Web-based Management of Pediatric Functional Abdominal Pain

Study Overview
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Brief Summary
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Functional abdominal pain (FAP), a pediatric pain condition without significant organic pathology, is a precursor to chronic pain and high healthcare utilization in young adulthood. This project aims to identify child and family characteristics that predict differential responses to a Cognitive Behavior Therapy intervention administered online to patients with FAP and their parents. The goal is to acquire scientific knowledge to guide individualized treatment of patients with FAP.

Detailed Description
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The goal of our research is to identify individual differences in pediatric functional abdominal pain (FAP) that predict differential health outcomes and can be used to develop tailored approaches to the evaluation and treatment of FAP. Effective treatment of FAP is a critical public health issue because it is among the most common pain problems during childhood and prospectively predicts risk for chronic pain, disability, and frequent health service utilization (HSU) in early adulthood. Although cognitive behavior therapy (CBT) delivered by highly trained professionals in face-to-face sessions has been found to reduce pain in some FAP patients, such intensive resources are not generally available to the large population of FAP patients. This study will evaluate an alternative, more efficient approach to treating pediatric FAP. The study builds on and integrates recent work by two leading investigators in pediatric pain. First, in a prospective natural history study of pediatric onset FAP patients followed into late adolescence/early adulthood, PI Walker and colleagues identified three distinct patient profiles (i.e., Low Pain Adaptive, High Pain Adaptive, High Pain Dysfunctional) comprised of pain severity, pain cognitions, and affect at the time of the initial FAP evaluation in childhood. These profiles predicted chronic pain and related health outcomes at follow-up (FU) nearly a decade later. Patients with the High Pain Dysfunctional profile at baseline had the poorest symptom outcomes and also exhibited pro-nociceptive central pain modulation in laboratory pain testing at FU. The heterogeneity of the FAP pain profile groups suggests that they may differ in treatment needs and in the extent to which they benefit significantly more from adjunctive behavioral treatment as compared to usual care alone. Second, Co-Investigator Palermo developed and tested a CBT intervention delivered online (Web-based Management of Adolescent Pain; Web-MAP) which is an efficient, easily disseminated treatment that significantly reduced pain and disability in youth with a variety of chronic pain diagnoses in comparison to youth randomized to a usual care, wait-list control group. This study merges these lines of research into an innovative study that will, for the first time: (Aim 1) evaluate the efficacy of WebMAP administered to FAP patients and their parents; (Aim 2) evaluate baseline moderators of treatment response, including our previously validated FAP pain profiles, pro-nociceptive central pain modulation, and parent characteristics (protectiveness, modeling pain behavior, catastrophizing about the child's pain); and (Aim 3) evaluate potential mediators of the effect of WebMAP on health outcomes. Pediatric patients (n = 300) ages 11-17 years will be randomized to either WebMAP or a Usual Care (UC) control group following their initial subspecialty FAP evaluation. Assessments will be at baseline, mid- and post-treatment, and at 6- and 12-months post baseline. Study results will produce knowledge that can be used to more efficiently target interventions to FAP patients according to their individual needs and thereby extend evidence-based care to more patients and ultimately reduce overall costs of care.

Official Title
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Predicting Treatment Outcomes in Pediatric Functional Abdominal Pain

Conditions
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Gastrointestinal Disorders, Functional

Intervention / Treatment
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* Behavioral: Online Cognitive Behavior Therapy
* Behavioral: Online Education


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Referred for medical evaluation of abdominal pain of more than 3 months duration No prior diagnosis of organic disease that explains the pain Access to a computer and the internet Exclusion Criteria: Presence of major medical condition (e.g., diabetes) Does not speak English Has a disability that precludes participation Does not have a participating parent/guardian Found to have significant organic disease (e.g., ulcerative colitis) in the medical evaluation

Ages Eligible for Study
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Minimum Age: 11 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Online Cognitive Behavior Therapy<br>Online cognitive behavior therapy for coping with pain | Behavioral: Online Cognitive Behavior Therapy<br> <br> |
| Active Comparator: Online Education<br>Educational information about pain | Behavioral: Online Education<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline somatic symptoms | Change from baseline somatic symptoms as measured by the Children's Somatization Inventory | 2 months after baseline | 
| Change from baseline abdominal pain | Change from baseline abdominal pain as measured by Abdominal Pain Index | long-term follow-up (6 and 12 months after baseline) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline activity limitations | Change from baseline activity limitations as measured by the Patient Reported Outcomes Measurement Information System Pain Interference Scale | 2 months after baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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E-Health, Anxiety, Web-based intervention, Health services accessibility, Health diaries, National Institute of Child Health & Human Development (US.), Telemedicine, Parenting education, Irritable bowel syndrome, Intervention studies, Visceral pain, Chronic pain, Abdominal pain, Dyspepsia, Nausea, Nociception, Parents, Coping behavior, Depression, Catastrophization, Reinforcement (psychology), Self efficacy, Health services overutilization, Questionnaires, Self report, Health surveys, Prospective studies, Adolescent health, Mental health services