This R21 pilot study addresses behavioral and biopsychosocial research priorities of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) to conduct studies of non-pharmacological interventions, including technology-based interventions, for chronic symptoms such as pain. Chronic or recurrent pain is central feature of juvenile arthritis (JA). About 25 to 30 percent report moderate to severe pain and the great majority of children with JA report at least some pain lasting from 30 minutes to 24 hours a day, with a mean of 4.3 hours per day. In addition, long-term follow up shows that the adults who were diagnosed with JA report significantly greater pain, fatigue, and disability relative to gender-matched healthy cases. Thus, for many children with JA pain is a significant problem that persists into adulthood and is associated with significant disability. And, in spite of advancements in pharmacological treatments foonic childhood pain. The primary aim of this application is to develop and pilot test """"""""Jointstrong,"""""""" an adjunctive computer-based cognitive-behavioral intervention for pain in children with JA. This pilot study will randomly assign 36 children, 8 to 12 years with JA to the Jointstrong program or a wait-list control group. Daily diary measures of pain intensity, duration, and frequency, mood and stress, as well as quality of life measures will be taken during two-week intervals at baseline, immediate post-treatment, and 3-month follow-up. Hypotheses are that children who receive the Jointstrong in combination with standard medical care will demonstrate greater improvement on the pain, mood and stress, and quality of life measures than children in a standard medical care (wait-list) control group. If this pilot study is successful, a larger R01 clinical trial will be proposed to further validate the Jointstrong program. PROJECT NARRATIVE: The development of computer-based adjunctive pain management programs for children with chronic pain, such as JA, can be cost-effective and easily disseminated to patients and families via CD-ROM programs or on the Web. These programs can also reduce health care costs and functional disability and improve the quality of life for children with chronic or recurrent pain. ????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
