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The Impact of Spatial Distribution of Pain on Long-Term Trajectories for Chronic Pain Outcomes After Intensive
Sara E Williams1,2, Kendra J Homan1,2, Susan L Crowley3
1Departments of Pediatrics.
Insights
Factors like pain distribution, intensity, and coping efficacy significantly impact how children respond to intensive interdisciplinary pain treatment (IIPT). Understanding these elements can improve outcomes for severely disabled pediatric chronic pain patients.
Area of Science:
- Pediatric Pain Management
- Clinical Psychology
- Rehabilitation Medicine
Background:
- Intensive interdisciplinary pain treatment (IIPT) shows promise for pediatric chronic pain.
- Factors influencing differential treatment response in pediatric patients are not well understood.
Purpose of the Study:
- To examine the trajectory of functional disability over time in pediatric patients undergoing IIPT.
- To investigate the influence of pain spatial distribution, coping efficacy, and pain intensity on treatment response.
Main Methods:
- Multilevel modeling was used to analyze data from 110 pediatric patients.
- Self-report measures of functional disability, pain intensity, and coping efficacy were collected at multiple time points.
- The study examined interactions between time, pain characteristics, and coping efficacy.
Main Results:
- A model with three-way interactions revealed significant effects on functional disability.
- Widespread pain, high pain intensity, and poor coping efficacy were associated with greater functional disability.
- Patients with localized pain and poor coping efficacy showed initial improvement but later increased functional disability.
Conclusions:
- Spatial distribution of pain, coping efficacy, and pain intensity are crucial factors in pediatric chronic pain treatment response.
- Identifying these variables can help tailor treatments for better outcomes, especially for severely affected children.
Objectives:
Evidence for the effectiveness of intensive interdisciplinary pain treatment (IIPT) for pediatric chronic pain is growing; however, little research has considered factors that contribute to differences in patients' treatment response. The present study utilized multilevel modeling to examine trajectory of change over time in functional disability from clinic assessment to 6-month follow-up in pediatric patients participating in IIPT, considering spatial distribution of pain, coping efficacy, and pain intensity.
Materials And Methods:
Participants included 110 pediatric patients (Mage=14.65, SD=2.37; localized pain, 27.3%; widespread pain, 72.7%) consecutively admitted into IIPT. Patients completed self-report measures of functional disability, pain intensity, and coping efficacy at pretreatment assessment, admission, weekly during IIPT, discharge, and several follow-ups.
Results:
Analysis identified a model with 3 three-way interactions, including time, time squared, pain intensity, coping efficacy, and pain distribution, on functional disability. The spatial distribution of pain had the greatest impact on treatment trajectory in patients with widespread pain, high pain intensity, and poor coping efficacy; these patients demonstrated greater functional disability compared with patients with localized pain. In addition, patients with widespread pain and poor coping efficacy had the most functional disability across all levels of pain intensity. Patients with localized pain and poor coping efficacy demonstrated initial treatment gains, but evidenced an increase in functional disability at follow-up.
Discussion:
Overall, spatial distribution of pain, coping efficacy, and pain intensity played an important role in patients' response to treatment. Better understanding of these variables could improve treatment response, particularly for the most severely disabled chronic pain patients.
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