Author:

Keywords:

pediatric pain; graded exposure in vivo; pain-related fear; multi-level modeling; single case experimental design, Science & Technology, Life Sciences & Biomedicine, Anesthesiology, Clinical Neurology, Neurosciences, Neurosciences & Neurology, Pediatric pain, Graded exposure in vivo, Pain-related fear, Multilevel modeling, Single-case experimental design, LOW-BACK-PAIN, MUSCULOSKELETAL PAIN, CONTROLLED-TRIAL, IN-VIVO, FEAR, CHILDREN, MOVEMENT/(RE)INJURY, REHABILITATION, QUESTIONNAIRE, TRAJECTORIES, Activities of Daily Living, Adolescent, Avoidance Learning, Catastrophization, Child, Chronic Pain, Fear, Female, Follow-Up Studies, Humans, Male, Medical Records, Pain Management, Pain Measurement, Treatment Outcome, 11 Medical and Health Sciences, 17 Psychology and Cognitive Sciences, 32 Biomedical and clinical sciences, 42 Health sciences, 52 Psychology

Abstract:

Pain-related fear is typically associated with avoidance behavior and pain-related disability in youth with chronic pain. Youth with elevated pain-related fear have attenuated treatment responses, thus targeted treatment is highly warranted. Evidence supporting graded in-vivo exposure treatment (GET) for adults with chronic pain is considerable, but just emerging for youth. The current investigation represents the first sequential replicated and randomized single-case experimental phase design with multiple measures evaluating GET for youth with chronic pain, entitled GET Living. A cohort 27 youth (81% female) with mixed chronic pain completed GET Living. For each participant, a no-treatment randomized baseline period was compared with GET Living and 3- and 6-month follow-ups. Daily changes in primary outcomes fear and avoidance and secondary outcomes pain catastrophizing, pain intensity, and pain acceptance were assessed using electronic diaries and subjected to descriptive and model-based inference analyses (MLM). Based on individual effect size calculations, a third of participants significantly improved by the end of treatment on fear, avoidance, and pain acceptance. By follow-up over 80% of participants had improved across all primary and secondary outcomes. MLM results to examine the series of replicated cases were generally consistent. Improvements during GET Living was superior to the no-treatment randomized baseline period for avoidance, pain acceptance, and pain intensity, whereas fear and pain catastrophizing did not improve. All five outcomes emerged as significantly improved at 3-and 6-month follow-up. The results of this replicated SCED support the effectiveness of graded exposure for youth with chronic pain and elevated pain-related fear avoidance.