Get moving, GET living: Graded exposure treatment for adolescents with chronic musculoskeletal pain.

行动起来，生活：针对患有慢性肌肉骨骼疼痛的青少年的分级暴露治疗。

• 批准号: 9980786
• 负责人: LAURA E SIMONS
• 金额: $ 13.82万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9980786
• 关键词: Address; Adherence; Adolescence; Adolescent; Adult; Affect; Age; Ambulatory Care; Assessment tool; Behavior; Behavioral Mechanisms; Biomechanics; Chronic; Clinical; Coupled; Data; Diagnosis; Distress; Fright; Functional disorder; Funding; Gender; Health; Health Care Costs; Impairment; Intervention; Joints; Kinetics; Life; Living Wills; Measurement; Measures; Mental Health; Monitor; Motion; Movement; Musculoskeletal; Outcome; Outpatients; Pain; Pain management; Parents; Participant; Patients; Physical activity; Physical therapy; Play; Psychologist; Psychology; Randomized Controlled Trials; Readiness; Recurrence; Reporting; Research; Risk; Risk Factors; Schedule; Site; Technology; Work; actigraphy; adherence rate; avoidance behavior; base; chronic musculoskeletal pain; chronic pain; diaries; disability; experience; follow-up; functional disability; functional improvement; in vivo; innovation; pain outcome; physical therapist; prevent; primary outcome; protective behavior; public health relevance; response; satisfaction; secondary outcome; societal costs; treatment response

With up to a third of adolescents reporting recurrent or chronic musculoskeletal pain, it is a critical national health problem. The experience of chronic pain in adolescence negatively impacts overall health during this important life period, and increases the risk of pain and mental health problems in adulthood. Pain-related fear is repeatedly identified as an important factor that increases the likelihood of poor outcomes among adolescents with pain, and yet pain-related fear is rarely targeted in typical pain management (TPM). Perhaps unsurprisingly, TPM yields no change in pain-related fear, and modest improvements in functional disability. To overcome limitations of TPM for pain-related fear, graded in-vivo exposure treatment (GET) was developed. While TPM focuses on pain control via pain management psychology and impairment-based physical therapy, GET is jointly delivered by a pain psychologist and physical therapist targeting functional improvement, through exposing patients to activities previously avoided due to fear of pain. GET is successful in adults with chronic musculoskeletal pain! and our pilot data of GET for adolescents with chronic pain (GET Living) is robust, with significant declines in patient fear, activity avoidance, and disability. Uniquely, GET Living also targets parent distress and behavior, and our pilot data demonstrate decreases in parent fear, avoidance, and protective behavior. GET Living also distinguishes itself with an innovative assessment approach to patient progress and clinical endpoints. In addition to standard assessment tools, GET Living utilizes electronic daily diary technology to identify exactly when improvements in outcomes are occurring/not occurring, and objective biomechanical assessment using motion analysis and physical activity monitoring via Actigraphy. Building from this work, the proposed research concerns an exploratory randomized controlled trial (RCT) of GET Living aimed at measuring changes in fear and function for adolescents with chronic musculoskeletal pain when compared to TPM. This study will provide necessary findings to support or refute a large multi-site RCT. Aim 1 compares changes in pain-related fear (primary outcome), disability, and parent behavior (secondary outcomes) between GET Living and TPM. Aim 2 characterizes feasibility and acceptability of GET Living to inform implementation of a large multi-site RCT. Treatment of adolescent chronic musculoskeletal pain is suboptimal. Significant breakthroughs require directly targeting mechanisms underlying pain-related dysfunction, such as pain-related fear. Implementing innovative interdisciplinary outpatient treatment that addresses pain-related fear and dysfunction, coupled with proof-of-concept electronic daily diaries and biomechanical assessment to determine clinical endpoints and treatment response, will lead to advancements in our understanding and treatment of adolescent chronic pain. These findings will directly inform the decision of whether to proceed with a large multi-site RCT of GET Living, serving as the basis for potential large-scale implementation of GET Living nationwide.

多达三分之一的青少年报告复发或慢性肌肉骨骼疼痛，这是一个关键的民族 健康问题。青春期慢性疼痛的经验对此对整体健康产生负面影响 重要的生活时期，并增加了成年后疼痛和心理健康问题的风险。与疼痛有关的恐惧 反复被确定为增加结果之间不良结果的重要因素 在典型的疼痛管理（TPM）中，很少针对疼痛且与疼痛有关的恐惧的青少年。 也许毫不奇怪，TPM不会改变与疼痛相关的恐惧，功能的适度改善 残疾。为了克服与疼痛相关的恐惧的局限 是开发的。而TPM通过疼痛管理心理学和基于损害的疼痛控制着重于疼痛 物理疗法，Get由疼痛心理学家和物理治疗师共同提供功能 通过使患者暴露于由于担心疼痛而避免的活动，改进。获得成功 在患有慢性肌肉骨骼疼痛的成年人中！以及我们对患有慢性疼痛的青少年GET的飞行员数据（Get 生活）是强大的，患者的恐惧，避免活动和残疾的下降大幅下降。独特，得到 生活也针对父母的困扰和行为，我们的飞行员数据表明​​，父母恐惧的减少， 避免和保护行为。通过创新的评估，生活也可以区分自己 患者进步和临床终点的方法。除了标准评估工具外，还活着 利用电子日记技术来确定结果何时发生/不进行 通过运动分析和体育活动监测通过 动作法。拟议的研究涉及一项探索性随机对照试验，涉及这项工作。 （RCT）旨在衡量慢性青少年的恐惧和功能变化 与TPM相比，肌肉骨骼疼痛。这项研究将提供必要的发现来支持或驳斥 大型多站点RCT。 AIM 1比较与疼痛相关的恐惧（主要结果），残疾和父母的变化 行为（次要结果）在谋生与TPM之间。 AIM 2的特征是可行性和 可接受的生活能够告知实施大型多站点RCT。青春期慢性的治疗 肌肉骨骼疼痛是次优的。重大突破需要直接定位机制 与疼痛有关的功能障碍，例如与疼痛有关的恐惧。实施创新的跨学科门诊 解决与疼痛有关的恐惧和功能障碍的治疗，再加上概念验证电子日常 日记和生物力学评估以确定临床终点和治疗反应，将导致 我们对青少年慢性疼痛的理解和治疗方面的进步。这些发现将直接 告知是否要进行大量多站点的谋生的决定，并作为基础 在全国范围内潜在的大规模实施。

项目成果

mHealth for pediatric chronic pain: state of the art and future directions.

• DOI: 10.1080/14737175.2020.1819792
• 发表时间: 2020-11
• 期刊: Expert review of neurotherapeutics
• 影响因子: 4.3
• 作者: Richardson PA;Harrison LE;Heathcote LC;Rush G;Shear D;Lalloo C;Hood K;Wicksell RK;Stinson J;Simons LE
• 通讯作者: Simons LE

Graded exposure treatment for adolescents with chronic pain (GET Living): Protocol for a randomized controlled trial enhanced with single case experimental design.

患有慢性疼痛的青少年的分级暴露治疗（GET Living）：通过单例实验设计增强的随机对照试验方案。

• DOI: 10.1016/j.conctc.2019.100448
• 发表时间: 2019
• 期刊: Contemporary clinical trials communications
• 影响因子: 1.5
• 作者: Simons,LauraE;Harrison,LaurenE;O'Brien,ShannonF;Heirich,MarissaS;Loecher,Nele;Boothroyd,DerekB;Vlaeyen,JohanWS;Wicksell,RikardK;Schofield,Deborah;Hood,KoreyK;Orendurff,Michael;Chan,Salinda;Lyons,Sam
• 通讯作者: Lyons,Sam