Toward an Effective Chronic Pain Treatment Model in Children
Our specific aims are:
1) to make a quantitative and qualitative comparison of the PPC treatment model with that used to treat persistent pain in two pediatric subspecialty clinics, comparing changes in patient pain level, anxiety, depression, self-efficacy and functioning;
2) to examine in depth the
children's cognitive beliefs and affective reactions to pain, the sources
of these beliefs and reactions, and the process of changes in cognition,
anxiety and depression, and behavior during Clinic treatment; and
3) to use the quantitative and qualitative data gathered to identify specific
factors within the PPC treatment model which may be further evaluated
in the next phase, a controlled clinical trial of this model for the treatment
of pain and co-morbid anxiety and depression.
Hypotheses: The study will use oral history master narratives; validated quantitative measures of patient self-efficacy, self-management (an indicator of function) and perceived barriers to feeling better; validated quantitative measures of pain level, co-morbid anxiety and depression, and conversational analysis of physician-patient interactions to test these hypotheses:
1) that, at six months after the first visit, PPC patients show higher scores, and greater changes in score in pain level, self-efficacy, self-management, anxiety, depression, and perceived barriers to feeling better, on the quantitative scales, than children seen in the other clinics;
2) that, measured at six months, positive changes in scores on self-efficacy and function scales have a positive correlation with negative changes in scores on scales measuring pain level, anxiety, and depression;
3) that, measured at six months, positive changes in scores on self-efficacy and function scales have a positive correlation with negative changes in parent scores on scales measuring anxiety and depression;
4) that master narratives in the oral histories of PPC children have more frequent references to themes of positive change, self-efficacy, and self-management than master narratives in the oral histories of children seen in other clinics;
5) that the patient-centered interactions in the intake interview, identified by conversational analysis, correlate with patient satisfaction with and adherence to the treatment program, as measured by a brief adherence/satisfaction scale;
6) and therefore that the PPC treatment model is more effective than the traditional medical model used in pediatric subspecialty clinics in treating children with recurrent pain.