Avoid or engage? Outcomes of graded exposure in youth with chronic pain using a sequential replicated single-case randomized design
Laura E Simons, Johan W S Vlaeyen, Lies Declercq, Allison M Smith, Justin Beebe, Melinda Hogan, Eileen Li, Corey A Kronman, Farah Mahmud, Jenelle R Corey, Christine B Sieberg, Christine Ploski, Laura E Simons, Johan W S Vlaeyen, Lies Declercq, Allison M Smith, Justin Beebe, Melinda Hogan, Eileen Li, Corey A Kronman, Farah Mahmud, Jenelle R Corey, Christine B Sieberg, Christine Ploski
Abstract
Pain-related fear is typically associated with avoidance behavior and pain-related disability in youth with chronic pain. Youth with elevated pain-related fear have attenuated treatment responses; thus, targeted treatment is highly warranted. Evidence supporting graded in vivo exposure treatment (GET) for adults with chronic pain is considerable, but just emerging for youth. The current investigation represents the first sequential replicated and randomized single-case experimental phase design with multiple measures evaluating GET for youth with chronic pain, entitled GET Living. A cohort of 27 youth (81% female) with mixed chronic pain completed GET Living. For each participant, a no-treatment randomized baseline period was compared with GET Living and 3- and 6-month follow-ups. Daily changes in primary outcomes fear and avoidance and secondary outcomes pain catastrophizing, pain intensity, and pain acceptance were assessed using electronic diaries and subjected to descriptive and model-based inference analyses. Based on individual effect size calculations, a third of participants significantly improved by the end of treatment on fear, avoidance, and pain acceptance. By follow-up, over 80% of participants had improved across all primary and secondary outcomes. Model-based inference analysis results to examine the series of replicated cases were generally consistent. Improvements during GET Living was superior to the no-treatment randomized baseline period for avoidance, pain acceptance, and pain intensity, whereas fear and pain catastrophizing did not improve. All 5 outcomes emerged as significantly improved at 3- and 6-month follow-ups. The results of this replicated single-case experimental phase design support the effectiveness of graded exposure for youth with chronic pain and elevated pain-related fear avoidance.
Conflict of interest statement
Disclosures: This investigation was supported by American Pain Society/Sharon S. Keller Chronic Pain Research Grant, Deborah Munroe Noonan Memorial Research Fund, and NIAMS/R21 AR072921 awarded to LES). Johan W.S. Vlaeyen is supported by the research program “From acute aversive sensations to chronic bodily symptoms”, a long-term structural Methusalem funding (METH/15/011) by the Flemish government, Belgium. There are no conflicts of interest to report.
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Source: PubMed