Measuring Treatment Response in an Outpatient Pediatric Pain Program

Abstract

The primary outcome in many treatment studies for pediatric chronic pain has been reduced pain intensity, but it is well documented that several facets of chronic pain, including poor coping and functional disability, negatively impact daily functioning and mood. Given recent attention to defining and collecting evidence-based clinical outcomes, it is important to develop feasible methods of measuring these behavioral outcomes in clinical settings. This article describes the process of translating empirically derived measures of pain intensity, pain coping efficacy, and functional disability into clinical practice and provides a first step toward developing an indicator for classifying “positive treatment response” for patients completing a course of cognitive–behavioral therapy (CBT) for pain management. Patients (n = 100, ages 8–18 years) completed outcome measures of disability, coping, and pain intensity during every CBT treatment session. A treatment response indicator was created to represent a positive treatment response to CBT appropriate for clinical settings: 25% decrease in disability OR 40% increase in pain coping efficacy OR 30% decrease in pain intensity at the end of active treatment. Results showed that 75% of patients met criteria for a positive treatment response. Specifically, 60% achieved a 25% reduction in FDI, 34% ended active treatment with a 40% or greater increase in pain coping efficacy, and 44% achieved a 30% reduction in average pain intensity. This study describes the process of using outcome measures to measure positive treatment response in pediatric behavioral pain management.