Treating Chronic Pain in Adolescents
Amanda Bye, PsyD, Behavioral Medicine Specialist
Collaborative Family Healthcare Association 15th Annual ConferenceOctober 10-12, 2013 Broomfield, Colorado U.S.A.
Session # E2bFriday, October 11, 2013
Objectives
• Provide an understanding of the rationale for and key components of collaborative pain care
• Identify how chronic pain affects teens, families and medical professionals
• Learn ways to treat this population that work for the family and medical professionals in an integrative setting
Case• 14 year old female with
chronic abdominal pain for 8 months. No clear medical cause
• Tutor comes into the home as Cindy no longer goes to school. She has also stopped spending time with friends
• Will go to emergency room or her doctor’s office at least once per week. Mother takes time off from work for these appointments.
• “Nothing helps.”• Family stress in the past year
The Problem
• Adolescents with chronic pain have historically been a challenge to treat
• It is estimated that 25-46% of patients under the age of 18 years have experienced chronic pain, these patients require more emergency room, primary care and specialist visits. *
• This is a significant cost to both the family and medical team
*Harrison, T. (2011). Pediatric chronic pain: There is hope. Clinical and Health Affairs. Retrieved fromhttp://www.minnesotamedicine.com/tabid/3692/default.aspx
Solution• Implementation of teen
chronic pain program that is effective in increasing overall functioning and decreasing the cost to families and in medical
• Program content was based on empirically validated chronic pain programs for adults and relationship groups for teens
• Integrative care
Requirements for Inclusion into the Program
• Ages 12-18 years• >6 months of pain• No clear medical explanation for the pain• Pain is interfering in basic functioning
Integrative Approach to Care
• Psychologist• Primary Care Physician• Specialty services• Consultation with pain physician at TCH• Mental Health• Family members• School involvement
The Group• 4-week program. First week parent/caregiver
attends the 2 hour group. Attend last 30 minutes of each subsequent group
• Week 1- basic information about pain• Week 2- behavioral approaches to treating pain• Week 3- cognitive approaches• Week 4- whole body health and relapse
prevention
Measures used pre and post group
• Modified PHQ-9 and GAD scales were completed by the teens
• Brief Pain Inventory (BPI) • Outside referral costs to Kaiser Permanente• Number of visits• School attendance data• Anecdotal parental report
Results• Clinically significant decrease in number of office and
phone visits with primary care (p=0.0011 , p=0.006 respectively)
• No significant change in email contacts• No clinically significant change in GAD scores (n=11)• Modified PHQ-9 scores approached significance
(n=18)• Increase in attendance days• Increase in functioning reported by parents but no
clinically sig difference on Brief Pain Inventory Scale (n=16)
Results
• No difference in severity of depression or anxiety
• Brief Pain Inventory- Pain affected walking and relationships significantly less than the other scales.
Limitations
• Number of participants admittedly small• Number of completed questionnaires small• Follow-up questionnaires several months later
could show if the teen functioned better after having time to use the skills
• Parent questionnaires would also be a good source of data
Conclusions
• Effective in decreasing outside referral costs• Decreasing number of office and telephone
visits in medical• Increasing school attendance• Parental report of improvement in symptoms• No change in patient-reported improvement in
functioning but this may be related to not having enough time to show improvement or family dynamics