Trajectories of change during a randomized controlled trial of internet-delivered psychological treatment for adolescent chronic pain

Abstract

Although pain and function improve at immediate post-treatment for youth receiving cognitive-behavioral therapy for chronic pain, limited data are available to understand changes that youth make during psychological treatment. We sought to characterize distinct trajectory patterns of change in pain and function in order to understand the temporal association of these changes during internet-delivered cognitive-behavioral treatment. Weekly repeated assessments of pain and function were conducted during eight weeks of treatment among 135 adolescents, ages 11 to 17 years, with chronic pain who were randomized to the cognitive-behavioral intervention (CBT) arm of an ongoing trial of internet-delivered CBT (Web-Based Management of Adolescent Pain; Web-MAP2). Using random effects growth mixture models we characterized pain and functional disability trajectories finding distinct trajectory groups indicating patterns of both linear as well as quadratic effects. Trajectories of change showed that some patients’ pain and functional disability was improving, others worsened, or changed minimally. Paired t-tests compared the within-subject relative change rate in pain and function demonstrating similar change range for pain and function during the treatment period. There was no support for improvements in either pain or function to precede changes in the other domain. Findings may be useful in informing future studies of psychosocial treatments for pediatric chronic pain to consider how to target treatment strategies to distinct patient response profiles. This may lead to the development of intervention strategies that can both more effectively target children’s pain and function during treatment, and lead to sustained changes following treatment.

A Clinical Pilot Study of Individual and Group Treatment for Adolescents with Chronic Pain and Their Parents: Effects of Acceptance and Commitment Therapy on Functioning

“…As seen in our evaluation of clinically-significant changes, it is evident that some adolescents and parents benefit greatly from the interventions, whereas some do not. In a recent study of pain and functional disability trajectories during Internet-delivered CBT-treatment in an adolescent sample with chronic pain, the authors also note improvements for some participants and worsening or minimal improvements for others [61]. To date, we lack sufficient evidence for which components of treatment are related to change or which characteristics of pediatric patients suffering from chronic pain predict or moderate outcomes of both traditional CBT- and ACT-based interventions.…”

Internet-delivered cognitive-behavioral treatment for adolescents with chronic pain and their parents

“…We have published 1 article concerning trajectories of pain and function during the treatment period for adolescents randomized to the Internet CBT condition 28 ; however, that article did not present treatment outcome analyses.…”

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

“…We have previously published three manuscripts using data from this trial. The first manuscript evaluated trajectories of change in children’s pain intensity and activity limitations during the 8–10-week treatment period [30]. The second manuscript reported primary treatment efficacy outcomes at 6-month follow-up [29].…”