Pediatric Chronic Pain Eased by Early Intervention, Parental Involvement

“This program works because we focus on parent change as much as child change,” emphasizes Dr. Coakley, adding that working with parents separately is key. “There are six hours of training for parents in this program,” she says, “and it is very difficult to obtain that much time with a parent to talk about issues regarding their children outside a dedicated program, such as this.”

The program helps kids learn techniques to stay active and engaged in sports and other activites of normal life.

Outcomes to Date

At the 2014 Pediatric Rheumatology Symposium (PRYSM) meeting, Dr. Coakley presented outcomes to date on The Comfort Ability program that began in 2010. She presented outcomes on 122 patients, the majority of whom were female (78%), Caucasian (79%), with a mean age of 14 years, and 28 months’ duration of pain. Many of the children in the study reported using various concurrent interventions, such as medication, acupuncture, psychotherapy, physical therapy and self-management strategies.

To evaluate efficacy, Dr. Coakley looked at several outcomes based on reports by both parents and children, and compared responses at baseline to those at one week, one month and three months following the intervention.

At one week, the reports by parents showed significant declines from baseline in measures that looked at worrying about the child’s pain (pain catastrophizing scale [PCS]), protecting the child from pain (Adult Response to Child Symptoms [ARCS]), feeling responsible for the child’s pain (Helping for Health Inventory [HHI]) and Pain Self Efficacy Scale (PSES). These significant improvements were maintained at one month and three months following the intervention.

Similar findings were found based on the reports by children. At one week, children also showed significant declines from baseline in PCS, functional disability and PSES that were maintained over one month and three months.

Overall, the findings indicate that parents reduced their use of pain-reinforcing parenting practices, reduced worrying about their child’s pain, had increased confidence in the child’s ability to manage his or her own pain and were very satisfied with the intervention.

For children, the findings indicate improved pain self-efficacy, reduced catastrophizing symptoms, improved function and reduced pain.

Publication of these findings can be expected in the near future, according to Dr. Coakley, who also has written a book for parents to help their children manage pain that will be published by Yale University Press in 2015.

Future Directions

Based on the current evidence and experience of the program, Dr. Coakley emphasizes the need to establish services, such as this, that make it easy for parents to receive intervention and skills to help their child manage his or her chronic pain, as well as to ensure that parents have access to these services early in their child’s experience of pain or medical stress. She also emphasizes the need for the availability of more comprehensive services for families who need additional support.