Randomized controlled trial of an Internet-delivered family cognitive–behavioral therapy intervention for children and adolescents with chronic pain

Palermo, Tonya M.; Wilson, Anna C.; Peters, Meaghan; Lewandowski, Amy; Somhegyi, Hannah

doi:10.1016/j.pain.2009.07.034

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Volume 146, Issue 1 , Pages 205-213, November 2009

Randomized controlled trial of an Internet-delivered family cognitive–behavioral therapy intervention for children and adolescents with chronic pain

Tonya M. Palermo
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
- Corresponding author. Address: Department of Anesthesiology and Perioperative Medicine, Mail Code: UHN-2, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239-3098, USA. Tel.: +1 503 494 0848; fax: +1 503 494 3092.
Anna C. Wilson
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
Meaghan Peters
- Department of Psychology, George Fox University, Newberg, OR, USA
Amy Lewandowski
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
Hannah Somhegyi
- Department of Psychology, Lewis & Clark College, Portland, OR, USA

Received 20 March 2009; received in revised form 20 July 2009; accepted 25 July 2009. published online 20 August 2009.

Abstract

Cognitive–behavioral therapy (CBT) interventions show promise for decreasing chronic pain in youth. However, the availability of CBT is limited by many factors including distance to major treatment centers and expense. This study evaluates a more accessible treatment approach for chronic pediatric pain using an Internet-delivered family CBT intervention. Participants included 48 children, aged 11–17years, with chronic headache, abdominal, or musculoskeletal pain and associated functional disability, and their parents. Children were randomly assigned to a wait-list control group or an Internet treatment group. Primary treatment outcomes were pain intensity ratings (0–10 NRS) and activity limitations on the Child Activity Limitations Interview, both completed via an online daily diary. In addition to their medical care, the Internet treatment group completed 8weeks of online modules including relaxation training, cognitive strategies, parent operant techniques, communication strategies, and sleep and activity interventions. Youth randomized to the wait-list control group continued with the current medical care only. Findings demonstrated significantly greater reduction in activity limitations and pain intensity at post-treatment for the Internet treatment group and these effects were maintained at the three-month follow-up. Rate of clinically significant improvement in pain was also greater for the Internet treatment group than for the wait-list control group. There were no significant group differences in parental protectiveness or child depressive symptoms post-treatment. Internet treatment was rated as acceptable by all children and parents. Findings support the efficacy and acceptability of Internet delivery of family CBT for reducing pain and improving function among children and adolescents with chronic pain.