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

Faculty Disclosure

I have not had any relevant financial relationships

during the past 12 months.

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

Case

In your current role, what would you do to help this family?

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

Treatment Options

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

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

How might this group have benefitted Cindy, her family and her treatment

team?

Learning Assessment

Audience Question & Answer

Session Evaluation

Please complete and return theevaluation form to the classroom monitor

before leaving this session.

Thank you!