The proposed study will use both qualitative and quantitative methodologies to evaluate a multidisciplinary Pain Clinic at UCLA for the treatment of chronic pain in children, a problem which affects some 10-20% of children under 17, is often co-morbid with anxiety and depression disorders, and may establish behaviors which increase the risk of chronic pain syndrome and pain-associated disability in adulthood. The UCLA Pediatric Pain Clinic uses a biopsychosocial model to treat chronic pain in children and to promote behavioral and therapeutic change through enhancement of the child's sense of self-efficacy. The study will use oral history master narratives; validated quantitative measures of patient self-efficacy, self-management (an indicator of function); validated quantitative measures of pain level, co-morbid anxiety and depression; and conversation analysis of physician-patient interactions to study the trajectory of change in the Pain Clinic patients and in patients with the same diagnosis drawn from two pediatric subspecialty clinics. Narratives of change drawn from the oral histories will be co-analyzed with scores on the pre and post-treatment quantitative measures and with observations of practitioner strategy and behavior in patient interactions.
Our specific aims are: 1) to make a quantitative and qualitative comparison of the PPC treatment model with that used to treat persistent pain in two pediatric subspecialty clinics, comparing changes in patient pain level, anxiety, depression, self-efficacy and functioning; 2) to examine in depth the children's cognitive beliefs and affective reactions to pain, the sources of these beliefs and reactions, and the process of changes in cognition, anxiety and depression, and behavior during Clinic treatment; and 3) to use the quantitative and qualitative data gathered to identify specific factors within the PPC treatment model which may be further evaluated in the next phase, a controlled clinical trial of this model for the treatment of pain and co-morbid anxiety and depression.
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