Randomized controlled trial of an Internet-delivered family cognitive–behavioral therapy intervention for children and adolescents with chronic pain

Abstract

Cognitive-behavioral therapy (CBT) interventions show promise for decreasing chronic pain in youth. However, the availability of CBT is limited by many factors including distance to major treatment centers and expense. This study evaluates a more accessible treatment approach for chronic pediatric pain using an Internet-delivered family CBT intervention. Participants included 48 children, ages 11-17 years, with chronic headache, abdominal, or musculoskeletal pain and associated functional disability, and their parents. Children were randomly assigned to a wait-list control group or an Internet treatment group. Primary treatment outcomes were pain intensity ratings (0-10 NRS) and activity limitations on the Child Activity Limitations Interview, both completed via an online daily diary. In addition to their medical care, the Internet treatment group completed 8 weeks of online modules including relaxation training, cognitive strategies, parent operant techniques, communication strategies, and sleep and activity interventions. Youth randomized to the wait-list control group continued with current medical care only. Findings demonstrated significantly greater reduction in activity limitations and pain intensity at post-treatment for the Internet treatment group and these effects were maintained at three-month follow-up. Rate of clinically significant improvement in pain was also greater for the Internet treatment group in comparison to the wait-list control group. There were no significant group differences in parental protectiveness or child depressive symptoms post-treatment. Internet treatment was rated as acceptable by all children and parents. Findings support the efficacy and acceptability of Internet delivery of family CBT for reducing pain and improving function among children and adolescents with chronic pain.

Supporting health-related parenting: A scoping review of programs assisted by the Internet and related technologies

“…These programs aim to encourage parents to use more positive and effective educational practices and to teach them how to coach their chronically ill child to control pain or other symptoms. Several family-based CBT programs to control chronic pain, which include multiple elements, such as relaxation training, activity pacing, problem solving, and distraction techniques (Nieto et al, 2015;Palermo et al, 2016Palermo et al, , 2009Stinson et al, 2010) have offered preliminary evidence Other examples are the Triple-P programs for parents of children with asthma (Clarke et al, 2013) and type-1 diabetes (Doherty et al, 2013). These programs, derived from the Triple P Positive Parenting Program to prevent behavioural and emotional child problems, are based on the social learning theory and are aimed at increasing parental self-efficacy, through training on disease management strategies.…”

“…Eysenbach (2001, p.1) defined eHealth as "health services and information delivered or enhanced through the Internet and related technologies", including any applications of intervention technologies to promote or modify health behaviours. These eHealth interventions use a variety of technologies such as the Internet, cell phones, personal digital assistant, compact disk, pagers, computer games, and virtual reality (Palermo, Wilson, Peters, Lewandowski, & Somhegyi, 2009). …”

Recent developments in the treatment of migraine in children and adolescents

“…A study from 2009 [64], evaluated an Internet-delivered family CBT intervention. Children were randomly assigned to a waitlist control group or an Internet treatment group.…”

How to Deal with Pediatric Functional Gastrointestinal Disorders

“…Benefit of the treatment lasted for at least 6 months. Another study evaluated the use of Internet based cognitive behavioral therapy in children with a variety of chronic pain syndromes, including abdominal pain [37]. The treatment group completed 8 weeks of online modules including relaxation training, cognitive strategies, parent operant techniques, communication strategies, and sleep and activity interventions.…”