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. Session # E2b Friday, October 11, 2013

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

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

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

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

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

Treatment Options

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 Ages years >6 months of pain No clear medical explanation for the pain Pain is interfering in basic functioning

Integrative Approach to Care Psychologist Primary Care Physician Specialty services Consultation with pain physician at TCH Mental Health Family members School involvement

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 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

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 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)

Results No difference in severity of depression or anxiety Brief Pain Inventory- Pain affected walking and relationships significantly less than the other scales.

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 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

How might this group have benefitted Cindy, her family and her treatment team?

Learning Assessment Audience Question & Answer

Session Evaluation Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you!