Peer mentorship to promote effective pain management in adolescents: study protocol for a randomised controlled trial

Abstract

BackgroundThis protocol is for a study of a new program to improve outcomes in children suffering from chronic pain disorders, such as fibromyalgia, recurrent headache, or recurrent abdominal pain. Although teaching active pain self-management skills through cognitive-behavioral therapy (CBT) or a complementary program such as hypnotherapy or yoga has been shown to improve pain and functioning, children with low expectations of skill-building programs may lack motivation to comply with therapists' recommendations. This study will develop and test a new manualized peer-mentorship program which will provide modeling and reinforcement by peers to other adolescents with chronic pain (the mentored participants). The mentorship program will encourage mentored participants to engage in therapies that promote the learning of pain self-management skills and to support the mentored participants' practice of these skills. The study will examine the feasibility of this intervention for both mentors and mentored participants, and will assess the preliminary effectiveness of this program on mentored participants' pain and functional disability.MethodsThis protocol will recruit adolescents ages 12-17 with chronic pain and randomly assign them to either peer mentorship or a treatment-as-usual control group. Mentored participants will be matched with peer mentors of similar age (ages 14-18) who have actively participated in various treatment modalities through the UCLA Pediatric Pain Program and have learned to function successfully with a chronic pain disorder. The mentors will present information to mentored participants in a supervised and monitored telephone interaction for 2 months to encourage participation in skill-building programs. The control group will receive usual care but without the mentorship intervention. Mentored and control subjects' pain and functioning will be assessed at 2 months (end of intervention for mentored participants) and at 4 month follow-up to see if improvements persist. Measures of treatment adherence, pain, disability, and anxiety and depression will be assessed throughout study participation. Qualitative interviews for mentors, mentored participants, and control subjects will also be administered.Trial registrationClinicalTrials.gov NCT01118988.

Supported self-care for children and adolescents with chronic disease and their families

“…To evaluate the knowledge of the child/adolescent and/or family about the health condition (18)(19)(20) Question the child/adolescent and/or his/her family about their strategies for self-care (19,21) Ask the child/adolescent and/or family what are the barriers to self-care (21)(22)(23) To assess the importance and degree of confidence of the child/ adolescent and/or family for self-care (19) To evaluate the child/adolescent and/or family adherence in activities present in the self-care plan (17,(24)(25)(26)(27)(28)(29) To evaluate the capacity of the patients and/or family to perform an intervention (14,19,30) To determine the strategies used by the child/adolescent with chronic disease for rehabilitation/coping (21,31) To assess the emotional state (depression, mood, anxiety, etc.) of the child/adolescent and/or the family, which may influence self-care actions (13,17,23,30,(32)(33) To evaluate the process of health care transition (HCT) from pediatric to adult-centered health care delivery systems (16,18,21,(34)(35) Counseling Inform the child/adolescent and/or family about the symptoms of the disease and/or therapeutic measures (17,27,36) , while recognizing the cultural uniqueness (19) Inform the child/adolescent and/or family that behavioral changes are as important as taking medications (20) To report the evidence on behavioral changes in health …”

“…of the child/adolescent and/or the family, which may influence self-care actions (13,17,23,30,(32)(33) To evaluate the process of health care transition (HCT) from pediatric to adult-centered health care delivery systems (16,18,21,(34)(35) Counseling Inform the child/adolescent and/or family about the symptoms of the disease and/or therapeutic measures (17,27,36) , while recognizing the cultural uniqueness (19) Inform the child/adolescent and/or family that behavioral changes are as important as taking medications (20) To report the evidence on behavioral changes in health (17) Sharing evidence-based clinical guidelines to encourage the child/adolescent and/or family to participate in treatment (17,35) Provide educational material on self-management (16,20,27,(36)(37) Include motivational strategies (15) …”

“…Refer the child/adolescent and/or family to a group or self-care course (self-management) (27) Identify possible resources in the family and community that can support self-care (15) Establish an intervention program, with weekly sessions, with the aim of improving the knowledge of the child/adolescent and/or the family and involving them in self-care (27,(37)(38) Implement a self-care intervention centered on the patient and/ or his/her family (20,27,38) Promoting multi-professional teamwork (20,38) Interventions using technological resources, such as telemedicine, virtual reality and computer programs, in various aspects of rehabilitation (4,(16)(17)21,33,(36)(37) Chart 2…”

A Model for Pain Self-Management of Patients with Haemophilia: Peer Education

“…ment of pain to be the main reases for lack of adherence [27][28]. This finding suggests that determining methods to improve adherence to recommended treatments is a necessary step to improving pain and functioning in this population.…”

“…The study found that a positive attitude and adherence can be enhanced if people have the opportunity to interact with peers who model and reinforce adherent behaviors [17][18][19][20][21][22][23][24][25][26][27][28][29]. Dictionary defines peer as one that is of equal standing with another: one belonging to the same societal group especially based on age, grade, or status.…”