title: Differential changes in functional disability and pain intensity over the course of psychological treatment for children with chronic pain.
abstract: Patients presenting for treatment of chronic pain often believe that pain reduction must be achieved before returning to normal functioning. However, treatment programs for chronic pain typically take a rehabilitative approach, emphasizing decreasing pain-related disability first with the expectation that pain reduction will follow. This information is routinely provided to patients, yet no studies have systematically examined the actual trajectories of pain and disability in a clinical care setting. In this study of youth with chronic pain (N=94, 8 to 18 years), it was hypothesized that 1) functional disability and pain would decrease over the course of psychological treatment for chronic pain and 2) functional disability would decrease more quickly than pain intensity. Participants received cognitive behavioral therapy (CBT) for pain management (M=5.6 sessions) plus standard medical care. The Functional Disability Inventory and a Numeric Rating Scale of average pain intensity were completed by the child at every CBT session. Hierarchical linear modeling was conducted to examine the longitudinal trajectories of disability and pain. Standardized estimates of the slopes of change were obtained to test differences in rates of change between pain and disability. Results showed an overall significant decline in functional disability over time. Although pain scores reduced slightly from pretreatment to posttreatment, the longitudinal decline over treatment was not statistically significant. As expected, the rate of change of disability was significantly more rapid than pain. Evidence for variability in treatment response was noted, suggesting the need for additional research into individual trajectories of change in pediatric pain treatment.
authors: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Pain Management Center, Cincinnati Children's Hospital Medical Center, and Department of Anesthesiology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA. Electronic address: anne.lynch-jordan@cchmc.org.
authors: Anne M
authors: AM
authors: Lynch-Jordan
authors: Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.
authors: Soumitri
authors: S
authors: Sil
authors: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
authors: James
authors: J
authors: Peugh
authors: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
authors: Natoshia
authors: N
authors: Cunningham
authors: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Pain Management Center, Cincinnati Children's Hospital Medical Center, and Department of Anesthesiology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
authors: Susmita
authors: S
authors: Kashikar-Zuck
authors: Pain Management Center, Cincinnati Children's Hospital Medical Center, and Department of Anesthesiology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
authors: Kenneth R
authors: KR
authors: Goldschneider
mesh_terms: D000293:Adolescent; D002648:Child; D059350:Chronic Pain / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D012720:Severity of Illness Index
keywords: Functional disability; Pain intensity; Pediatric chronic pain; Symptom trajectories