Problem-solving skills training for parents of children with chronic pain

Abstract

This pilot randomized controlled trial aimed to determine the feasibility, acceptability, and preliminary efficacy of parental problem solving skills training (PSST) compared to treatment as usual (TAU) on improving parental mental health symptoms, physical health and well-being, and parenting behaviors. Effects of parent PSST on child outcomes (pain, emotional and physical functioning) were also examined. Participants included 61 parents of children aged 10–17 years with chronic pain randomized to PSST (n = 31) or TAU (n = 30). Parents receiving PSST participated in 4–6 individual sessions of training in problem solving skills. Outcomes were assessed at pre-treatment, immediately post-treatment, and at 3-month follow up. Feasibility was determined by therapy session attendance, therapist ratings, and parent treatment acceptability ratings. Feasibility of PSST delivery in this population was demonstrated by high compliance with therapy attendance, excellent retention, high therapist ratings of treatment engagement, and high parent ratings of treatment acceptability. PSST was associated with post-treatment improvements in parental depression (d = −0.68), general mental health (d = 0.64), and pain catastrophizing (d = −0.48), as well as in child depression (d = −0.49), child general anxiety (d = −0.56), and child pain-specific anxiety (d = −0.82). Several effects were maintained at 3-month follow-up. Findings demonstrate that PSST is feasible and acceptable to parents of youth with chronic pain. Treatment outcome analyses show promising but mixed patterns of effects of PSST on parent and child mental health outcomes. Further rigorous trials of PSST are needed to extend these pilot results.

Longitudinal change in parent and child functioning after internet-delivered cognitive-behavioral therapy for chronic pain

“…For example, one pilot RCT has evaluated the feasibility, acceptability and preliminary efficacy of problem-solving skills training (PSST) for parents of children with chronic pain [27, 28]. PSST is based on the social problem solving model [8] and teaches parents a structured approach to solving short- and long-term problems to reduce stress.…”

“…PSST is based on the social problem solving model [8] and teaches parents a structured approach to solving short- and long-term problems to reduce stress. Compared to standard care in a multidisciplinary pediatric pain clinic, parents who received PSST demonstrated greater decreases in distress and maladaptive behavioral responses to pain [27]. Positive downstream effects on children’s mental health were also found for the PSST group, even though children did not receive the PSST intervention [27].…”

“…Compared to standard care in a multidisciplinary pediatric pain clinic, parents who received PSST demonstrated greater decreases in distress and maladaptive behavioral responses to pain [27]. Positive downstream effects on children’s mental health were also found for the PSST group, even though children did not receive the PSST intervention [27]. This pattern of findings is consistent with results from randomized controlled trials of PSST for parents of youth with other chronic medical conditions, including cancer, traumatic brain injury, and asthma [10, 18].…”

Psicología y dolor crónico infantil

“…Estas intervenciones se han contrastado en poblaciones con diferentes tipos de dolor, en estudios aleatorizados y controlados (54,55), aunque alguno incluye ensayos sin grupo control (45) y, en general, se han obtenido mejoras significativas en una amplia gama de variables, en comparación con los grupos control. Estas mejoras se observan tanto en lo que respecta a la situación de los niños con dolor crónico (por ejemplo, disminución de la intensidad del dolor, de los niveles de ansiedad y de las ausencias escolares, y/o una mejora del funcionamiento físico (45,(54)(55)(56)(57), como en las variables relacionadas con los padres (por ejemplo, disminución de sintomatología depresiva, del estrés o de los pensamientos catastróficos ante el dolor del hijo y de respuestas solícitas ante las conductas de dolor del hijo, aumento de la salud mental y de las estrategias de solución de problemas de los padres (45,54,(56)(57)(58). Algunos estudios han mostrado que algunas de estas mejoras se mantenían a los 3 y 6 meses tras el tratamiento, por ejemplo, en relación con la intensidad del dolor, la severidad de los síntomas gastrointestinales o la reducción de respuestas solícitas de los padres (55,57,59).…”

“…En ocasiones, la intervención se plantea específicamente para los padres (54), en otras se utiliza un formato conjunto, es decir, hijos y padres acuden simultáneamente a las sesiones (57), e incluso en otras se propone una combinación de los anteriores: a algunas sesiones solo asisten los hijos y en otras asisten de forma conjunta padres e hijos (55). Se ha comprobado que la incorporación de los padres al tratamiento es igual de eficaz si se realiza en persona o bien por teléfono (59).…”