A randomized controlled trial of graded exposure treatment (GET living) for adolescents with chronic pain

Abstract

Graded exposure treatment (GET) is a theory-driven pain treatment that aims to improve functioning by exposing patients to activities previously feared and avoided. Combining key elements of GET with acceptance-based exposure, GET Living (GL) was developed for adolescents with chronic pain (GL). Based on robust treatment effects observed in our single-case experimental design pilot trial of GL (NCT01974791), we conducted a 2-arm randomized clinical trial comparing GL with multidisciplinary pain management (MPM) comprised of cognitive behavioral therapy and physical therapy for pain management (NCT03699007). A cohort of 68 youth with chronic musculoskeletal pain (M age 14.2 years; 81% female) were randomized to GL or MPM. Owing to COVID-19 restrictions, 54% of participants received zoom video delivered care. Assessments were collected at baseline, discharge, as well as at 3-month and 6-month follow-up. Primary outcomes were self-reported pain-related fear and avoidance. Secondary outcomes were child functional disability and parent protective responses to child pain. As hypothesized, GL improved in primary and secondary outcomes at 3-month follow-up. Contrary to our superiority hypothesis, there was no significant difference between GL and MPM. Patients reported both GL and MPM (in person and video) as credible and were highly satisfied with the treatment experience. Next steps will involve examining the single-case experimental design data embedded in this trial to facilitate an understanding of individual differences in treatment responses (eg, when effects occurred, what processes changed during treatment within the treatment arm). The current findings support GET Living and MPM for youth with chronic pain.

Figure 1.

CONSORT of enrollment.

Figure 2.. Primary Outcomes for GET Living (GL) and Multidisciplinary Pain Management (MPM).

Changes from basline (BL) to discharge (End), 3-month follow-up (3m), and 6-month follow-up (6m) for primary outcomes of Fear of Pain, Avoidance of Activities, Photographs of Daily Activities (PHODA) Worry, and PHODA anticipated pain.

Figure 3.. Secondary Outcomes for GET Living (GL) and Multidisciplinary Pain Management (MPM).

Changes from basline (BL) to discharge (End), 3-month follow-up (3m), and 6-month follow-up (6m) for secondary outcomes of Functional Disability and Parent Protective Behavior.