期刊
PAIN
卷 162, 期 12, 页码 2945-2955出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/j.pain.0000000000002288
关键词
Chronic pain; Functional abdominal pain; Cognitive behavioral therapy; Pain education; Internet-delivered; Pediatric; Treatment moderators; Patient subgroup; Precision medicine
资金
- National Institutes of Health (NIH) [R01 HD076983, P30 HD15052, DK058404, T32 MH018921, T32 GM 108554]
The results of this study suggest that subgrouping pediatric FAP patients based on pain-related psychological characteristics can significantly impact the effectiveness of cognitive behavior therapy. Specifically, adolescents classified as high pain dysfunctional (HPD) showed greater reduction in GI symptoms and abdominal pain with CBT compared to those classified as high pain adaptive (HPA) and low pain adaptive (LPA). This research highlights the importance of personalized treatment approaches based on patient subgroups in optimizing treatment outcomes for pediatric FAP.
Inconsistent results of psychological treatments for pediatric functional abdominal pain (FAP) may be due to heterogeneity of patients' pain-related psychological characteristics. This randomized controlled trial tested whether statistically derived patient subgroups (high pain dysfunctional [HPD], high pain adaptive [HPA], and low pain adaptive [LPA]) moderated response to cognitive behavior therapy (CBT) for adolescents with FAP and their parents (n = 278 dyads; patients were 66% female, mean [SD] age was 14.62 [1.88] years, and parents were 95% female). Randomization to Internet-delivered CBT vs Internet-delivered pain education (EDU) was stratified by patient subgroup. Follow-up assessments of gastrointestinal (GI) symptoms (primary outcome), abdominal pain, and pain interference were at midtreatment, posttreatment, 6 months, and 12 months. Data were analysed using linear mixed effects models. Significant treatment x subgroup x time interaction effects showed that patient subgroup significantly moderated the effect of treatment on GI symptoms (t[853 = -2.93, P = 0.003) and abdominal pain (t(844) = -2.14, P = 0.03) across the treatment period. Among HPD youth, those in CBT had significantly greater GI symptom reduction than those in EDU through posttreatment. By contrast, among HPA and LPA youth, symptom improvement did not differ by treatment condition. Furthermore, among all patients assigned to CBT, HPD youth demonstrated significantly greater reductions in GI symptoms compared with HPA and LPA youth and greater reductions in abdominal pain compared with LPA youth. All subgroups maintained symptom reductions throughout the follow-up period. Results suggest that subgrouping FAP patients may inform treatment allocation and optimize treatment response.
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