Chronic pain that persists or recurs for more than 3 months is now recognized as a significant problem that may affect 25-30 percent of children, with the prevalence increasing as children move into adolescence. Recurrent pain can severely limit a child's social, academic, and physical functioning, with long-term impact on his or her career path and quality of life. When pain persists and does not respond to standard treatment, adolescents over time will develop adaptive or maladaptive patterns of behavior that promote or inhibit continued functioning. Work within the cognitive-behavioral model has helped to show how maladaptive behaviors in response to pain may be reinforced and perpetuated by anxieties about the meaning of the pain, expectancies of harm and negative outcomes, and lack of self-efficacy to learn pain self-management skills. Cognitive-behavioral or coping skills therapies are often effective in teaching pain self- management skills to adults and adolescents, in helping to change maladaptive behaviors, and to improve functioning. But recent published models of pain management identify patient motivation as essential to a good outcome with these therapies. Patients who lack motivation to learn pain self-management, due to a low sense of self-efficacy or negative expectations of the value of learning these skills, may show little benefit. Even in an integrative pediatric pain clinic, where psychotherapy and many complementary and alternative therapies are offered, only adolescents with sufficient motivation will follow through on recommendations to participate in these therapies and learn pain self-management skills. Preliminary data from a recent multi-method study conducted by the investigators suggest that adolescent motivation to learn pain self- management may be reduced by lack of ongoing reinforcement after a clinic visit and/or by patients'perceptions of difference from peers and of isolation in an inexplicable illness. We propose to conduct a pilot study: an exploratory controlled trial of an innovative peer-mentorship intervention to model behavior and provide ongoing reinforcement to adolescents, relieve perceptions of difference, isolation and helplessness, and support and reinforce positive expectations and self-efficacy beliefs, using a structured protocol developed within a social learning model based on cognitive- behavioral theory.
Many American adolescents suffer from recurrent pain, which may impair their physical, social, and academic functioning. Although they may benefit from therapies that teach pain self-management skills, adolescents who feel isolated in their illness and have low expectations of benefiting from therapy may fail to participate or to persist in such therapies without sufficient reinforcement. This research will test a peer- mentorship intervention that may promote adherence and skills-building through modeling and reinforcement, with positive effects on physical, social and academic functioning.
| Goldenberg, David; Payne, Laura A; Hayes, Loran P et al. (2013) Peer mentorship teaches social tools for pain self-management: A case study. J Pain Manag 6:61-68 |
| Allen, Laura B; Tsao, Jennie C I; Hayes, Loran P et al. (2011) Peer mentorship to promote effective pain management in adolescents: study protocol for a randomised controlled trial. Trials 12:132 |
