BEHAVIORAL MEDICINE APPROACHES TO PEDIATRIC ACUTE PAIN

行为医学治疗小儿急性疼痛

• 批准号: 2889380
• 负责人: KEITH J. SLIFER
• 金额: $ 24.97万
• 依托单位: HUGO W. MOSER RES INST KENNEDY KRIEGER
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-04-01 至 2001-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2889380
• 关键词: age difference; anxiety; autogenic training; behavior modification; behavior prediction; behavior therapy; behavioral /social science research tag; behavioral medicine; child behavior; clinical research; coping; counseling; fear; gender difference; human subject; injection /infusion; middle childhood (6-11); operant conditionings; pain; pain threshold; pediatric nursing; preschool child (1-5); psychological adaptation; questionnaires; statistics /biometry

DESCRIPTION: Children requiring repeated invasive medical procedures may develop behavioral disturbances despite pharmacological interventions for pain. Behavioral distress disrupts procedures, diminishes the child's quality of life, stresses the family, and may impact the child's overall psychological adjustment. Children ages three to seven will be studied as they undergo repeated (needle stick) procedures (e.g. venipuncture, infusaport sticks, subcutaneous or intramuscular injections). The effects of three behavioral interventions for supplementing medical management of procedural pain will be compared. Experimental groups will be stratified by baseline behavioral distress, intensity of the medical protocol, age and gender. Behavioral distress and related variables will be measured during a series of five consecutive needle stick procedures of the same type for each child. The Operant intervention includes procedures from the basic research literature on operant and respondent conditioning, which have reduced negative behavioral effects of aversive stimulation consistently and across species. The Interactive Distraction intervention uses salient and novel stimuli to compete with the child's perception of noxious stimuli, and was designed to be highly cost-effective. The third, Usual Care intervention is based on standard nursing care. A group experimental design will compare treatment effects on: (1) behavioral and physiological measures of distress during needle sticks, (2) a standardized measure of overall behavioral adjustment, and (3) professional time required. The Operant intervention should produce the most robust and immediate improvements in procedure-related distress and arousal, but will be more costly. Interactive Distraction should be effective for children with lower levels of behavioral distress, and may prevent the development of severe behavioral distress. The Operant intervention, which emphasizes behavioral momentum, discrimination training and counterconditioning during simulated medical procedures (in addition to distraction) is expected to be more effective for children with severe behavioral distress and evidence of conditioned anxiety at baseline. A multivariate analysis of covariance will examine the value of screening measures of child coping style, developmental status, age and baseline behavioral distress in predicting differential responses to the three interventions. The results may lead to better matching of interventions to children for greater treatment economy.

描述：需要重复侵入性医疗程序的孩子可能 尽管有药理学干预措施 疼痛。 行为困扰破坏了程序，减少了孩子的 生活质量，压力家庭，可能会影响孩子的整体 心理调整。 三至七岁的儿童将被研究为 他们经过重复（针刺）程序（例如，静脉穿刺， 注射棒，皮下或肌肉内注射）。 效果 用于补充医疗管理的三种行为干预措施 将比较程序性疼痛。 实验组将通过 基线行为困扰，医疗方案的强度，年龄和年龄 性别。 行为困扰和相关变量将在 每种连续五个连续类型的针刺程序 孩子。 操作人员干预包括基础研究的程序 有关操作者和受访者条件的文献，这些文献已减少 negative behavioral effects of aversive stimulation consistently and across 物种。 互动干预干预使用显着和新颖 刺激与孩子对有害刺激的看法竞争，并且 设计为高度成本效益。 第三，通常的护理干预是 基于标准护理。 小组实验设计将比较 治疗效果：（1）行为和生理措施 在针刺期间，（2）总体行为的标准化度量 调整和（3）所需的专业时间。 操作人员干预 应该产生最强大，最直接的改进 与程序有关的困扰和唤醒，但会更加昂贵。 互动分散注意力应该对较低级别的儿童有效 行为困扰，并可能阻止发生严重行为的发展 困扰。 强调行为动量的操作干预措施， 模拟医疗期间的歧视培训和反条件 预计程序（除了分心之外）对 严重的行为困扰和条件焦虑的证据 基线。 协方差的多元分析将检查值 筛选儿童应对风格，发育状况，年龄和年龄的措施 基线行为困扰在预测对差异的反应时 三个干预措施。 结果可能会导致更好的匹配 对儿童进行更大的治疗经济的干预措施。