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Session # E2b Friday, October 11, 2013. Treating Chronic Pain in Adolescents. Amanda Bye, PsyD , Behavioral Medicine Specialist. Collaborative Family Healthcare Association 15 th Annual Conference October 10-12, 2013 Broomfield, Colorado U.S.A. Faculty Disclosure.

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Treating Chronic Pain in Adolescents


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treating chronic pain in adolescents

Session # E2b

Friday, October 11, 2013

Treating Chronic Pain in Adolescents

Amanda Bye, PsyD, Behavioral Medicine Specialist

Collaborative Family Healthcare Association 15th Annual Conference

October 10-12, 2013 Broomfield, Colorado U.S.A.

faculty disclosure
Faculty Disclosure

I have not had any relevant financial relationships during the past 12 months.

objectives
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
slide4
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
slide5
Case

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

the problem
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 from

http://www.minnesotamedicine.com/tabid/3692/default.aspx

solution
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
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
Integrative Approach to Care
  • Psychologist
  • Primary Care Physician
  • Specialty services
  • Consultation with pain physician at TCH
  • Mental Health
  • Family members
  • School involvement
the group
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
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
results1
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)
results2
Results
  • No difference in severity of depression or anxiety
  • Brief Pain Inventory- Pain affected walking and relationships significantly less than the other scales.
limitations
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
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
learning assessment
Learning Assessment

Audience Question & Answer

session evaluation
Session Evaluation

Please complete and return theevaluation form to the classroom monitor before leaving this session.

Thank you!