Effects of a Guided Internet-Delivered Self-Help Intervention for Adolescents With Chronic Pain.
Cognitive-behavioral therapy (CBT) is effective in reducing the frequency and intensity of chronic pain in adolescents. However, CBT seems not to be considered acceptable by all adolescents. The main aim of our study was therefore to evaluate the effects of guided Internet-delivered self-help for adolescents with chronic pain. Adolescents (N = 69) were assessed on the outcome measures of pain, coping, disability, catastrophizing, rewarding of pain behavior by parents, and quality of life. Measures were taken 7 weeks before treatment and at pretreatment, posttreatment, and 3-month follow-up. Multilevel modeling was used for longitudinal analysis of the data. Pain intensity, interference caused by pain, rewarding of pain behavior by parents, and sleep problems significantly decreased during the intervention. The quality-of-life scores for pain, general behavior, mental health, family activities, and health changes also significantly improved during the intervention. With regard to coping, only problem-focused avoidance behavior significantly increased. No significant differences were found for pain-related disability and pain catastrophizing. Contrary to expectations, guided Internet-delivered self-help for chronic pain is difficult to use in adolescents, resulting in treatment attrition and loss to follow-up.


BACKGROUND
Dutch Trial Register NTR1926.


CONCLUSIONS
The results of this trial suggest that Internet-based self-management is effective in decreasing pain intensity in adolescents with chronic pain. Because the intervention is grounded in CBT, we expect the underlying mechanism to be a change in self-management skills and in the ability of challenging dysfunctional thoughts.
Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MC University Medical Centre, Rotterdam, The Netherlands. Electronic address: j.s.voerman@erasmusmc.nl.
Jessica S
JS
Voerman
Rijndam Rehabilitation Centre, Rotterdam, The Netherlands.
Sylvia
S
Remerie
Rijndam Rehabilitation Centre, Rotterdam, The Netherlands.
Tessa
T
Westendorp
Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
Reinier
R
Timman
Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
Jan J V
JJ
Busschbach
Department of Clinical Psychology, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands.
Jan
J
Passchier
Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
Cora
C
de Klerk
D000223:Adaptation, Psychological; D000293:Adolescent; D001362:Avoidance Learning; D058443:Catastrophization; D002648:Child; D059350:Chronic Pain / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D005190:Family / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008137:Longitudinal Studies; D008297:Male; D059408:Pain Management / Q000379:methods*; D010352:Patient Dropouts; D017060:Patient Satisfaction; D012201:Reward; D012648:Self Care / Q000379:methods*; D012893:Sleep Wake Disorders / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome
Internet; Pain management; adolescent; cognitive therapy; telephone