Cited by 56Pediatric Pain Management TechniquesMusculoskeletal pain and rehabilitationPain Management and Treatment

The DOI matches its Crossref record; 51 of the 51 references it cites were found in a registry or an index.

Avoid or engage? Outcomes of graded exposure in youth with chronic pain using a sequential replicated single-case randomized design

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Abstract

Pain-related fear is typically associated with avoidance behavior and pain-related disability in youth with chronic pain. Youth with elevated pain-related fear have attenuated treatment responses; thus, targeted treatment is highly warranted. Evidence supporting graded in vivo exposure treatment (GET) for adults with chronic pain is considerable, but just emerging for youth. The current investigation represents the first sequential replicated and randomized single-case experimental phase design with multiple measures evaluating GET for youth with chronic pain, entitled GET Living. A cohort of 27 youth (81% female) with mixed chronic pain completed GET Living. For each participant, a no-treatment randomized baseline period was compared with GET Living and 3- and 6-month follow-ups. Daily changes in primary outcomes fear and avoidance and secondary outcomes pain catastrophizing, pain intensity, and pain acceptance were assessed using electronic diaries and subjected to descriptive and model-based inference analyses. Based on individual effect size calculations, a third of participants significantly improved by the end of treatment on fear, avoidance, and pain acceptance. By follow-up, over 80% of participants had improved across all primary and secondary outcomes. Model-based inference analysis results to examine the series of replicated cases were generally consistent. Improvements during GET Living was superior to the no-treatment randomized baseline period for avoidance, pain acceptance, and pain intensity, whereas fear and pain catastrophizing did not improve. All 5 outcomes emerged as significantly improved at 3- and 6-month follow-ups. The results of this replicated single-case experimental phase design support the effectiveness of graded exposure for youth with chronic pain and elevated pain-related fear avoidance.

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Crossref · 10.1097/j.pain.0000000000001735

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  • The SCED trial results supported the effectiveness of graded exposure for youth with chronic pain and elevated pain-related fear avoidance and provided sufficient evidence to proceed with an RCT comparing GL with an active evidence-based intervention.

    “The results of this sinlge-arm SCED trial supported the effectiveness of graded exposure for youth with chronic pain and elevated pain-related fear avoidance and provided sufficient evidence to proceed with a randomized clinical trial to compare GL with an active evidence-based intervention in youth with chronic pain.”

    From A randomized controlled trial of graded exposure treatment (GET living) for adolescents with chronic pain (2024) · cites this paper as [60]

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  • In the SCED pilot trial of GL, one third of patients improved at end of treatment and up to 80% improved by 3-month follow-up.

    “Data from our single arm, single case experimental design (SCED) trial of GL in adolescents demonstrated that one third of patients improved at the end of treatment with up to 80% improving by 3-month follow-up[60].”
  • GET Living was developed for adolescents with chronic pain by combining key elements of GET with acceptance-based exposure.

    “Combining key elements of GET with acceptance based exposure, GET Living was developed for adolescents with chronic pain (GL).”
  • In the SCED trial, multilevel modeling showed improvement during GL was superior to pre-treatment randomized baseline for avoidance, pain acceptance, and pain intensity, and fear and pain catastrophizing were significantly improved at 3- and 6-month follow-up.

    “Using multilevel modeling, improvement during GL was superior to pre-treatment randomized baseline for avoidance, pain acceptance, and pain intensity, with fear and pain catastrophizing also being significantly improved at 3- and 6-month follow-up[60].”
  • It is likely that the pandemic's effect subtly impacted all aspects of this trial and could have attenuated treatment effects, as improvements were smaller than observed in the GL pilot trial.

    “Although we aimed to capture the impact of the pandemic on our trial cohort and detailed these findings previously[50], it is likely that its effect subtly impacted all aspects of this trial and could have attenuated treatment effects as improvements were smaller than observed in the GL pilot trial[60].”

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  1. 2013, R development core team, RA Lang Environ Stat Comput, 55, 275

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Metadata

Authors
Simons, L. E., Vlaeyen, J. W. S., Declercq, L., Smith, A. M., Beebe, J., Hogan, M., Li, E., Kronman, C. A., Mahmud, F., Corey, J. R., Sieberg, C. B., & Ploski, C.
Affiliations
  • Stanford Medicine (US)
  • Maastricht University (NL)
  • Boston Children's Hospital (US)
  • Simmons University (US)
Corresponding author
Simons, Laura E.
Venue
Pain
Published
2019-10-28
Volume
161
Issue
3
Pages
520-531
ISSN
  • 0304-3959 (ISSN-L)
  • 1872-6623
OpenAlex
W2988211041
Cited by
56
References
51
Citations by year
2026: 6 · 2025: 4 · 2024: 12 · 2023: 8 · 2022: 9 · 2021: 9 · 2020: 5 · 2019: 1
FWCI
6.20
Type
journal article
Language
en
Open access
Locations
  • Pain (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
  • Lirias (KU Leuven) (submittedVersion, other-oa)
Funders
  • American Pain Society
  • Vlaamse regering (METH/15/011)
  • National Institute of General Medical Sciences (L30 GM134514, K23GM123372)
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (R21AR072921)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords
graded exposure, chronic pain, youth, fear of pain, avoidance behavior, pain catastrophizing, pain acceptance, pain intensity, electronic diary
MeSH terms
Activities of Daily Living, Adolescent, Avoidance Learning, Child, Fear, Female, Follow-Up Studies, Humans, Male, Medical Records, Pain Measurement, Treatment Outcome, Catastrophization, Chronic Pain, Pain Management

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