. Core game concepts were developed in collaboration with various stakeholders. Four cycles of game usability testing have been conducted with 16 English-speaking children (average age=10.1 years; 10 female, 6 male) and 11 parents. Participants interacted with the game in a step-wise manner and errors and efficiencies were documented. Participants also provided feedback through a semi-structured interview. Data were analyzed using content analyses. Children and parents responded positively to the game. Suggestions have been minor (e.g., changing specific graphics) and no changes were made to core game mechanics. Also documented were minor errors related to navigation and visual presentation. Children with JIA may benefit from educational games to teach self-management strategies in order to improve pain and HRQL. Based upon user suggestions, prototype changes will be implemented, translated and tested. Feasibility and effectiveness of the game will be evaluated using a pilot randomized control trial. Supported by a grant from the Canadian Institutes of Health Research (CIHR).
(529) A multidisciplinary approach to pediatric back pain: characteristics and outcomes A Lynch-Jordan, J Trygier, K Barnett, O Ayala, and A Szabova; Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
Youth seeking treatment for chronic back pain are often significantly disabled—with physical, behavioral, and emotional impairments. Multidisciplinary care is recommended to minimize functional disability and pain intensity, but can be time-intensive and therefore less likely to occur. This study describes the treatment and clinical outcomes for a group of optimally compliant patients with chronic back pain. Participants (n=19) (Mage=14.8) presented to a pediatric pain management clinic with a primary complaint of