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Papers of the Week

Papers: 12 Oct 2019 - 18 Oct 2019


Human Studies

2020 May - Jun

J Pain



Moderators of internet-delivered cognitive-behavioral therapy for adolescents with chronic pain: Who benefits from treatment at long-term follow-up?


Cognitive-behavioral therapy (CBT) is effective for pediatric chronic pain, but little is understood about which youth are most likely to benefit. The current study aimed to identify individual characteristics for which CBT yielded the greatest (and least) clinical benefit among adolescents with chronic pain participating in a multi-center randomized controlled trial (RCT) of internet-delivered CBT (WebMAP2). A total of 273 adolescents ages 11-17 with chronic pain (Mage=14.7; 75.1% female) were randomly assigned to internet-delivered CBT or internet-delivered pain education and evaluated at pre-treatment, post-treatment, and two longer-term follow-up periods (6 and 12 months). Multi-level growth models tested several adolescent- and parent-level moderators of change in pain-related disability including (1) adolescent age, sex, pain characteristics, distress, and sleep quality and (2) parent education level, distress, and protective parenting behaviors. Young adolescents (ages 11-14 vs. older adolescents ages 15-17) and those whose parents experienced lower levels (vs. higher levels) of emotional distress responded better to internet CBT treatment, showing greater improvements in disability up to 12 months post-treatment. This study expands knowledge on who benefits most from internet-delivered psychological treatment for youth with chronic pain in the context of a large multicenter RCT, suggesting several avenues for maximizing treatment efficacy and durability in this population. Perspective: This study identified adolescent- and parent-level predictors of treatment response to Internet-based CBT for pediatric chronic pain up to 12 months later. Younger adolescents and those whose parents had lower levels of distress may particularly benefit from this intervention. Older adolescents and those whose parents exhibit higher distress may require alternative treatment approaches.