Behavioral Medicine Treatment for Adolescents in Pain
Condition: Pain
Study type: Interventional

Summary: 
      Recurrent pain, such as headache, stomach pain and musculoskeletal pain is common in children
      and adolescents. Children and adolescents are reported to have restrictions in daily life
      activities, social contacts, and school attendance, and to have poorer academic skills and as
      well as an increased utilization of heath care services due to pain problems. The treatment
      approaches available today for teenagers with pain are often biological/physiological and
      little evidence for their effectiveness has been shown. It is urgent to try new interventions
      for pain problems in early ages in order to prevent disability, development of maladaptive
      coping strategies and to avoid negative impact on daily activities.

      The optimal treatment regime for paediatric pain patients has been suggested to be cognitive
      behavioural approach integrated with physical therapy The aim of this project is to develop
      and evaluate in a randomized controlled trial a treatment program with a behavioural medicine
      approach (suitable to use in primary care or school based health care context) compared with
      standard treatment for adolescents with persistent pain problems. The aim is also to compare
      short and long-term costs for patients and for the health care system related to the two
      interventions, in order to determine strategies for future cost-effective care of children
      and adolescents experiencing recurrent pain.
    

Detailed description: 
      Chronic or recurrent pain symptoms are widely studied and generally regarded as an important
      public health concern in adults. The prevalence of pain symptoms are reported to be as high
      as 25-30 % in children and adolescents. Children and adolescents are reported to have
      restrictions in daily life activities, social contacts, and school attendance, and to have
      poorer academic skills and as well as an increased utilization of heath care services due to
      pain problems. These patients suffer from a wide variety of problems, for example sports
      injuries, persistent postoperative pain, musculoskeletal pains, headaches or multiple
      recurrent pain problems. The treatments given today to adolescents are dealing with symptoms
      in a physical manner.

      In this study participants will be recruited among adolescents referred to paediatric
      physiotherapy. The participants will be randomly allocated to either physiotherapy including
      standard treatment or a behavioural medicine treatment program. Standard treatment includes
      muscle strengthening, stretching, posture training, training of relaxation techniques and
      information about pain according to the best empirical praxis.

      The behavioural medicine treatment program will include the same components as the standard
      treatment with the addition of age appropriate interventions aimed to address the emotional
      and behavioural processes of pain. The treatment is based on earlier intervention programs
      and includes the following phases;

        -  Individual functional behavioural analysis The adolescents lists specific important and
           frequent activities and situations they have problems to master due to pain and target
           activities are then chosen. Individual capabilities (both physical and psychological),
           behavioural responses, and their short and long-term consequences are identified.
           Parental responses and their impact on adolescent's pain behaviours are noted. Target
           activity related treatment goals as well goals for engagement in the treatment are
           defined from the individual functional behavioural analysis.

        -  Basic skill acquisition Physical abilities and cognitive skills required for improvement
           of behaviour in target activities are trained. For example to meet the problem of fear
           of movement, graded activity, or exposure will be provided. When negative thoughts are
           recognized the adolescents are taught and trained on how to replace these thoughts,
           self-efficacy for target activities are increased by carefully selected activities witch
           allows the adolescent to succeed and by repeated feedback from the physiotherapists.
           Adequate coping strategies for restoring and sustaining activities are taught and
           trained. Parents are trained on how to support new behaviours.

        -  Applied skill acquisition The basic capabilities are put together in order to shape the
           more complex skills required when applying in target activities. Self- efficacy is
           reinforced by feedback from both the physiotherapists and parents.

        -  Generalisation This phase includes the generalisation of new, both physical and
           psychological skills to other, for the adolescent important, activities.

        -  Maintenance and relapse prevention This phase includes the identification of "risk
           situations", and recognition of how adolescents and parents can support positive
           behaviours further.

      Patient follow-ups takes place immediately after completed intervention, after 6 months and
      after one year and two years after intervention in order to evaluate the long-term effect.

      • Parents The treatment is based on earlier intervention program and includes; Information on
      pain and pain behaviours and parental impact on adolescent's pain behaviours. An individual
      intervention plan according to each teenager's problems is made. All parents will be trained
      on how to support new positive health behaviours.
    

Intervention name(s): Behavioural medicine treatment; Standard treatment
Intervention type(s): Behavioral; Other
Intervention description(s): The behavioural medicine treatment program will include muscle strengthening, stretching, posture training, training of relaxation techniques and information about pain according to the best empirical praxis and age appropriate interventions aimed to address the emotional and behavioural processes of pain.; Standard treatment includes muscle strengthening, stretching, posture training, training of relaxation techniques and information about pain according to the best empirical praxis
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment