Highlights
- •Internet therapy seemed to reduce pain in adolescents with chronic pain.
- •Rewarding of pain behavior by parents and sleep problems decreased during treatment.
- •With regard to coping, only problem-focused avoidance behavior significantly increased.
- •Pain-related disability and pain catastrophizing did not change.
- •Internet therapy for chronic pain seemed difficult to employ in adolescents.
Abstract
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. Trial registration: Dutch Trial Register NTR1926.
Perspective
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.
Key words
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References
- The promise and pitfalls of the internet for cognitive behavioral therapy.BMC Med. 2010; 8: 82
- Reliability of the visual analog scale in children with acute pain in the emergency department.Pain. 2012; 153: 839-842
- Coping and quality of life in relation to headache in Dutch schoolchildren.Eur J Pain. 2002; 6: 315-321
- Antecedents, concomitants, and consequences of pediatric headache: confirmatory construct validation of two parent-report scales.J Behav Med. 1999; 22: 437-456
- The Children's Headache Assessment Scale (CHAS): factor structure and psychometric properties.J Behav Med. 1994; 17: 159-179
- Pain coping profiles in adolescents with chronic pain.Pain. 2008; 140: 368-375
- Statistical Power Analysis for the Behavioral Sciences.Lawrence Erlbaum, Hillsdale, NY1988
- The child version of the pain catastrophizing scale (PCS-C): a preliminary validation.Pain. 2003; 104: 639-646
- Systematic review of randomised controlled trials of psychological therapy for chronic pain in children and adolescents, with a subset meta-analysis of pain relief.Pain. 2002; 99: 157-165
- Validity of four pain intensity rating scales.Pain. 2011; 152: 2399-2404
- Pain in children and adolescents: prevalence, impact on daily life, and parents' perception, a school survey.Scand J Caring Sci. 2011; 25: 27-36
- PedMIDAS: development of a questionnaire to assess disability of migraines in children.Neurology. 2001; 57: 2034-2039
- Online psychological treatment for pediatric recurrent pain: a randomized evaluation.J Pediatr Psychol. 2006; 31: 724-736
- Depression and functional disability in chronic pediatric pain.Clin J Pain. 2001; 17: 341-349
- Changes in pain coping, catastrophizing, and coping efficacy after cognitive-behavioral therapy in children and adolescents with juvenile fibromyalgia.J Pain. 2013; 14: 492-501
- The CHQ User's Manual.The Health Institute, New England Medical Centre, Boston, MA1996
- A meta-analysis of web-delivered tailored health behavior change interventions.J Health Commun. 2013; 18: 1039-1069
- Psychosocial risks for disability in children with chronic back pain.J Pain. 2006; 7: 244-251
- Sex and age differences in coping styles among children with chronic pain.J Pain Symptom Manage. 2007; 33: 208-216
- Gedragstherapie. 2001; 34 ([in Dutch]): 325-336
- Core outcome domains and measures for pediatric acute and chronic/recurrent pain clinical trials: PedIMMPACT recommendations.J Pain. 2008; 9: 771-783
- A cognitive-behavioural program for adolescents with chronic pain-a pilot study.Patient Educ Couns. 2005; 59: 126-134
- Getting a grip on pain: a model on pain and quality of life in adolescents with chronic pain (doctoral dissertation).in: Department of Medical Psychology and Psychotherapy. Erasmus MC University Medical Centre, Enschede2004: 165
- Methodological challenges in online trials.J Med Internet Res. 2009; 11: e9
- Randomized controlled trial of an Internet-delivered family cognitive-behavioral therapy intervention for children and adolescents with chronic pain.Pain. 2009; 146: 205-213
- Development and validation of the Child Activity Limitations Interview: a measure of pain-related functional impairment in school-age children and adolescents.Pain. 2004; 109: 461-470
- Pain in children and adolescents: a common experience.Pain. 2000; 87: 51-58
- The natural course of chronic benign pain in childhood and adolescence: a two-year population-based follow-up study.Eur J Pain. 2003; 7: 551-559
- Reliability and validity of the child health questionnaire-child form (CHQ-CF87) in a Dutch adolescent population.Qual Life Res. 2002; 11: 575-581
- Feasibility, reliability, and validity of adolescent health status measurement by the Child Health Questionnaire Child Form (CHQ-CF): internet administration compared with the standard paper version.Qual Life Res. 2007; 16: 675-685
- The Pain Coping Questionnaire: preliminary validation.Pain. 1998; 76: 83-96
- Pain among children and adolescents: restrictions in daily living and triggering factors.Pediatrics. 2005; 115: e152-e162
- Psychological, behavioral, and family characteristics of pediatric patients with chronic pain: a 1-year retrospective study and cluster analysis.Clin J Pain. 2005; 21: 432-438
- The cost of somatization.J Psychosom Res. 1991; 35: 307-312
- Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis.Psychol Med. 2007; 37: 319-328
- A systematic review of internet-based self-management interventions for youth with health conditions.J Pediatr Psychol. 2009; 34: 495-510
- Comparison between administration via Internet and paper-and-pencil administration of two clinical instruments: SCL-90-R and GHQ-28.J Behav Ther Exp Psychiatry. 2008; 39: 201-208
- Coping with pain: a motivational perspective.Pain. 2008; 139: 1-4
- Gedragstherapie. 2003; 36 ([in Dutch]): 299-307
- Early signaling, referral, and treatment of adolescent chronic pain: a study protocol.BMC Pediatr. 2012; 12: 66
- Parental response to child illness behavior.J Pediatr Psychol. 1992; 17: 49-71
- Development and psychometric properties of a pain-related problem list for adolescents (PPL).Patient Educ Couns. 2005; 58: 209-215
- Methodological issues in Internet-mediated research: a randomized comparison of internet versus mailed questionnaires.J Med Internet Res. 2011; 13: e109
Article info
Publication history
Published online: August 14, 2015
Accepted:
July 28,
2015
Received in revised form:
July 20,
2015
Received:
January 19,
2015
Footnotes
The study was funded by Innovatiefonds Zorgverzekeraars, Pijnkenniscentrum, and Stichting Coolsingel. The authors declare that they do not have any financial or other relationships that might lead to conflicts of interest.
Identification
Copyright
© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
