Program

Sep 12, 2008

OVERVIEW

The main purpose of
this study was to evaluate the impact of a seven-week internet-based treatment
program for pediatric recurrent pain patients. Forty-seven children and
adolescents were randomly assigned. The treatment group was compared to patients
who were still waiting to receive treatment for their pain. The goal of this
program was to reduce children’s pain through reading a web-based manual and
having weekly telephone or e-mail contact with a therapist. The children’s pain
(e.g. headaches and abdominal pain) was assessed with a pain diary kept by the
children that was collected every two weeks. Researchers assessed the
children’s pain and quality of life after 1 month and after 3 months
participation. The program considered a 50% reduction in diary pain scores to
indicate that the program was effective. The treatment group achieved a 71% and
a 72% reduction in diary pain scores at the 1- and 3- month follow up, whereas
the control group achieved only a 19% and a 14% reduction in diary pain scores.
The differences in diary pain scores between treatment and control groups were
significant.

DESCRIPTION OF
PROGRAM

Target
population: 
Boys and girls between the ages of 9 and 16 years who had
varying levels of pain severity (pain levels between high and low).

Children in the
seven-week program were asked to keep a pain diary that was collected every two
weeks. The pain diary was used to record the frequency and intensity of the
children’s pain. Both the children and the parents of the children in the
treatment group were instructed to work through online chapters of a treatment
program aimed at improving specific pain reduction skills (e.g., deep breathing,
relaxation, visualization, etc.). Theywere
asked to complete online questions at the end of each chapter. During the
treatment, the participants — parents and children — were contacted by e-mail
and telephone by therapists to discuss the lessons covered in the chapters. The
children and their parents were also encouraged to contact the therapist if they
had any questions. Children in both the treatment and non-treatment conditions
were interviewed 1 and 3 months after the treatment was completed and were asked
to complete post-treatment measures.

EVALUATION OF
PROGRAM

Hicks, C. L.,
Von Baeyer, C. L., and McGrath, P. J. (2006). Online psychological treatment for
pediatric recurrent pain: A randomized evaluation. Journal of Pediatric
Psychology
, 31(7), 724-736.

Evaluated
population: 
17 boys and 30 girls between the ages of 9 and 16 years with
varying levels of head or abdominal pain (ranging in severity from high to low).

Approach:
The children were recruited via the media, posters in physicians’ offices, and
advertisements in school newsletters. Once the children were accepted into the
study, they were separated by age (9-12 and 13-16 years) and pain severity (high
and low) and then randomly placed by block in the treatment or non-treatment
condition.

Children in both
the treatment and control groups filled out pain diaries before and after the
seven-week program. The pain diary was used to assess pain intensity four times
a day over a two-week period. During the intervention, the children in the
treatment group learned cognitive-behavioral relaxation techniques and cognitive
strategies to reduce pain. They also received background information on their
pain conditions and information about positive lifestyle choices over the
internet. At the end of each online chapter, the child answered questions about
the topics covered. After some chapters, there were questions for the children
and parents to answer together. Each child in the treatment condition also
received a personalized relaxation tape and a thought journal. At the end of
the seven-week treatment period, the researchers assessed the children’s pain at
a 1-month and a 3- month follow-up.

Results:
Before the treatment began, the children in the treatment group and the children
in the control group reported similar levels of pain. After the program, the
children in the treatment condition significantly reduced their reported pain
by 71% from the beginning the program to the 1-month follow up and by 72% to
the 3-month follow up. The children in the control group reduced their reported
pain by 19% at the 1-month follow up and by 14% at the 3-month follow up. Since
the treatment group’s reported pain reduction was more than 300% greater than
the control group’s pain reduction, there is evidence that the
internet/telephone-based treatment was effective in reducing children’s
pain.

There was no
significant difference, however, between the treatment and control groups when
it came to rating quality of life. It is not clear, however, whether the
children’s quality of life did not improve at all despite the pain reduction, or
whether the quality of life improved for both groups similarly despite the
difference in pain reduction.

Recurrent pain
produces many types of costs that are direct, indirect, and intangible. The
researchers estimated that the distance treatment applied in this study was 5.5
times more cost-effective with respect to the consumption of therapist time than
office-based individual therapy.

SOURCES FOR MORE
INFORMATION

References

Hicks, C. L., Von
Baeyer, C. L., and McGrath, P. J. (2006). Online psychological treatment for
pediatric recurrent pain: A randomized evaluation.Journal of
Pediatric Psychology, 31
(7), 724-736.

The content of the
treatment program was adapted from the Pain Module for the Family Help Project
at Dalhousie University. A summary of the treatment and sample pages of the
treatment program can be accessed at:

www.usask.ca/childpain/research/hicks/
.

 

KEYWORDS: Adolescents, Children, Provider-Based, Internet-Based, Counseling/Therapy, Physical Health

Program
information last updated 9/12/08