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The Influence of Anxiety Reduction on Clinical Response to Pediatric Chronic Pain Rehabilitation

Benore, Ethan PhD*; D’Auria, Alexandra BS*,†; Banez, Gerard A. PhD*; Worley, Sarah MS*; Tang, Anne MS*

doi: 10.1097/AJP.0000000000000127
Original Articles

Objectives: This study investigates the relationship between anxiety reduction and functional outcomes in children and adolescents receiving intensive interdisciplinary rehabilitation services for chronic pain (CP). Specifically, we evaluated whether: (1) anxiety changes over the course of treatment; (2) anxiety covaries with functional outcomes to rehabilitation; and (3) change in anxiety predicts change in functional outcomes from rehabilitation for CP. Using 3 separate measures assessing anxiety-related constructs, we hypothesized that anxiety would be associated with functioning, both before and following intensive rehabilitation for CP. Further, we hypothesized that a decrease in anxiety-related symptoms following rehabilitation would predict a positive change in functional outcomes.

Materials and Methods: Our sample consisted of 119 children and adolescents treated for CP in an interdisciplinary rehabilitation program between 2007 and 2012. Children completed 3 measures related to anxiety (general anxiety, pain-specific anxiety, pain catastrophizing) and 2 functional outcome measures (eg, Bath Adolescent Pain Questionnaire, PedsQL) as part of clinical care.

Results: Measures of anxiety-related constructs were significantly correlated with measures of impairment and functioning, both at admission and at 1-month postdischarge. Regression analyses demonstrated that, after controlling for age, sex, and pain level at admission, a decrease in anxiety significantly predicted between 14% and 40% unique variance in functional outcomes.

Discussion: The findings of this study support existing research on anxiety and CP, specifically the relationship between anxiety and pain-related disability. This study also supports the benefit of intensive interdisciplinary rehabilitation for both reducing anxiety and increasing functional outcomes, suggesting a possible link in children’s response to intervention. Study limitations and future directions for related research are discussed.

*Children’s Hospital, Cleveland Clinic, Cleveland

Department of Psychology, Kent State University, Kent, OH

G.A.B. has received a grant from CVS/Caremark Trust, Woonsocket, RI related to this research. The remaining authors declare no conflict of interest.

Reprints: Ethan Benore, PhD, Children’s Hospital, Cleveland Clinic, 2801 Martin Luther King Jr. Dr, Cleveland, OH 44104 (e-mail: benoree@ccf.org).

Received July 19, 2013

Received in revised form July 2, 2014

Accepted May 30, 2014

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