Natoshia Raishevich Cunningham1, Anjana Jagpal2, Susan T Tran3, Susmita Kashikar-Zuck1, Kenneth R Goldschneider4, Robert C Coghill4, Anne M Lynch-Jordan5. 1. Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; University of Cincinnati College of Medicine, Cincinnati, OH. 2. Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 3. Department of Psychology, DePaul University, Chicago, IL. 4. University of Cincinnati College of Medicine, Cincinnati, OH; Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 5. Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; University of Cincinnati College of Medicine, Cincinnati, OH; Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Abstract
OBJECTIVE: To evaluate whether clinical anxiety in children presenting to a pediatric pain management center is associated with a poorer treatment response for those who completed pain-focused cognitive behavioral therapy (CBT). STUDY DESIGN: The total sample consisted of 175 children, 40 of whom completed CBT for chronic pain. The Screen for Child Anxiety Related Emotional Disorders was completed at initial evaluation and outcome measures (average pain intensity and the Functional Disability Inventory) were collected during the initial evaluation and at the end of CBT. Group differences in outcomes were examined following CBT. The role of anxiety in CBT initiation and completion was also explored. RESULTS: Presence of clinical anxiety was associated with greater initiation and/or completion of pain-focused CBT but also a poorer treatment response. Specifically, the group with subclinical anxiety exhibited a substantial reduction in pain intensity, and the group with clinical anxiety exhibited a more limited response to treatment (F [1, 36] = 13.68 P < .01). A similar effect was observed for Functional Disability Inventory, such that the group with clinical anxiety had a significantly smaller response to treatment (F [1, 38] = 4.33 P < .05). The difference in pain and disability between groups following CBT suggest moderate effects (Cohen d = 0.77 and 0.78, respectively). CONCLUSIONS: Although youths with clinical anxiety are more likely to start and/or complete pain-focused CBT, anxiety has an adverse impact on CBT treatment response in children with chronic pain. Identification of patients with anxiety and use of tailored behavioral interventions may improve clinical outcomes.
OBJECTIVE: To evaluate whether clinical anxiety in children presenting to a pediatric pain management center is associated with a poorer treatment response for those who completed pain-focused cognitive behavioral therapy (CBT). STUDY DESIGN: The total sample consisted of 175 children, 40 of whom completed CBT for chronic pain. The Screen for ChildAnxiety Related Emotional Disorders was completed at initial evaluation and outcome measures (average pain intensity and the Functional Disability Inventory) were collected during the initial evaluation and at the end of CBT. Group differences in outcomes were examined following CBT. The role of anxiety in CBT initiation and completion was also explored. RESULTS: Presence of clinical anxiety was associated with greater initiation and/or completion of pain-focused CBT but also a poorer treatment response. Specifically, the group with subclinical anxiety exhibited a substantial reduction in pain intensity, and the group with clinical anxiety exhibited a more limited response to treatment (F [1, 36] = 13.68 P < .01). A similar effect was observed for Functional Disability Inventory, such that the group with clinical anxiety had a significantly smaller response to treatment (F [1, 38] = 4.33 P < .05). The difference in pain and disability between groups following CBT suggest moderate effects (Cohen d = 0.77 and 0.78, respectively). CONCLUSIONS: Although youths with clinical anxiety are more likely to start and/or complete pain-focused CBT, anxiety has an adverse impact on CBT treatment response in children with chronic pain. Identification of patients with anxiety and use of tailored behavioral interventions may improve clinical outcomes.
Authors: Soumitri Sil; Lesley M Arnold; Anne Lynch-Jordan; Tracy V Ting; James Peugh; Natoshia Cunningham; Scott W Powers; Daniel J Lovell; Philip J Hashkes; Murray Passo; Kenneth N Schikler; Susmita Kashikar-Zuck Journal: Pain Date: 2014-03-17 Impact factor: 6.961
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Authors: Natoshia R Cunningham; Anne Lynch-Jordan; Adam G Mezoff; Michael K Farrell; Mitchell B Cohen; Susmita Kashikar-Zuck Journal: J Pediatr Gastroenterol Nutr Date: 2013-05 Impact factor: 2.839
Authors: Kristen E Jastrowski Mano; Jenny R Evans; Susan T Tran; Kim Anderson Khan; Steven J Weisman; Keri R Hainsworth Journal: J Pediatr Psychol Date: 2012-06-07
Authors: Natoshia R Cunningham; Mitchell B Cohen; Michael K Farrell; Adam G Mezoff; Anne Lynch-Jordan; Susmita Kashikar-Zuck Journal: J Pediatr Gastroenterol Nutr Date: 2015-03 Impact factor: 2.839
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Authors: Ellyn K Dunbar; Phil J Greer; Stephen T Amann; Samer Alkaade; Peter Banks; Randall Brand; Darwin L Conwell; Christopher E Forsmark; Timothy B Gardner; Nalini M Guda; Michele D Lewis; Jorge D Machicado; Thiruvengadam Muniraj; Georgios I Papachristou; Joseph Romagnuolo; Bimaljit S Sandhu; Stuart Sherman; Adam Slivka; C Mel Wilcox; Dhiraj Yadav; David C Whitcomb Journal: Am J Gastroenterol Date: 2021-10-01 Impact factor: 12.045