title: The influence of anxiety reduction on clinical response to pediatric chronic pain rehabilitation.
abstract: OBJECTIVE
  This study investigates the relationship between anxiety reduction and functional outcomes in children and adolescents receiving intensive interdisciplinary rehabilitation services for chronic pain (CP). Specifically, we evaluated whether: (1) anxiety changes over the course of treatment; (2) anxiety covaries with functional outcomes to rehabilitation; and (3) change in anxiety predicts change in functional outcomes from rehabilitation for CP. Using 3 separate measures assessing anxiety-related constructs, we hypothesized that anxiety would be associated with functioning, both before and following intensive rehabilitation for CP. Further, we hypothesized that a decrease in anxiety-related symptoms following rehabilitation would predict a positive change in functional outcomes.
  
  
  METHODS
  Our sample consisted of 119 children and adolescents treated for CP in an interdisciplinary rehabilitation program between 2007 and 2012. Children completed 3 measures related to anxiety (general anxiety, pain-specific anxiety, pain catastrophizing) and 2 functional outcome measures (eg, Bath Adolescent Pain Questionnaire, PedsQL) as part of clinical care.
  
  
  RESULTS
  Measures of anxiety-related constructs were significantly correlated with measures of impairment and functioning, both at admission and at 1-month postdischarge. Regression analyses demonstrated that, after controlling for age, sex, and pain level at admission, a decrease in anxiety significantly predicted between 14% and 40% unique variance in functional outcomes.
  
  
  CONCLUSIONS
  The findings of this study support existing research on anxiety and CP, specifically the relationship between anxiety and pain-related disability. This study also supports the benefit of intensive interdisciplinary rehabilitation for both reducing anxiety and increasing functional outcomes, suggesting a possible link in children's response to intervention. Study limitations and future directions for related research are discussed.
authors: *Children's Hospital, Cleveland Clinic, Cleveland †Department of Psychology, Kent State University, Kent, OH.
authors: Ethan
authors: E
authors: Benore
authors: Alexandra
authors: A
authors: D'Auria
authors: Gerard A
authors: GA
authors: Banez
authors: Sarah
authors: S
authors: Worley
authors: Anne
authors: A
authors: Tang
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000209:etiology* / Q000534:rehabilitation*; D058443:Catastrophization; D002648:Child; D059350:Chronic Pain / Q000150:complications* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D013223:Statistics as Topic; D016896:Treatment Outcome