Restricted accessResearch articleFirst published online 2013-06
The Children’s Health & Illness Recovery Program (CHIRP): Feasibility and Preliminary Efficacy in a Clinical Sample of Adolescents With Chronic Pain and Fatigue
Our goal was to determine the feasibility and efficacy of a manualized treatment (CHIRP) for pediatric patients with chronic painful and fatiguing medical conditions in reducing symptoms and improving functioning. Participants included 26 clinical referrals with chronic pain and/or fatigue between the ages of 11 and 19, and their parent/guardian, who attended a 12-session manualized treatment employing a cognitive–behavioral systems-based intervention, along with strong advocacy for school-based accommodations. Pre- and postintervention ratings of pain, fatigue, and functional disability were obtained, along with helpfulness ratings in improving symptoms and functioning. Participants and parents reported highly favorable ratings of the helpfulness of the intervention in improving symptoms and overall daily functioning. Both participants and their parents reported significant improvements in pain, fatigue and functional disability. Pilot data indicate the CHIRP intervention appears to demonstrate considerable promise as an effective treatment for improving functioning in pediatric patients with these chronic conditions. Further controlled clinical trails are being planned.
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References
1.
CarterB. D., & KronenbergerW. K. (2002, April). The health experiences and behavior inventory (HEBI): Evaluation of the psychological dimensions of pediatric illness. Paper presented at the Great Lakes Conference on Child Health Psychology, Milwaukee, WI.
2.
CarterB. D., & ThrelkeldB. (2012). Psychosocial perspectives in the treatment of pediatric chronic pain. Pediatric Rheumatology, 10. doi:10.1186/1546-009610-15
3.
ClaarR. L.GuiteJ. W.KaczynskiK. J., & LoganD. E. (2010). Factor structure of the Adult Responses to Children’s Symptoms: Validation in children and adolescents with diverse chronic pain conditions. Clinical Journal of Pain, 26, 410–417. doi:10.1097/AJP.0b013e3181cf5706
4.
ClaarR. L., & WalkerL. S. (2006). Functional assessment of pediatric pain patients: Psychometric properties of the functional disability inventory. Pain, 121, 77–84. doi:10.1016/j.pain.2005.12.002
5.
DickB. D., & RiddellR. (2010). Cognitive and school functioning in children and adolescents with chronic pain: A critical review. Pain and Research Management, 15, 238–244.
6.
EcclestonC.PalermoT. M.WilliamsA. C.LewandowskiA.MorleyS.FisherE., & LawE. (2012). Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database of Systematic Reviews, 12, CD003968. doi:10.1002/14651858.CD003968.pub3
7.
GarraldaM. E., & ChalderT. (2005). Practitioner review: Chronic Fatigue Syndrome in childhood. Journal of Child Psychology and Psychiatry, 46, 1143–1151. doi:10.1111/j.1469-7610.2005.01424.x
8.
GarraldaM. E., & RangelL. (2004). Impairment and coping in children and adolescents with chronic fatigue syndrome: A comparative study with other pediatric disorders. Journal of Child Psychology and Psychiatry, 45, 543–552. doi:10.1111/j.1469-7610.2004.00244.x
9.
GathercoleS. E.DunningD. L., & HolmesJ. (2012). Cogmed training: Let’s be realistic about intervention research. Journal of Applied Research in Memory & Cognition, 1, 201–203.
10.
GrayD.Parker-CohenN. Y.WhiteT.ClarkA. T.SeinerS. H.AchillesJ., & McMahonW. M. (2001). A comparison of individual and family psychology of adolescents with chronic fatigue syndrome, rheumatoid arthritis, and mood disorders. Developmental and Behavioral Pediatrics, 22, 234–242.
11.
HaraldstadK.SorumR.EideH.NatvigG. K., & HelsethS. (2011). Pain in children and adolescents: Prevalence, impact on daily life, and parents’ perception, a school survey. Scandinavian Journal of Caring Science, 25, 27–36. doi:10.1111/j.1471-6712.2010.00785.x
12.
HechlerT.BlankenburgM.DobeM.KosfelderJ.HubnerB., & ZernikowB. (2010) Effectiveness of a multimodal inpatient treatment for pediatric chronic pain: A comparison between children and adolescents. European Journal of Pain, 14, 97.e1–97.e9. doi:10.1016/j.ejpain.2009.03.002
13.
HendersonE. M.LawE. F.PalermoT. M., & EcclestonC. (2012). Case study: Ethical guidance for pediatric e-health research using examples from pain research with adolescents. Journal of Pediatric Psychology, 37, 1116–1126. doi:10.1093/jpepsy/jss085
14.
HuangY.KatzB. Z.MearsC.KielhofnerG. W., & TaylorR. (2010). Postinfectious fatigue in adolescents and physical activity. Archives of Pediatric Adolescent Medicine, 164, 803–809. doi:10.1001/archpediatrics.2010.144
15.
HuguetA., & MiroJ. (2008). The severity of chronic pediatric pain: An epidemiological study. Journal of Pain, 9, 226–236. doi:10.1016/j.jpain.2007.10.015
16.
JohnsonS. K. (2007). Medically unexplained illness: Gender and biopsychosocial implications. Washington, DC: American Psychological Association.
17.
JonesJ. F.NisenbaumR.SolomonL.ReyesM., & ReevesW. C. (2004). Chronic fatigue syndrome and other fatiguing illnesses in adolescents: A population-based study. Journal of Adolescent Health, 35, 34–40. doi:10.1016/j.jadohealth.2003.09.007
18.
KaczynskiK. J.ClaarR. L., & LoganD. E. (2009). Testing gender as a moderator of associations between psychosocial variables and functional disability in children and adolescents with chronic pain. Journal of Pediatric Psychology, 34, 738–748. doi:10.1093/jpepsy/jsn113
19.
Kashikar-ZuckS.FlowersS. R.ClaarR. L.GuiteJ. W.LoganD. E.Lynch-JordanA. M., . . .WilsonA. C. (2011). Clinical utility and validity of the Functional Disability Inventory (FDI) among a multicenter sample of youth with chronic pain. Pain, 152, 1600–1607. doi:10.1016/j.pain.2011.02.050
20.
Kashikar-ZuckS.GoldschneiderK. R.PowersS. W.VaughtM. H., & HersheyA. D. (2001). Depression and functional disability in chronic pediatric pain. Clinical Journal of Pain, 17, 341–349. doi:10.1097/00002508-200112000-00009
21.
Kashikar-ZuckS.ParkinsI. S.TingT. V.VerkampE.Lynch-JordanA.PassoM., & GrahmT. B. (2010). Controlled follow-up study of physical and psychosocial functioning of adolescents with juvenile primary fibromyalgia syndrome. Rheumatology, 49, 2204–2209. doi:10.1093/rheumatology/keq254
22.
Kashikar-ZuckS.SwainN. F.JonesB. A., & GrahamT. B. (2005). Efficacy of cognitive-behavioral intervention for juvenile primary fibromyalgia syndrome. Journal of Rheumatology, 32, 594–602.
23.
KnookL. M. E.KonijnenbergA. Y.van der HoevenJ.KimpenJ. I.BuitelaarJ. K.van EngelandH., & de Graeff-MoederE. R. (2011). Psychiatric disorders in children and adolescents presenting with unexplained chronic pain: What is the prevalence and clinical relevancy?European Child & Adolescent Psychiatry, 20, 39–48. doi:10.1007/s00787-010-0146-0
24.
KruppL. B.LaRoccaN. G.Muir-NashJ., & SteinbergA. D. (1989). The fatigue severity scale: Application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of Neurology, 46, 1121–1123. doi:10.1001/archneur.1989.00520460115022
25.
LabergeL.GagnonC.JeanS., & MathieuJ. (2005). Fatigue and daytime sleepiness rating scales in myotonic dystrophy: A study of reliability. Journal of Neurological Neurosurgery and Psychiatry, 76, 1403–1405.
26.
LeoR. J.SrinivasanS. P., & ParekhS. (2011). The role of the mental health practitioner in the assessment and treatment of child and adolescent chronic pain. Child and Adolescent Mental Health, 16, 2–8. doi:10.1111/j.1475-3588.2010.00578.x
27.
LerdalA.WahlA.RustoenT.HanestadB. R., & MoumT. (2005). Fatigue in the general population: A translation and test of the psychometric properties of the Norwegian version of the fatigue severity scale. Scandinavian Journal of Public Health, 33, 123–130. doi:10.1080/14034940410028406
28.
LoganD. E.SimonsL. E.SteinM. J., & ChastainL. (2008). School impairment in adolescents with chronic pain. The Journal of Pain, 9, 407–416. doi:10.1016/j.pain.2007.12.003
29.
NijhofS. L.BleiijenbergG.UiterwaalC.KimpenJ. L., & van de PutteE. M. (2012). Effectiveness of internet-based cognitive behavioral treatment for adolescents with chronic fatigue syndrome (FITNET: A randomized controlled trial. Lancet, 379, 1412–1418. doi:10.1016/S0140-6736(12)60025-7
30.
PalermoT. M. (2012). CBT for chronic pain in children and adolescents. New York, NY: Oxford University Press.
31.
PalermoT. M.WilsonA. C.PetersM.LewandowskiA., & SomhegyiH. (2009). Randomized controlled trial of an Internet-delivered family cognitive-behavioral therapy intervention for children and adolescents with chronic pain. Pain, 146, 205–213. doi:10.1016/j.pain.2009.07.034
32.
PerquinC. W.HazebroekA.HunfeldJ.BohnenA. M.van Suijlekom-SmitL.PasschierJ., & van der WoudenJ. (2000). Chronic pain in children and adolescents: Observational studies. Pain, 87, 51–58.
33.
RosenthalR. (1991). Meta-analytic procedures for social research. London, England: Sage.
34.
SchiklerK. N. (2000). Is it juvenile rheumatoid arthritis or fibromyalgia?Adolescent Medicine, 84, 967–982.
35.
SimonsL. E.LoganD. E.ChastainL., & SteinM. (2010). The relation of social functioning to school impairment among adolescents with chronic pain. Clinical Journal of Pain, 26, 16–22. doi:10.1097/AJP.0b013e3181b511c2
36.
ThrelkeldB.CarterB. D.KronenbergerW. G., & KatsikasS. (2012, April). Factors associated with completers vs. dropouts in a manualized treatment program for adolescents with chronic pain and fatigue. Poster presented at the Midwest Conference on Pediatric Psychology, Milwaukee, WI.
37.
WalkerL. S., & GreeneJ. W. (1991). The functional disability inventory: Measuring a neglected dimension of child health status. Journal of Pediatric Psychology, 16, 39–58. doi:10.1093/jpepsy/16.1.39
38.
WhiteK.SpeechleyM.HarthM., & OstbyeT. (2000). Co-existence of chronic fatigue syndrome with fibromyalgia syndrome in the general population: A controlled study. Scandinavian Journal of Rheumatology, 29, 44–51. doi:10.1080/030097400750001789
39.
WicksellR. K.LennartM.LekanderM., & OlssonG. L. (2009). Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain: A randomized controlled study. Pain, 141, 248–257. doi:10.1016/j.pain.2008.11.006
40.
WilliamsP. G.HolmbeckG. N., & GreenleyR. N. (2002). Adolescent health psychology. Journal of Consulting and Clinical Psychology, 70, 828–842. doi:10.1037/0022-006X.70.3.828
