1 00:00:05,720 --> 00:00:07,520 I AM CATHERINE LAW, DIRECTOR OF 2 00:00:07,520 --> 00:00:09,240 COMMUNICATIONS AT THE NATIONAL 3 00:00:09,240 --> 00:00:13,400 CENTER FOR COMPLEMENTARY AND 4 00:00:13,400 --> 00:00:14,880 INTEGRATIVE HEALTH, OR NCCIH, AT 5 00:00:14,880 --> 00:00:15,480 THE NATIONAL INSTITUTES OF 6 00:00:15,480 --> 00:00:17,320 HEALTH. 7 00:00:17,320 --> 00:00:18,800 I WANT TO WELCOME YOU 8 00:00:18,800 --> 00:00:20,760 TO THE LATEST PRESENTATION IN 9 00:00:20,760 --> 00:00:23,600 NCCIH’S INTEGRATIVE MEDICINE 10 00:00:23,600 --> 00:00:26,720 RESEARCH LECTURE SERIES. 11 00:00:26,720 --> 00:00:29,080 TODAY’S LECTURE, "NEW INSIGHTS 12 00:00:29,080 --> 00:00:32,640 INTO PREVENTION AND MANAGEMENT 13 00:00:32,640 --> 00:00:34,920 OF CHRONIC PAIN IN CHILDREN AND 14 00:00:34,920 --> 00:00:36,440 ADOLESCENTS," IS PRESENTED BY 15 00:00:36,440 --> 00:00:39,800 DR. TONYA PALERMO FROM THE 16 00:00:39,800 --> 00:00:41,880 UNIVERSITY OF WASHINGTON. 17 00:00:41,880 --> 00:00:42,960 I AM NOW PLEASED TO INVITE 18 00:00:42,960 --> 00:00:44,480 DR. DAVID SHURTLEFF, DEPUTY 19 00:00:44,480 --> 00:00:47,480 DIRECTOR OF NCCIH, TO INTRODUCE 20 00:00:47,480 --> 00:00:49,880 OUR SPEAKER. 21 00:00:49,880 --> 00:00:51,840 AND I ALSO WANT TO NOTE THAT WE 22 00:00:51,840 --> 00:00:55,400 ARE JOINED TODAY BY DR. HELENE 23 00:00:55,400 --> 00:00:57,400 LANGEVIN, DIRECTOR OF NCCIH, AND 24 00:00:57,400 --> 00:00:59,360 DR. EMILY EDWARDS, DIRECTOR OF 25 00:00:59,360 --> 00:01:01,040 OUR DIVISION OF EXTRAMURAL 26 00:01:01,040 --> 00:01:03,120 RESEARCH HERE AT NCCIH. 27 00:01:03,120 --> 00:01:04,200 WE'RE PLEASED TO HAVE ALL OF 28 00:01:04,200 --> 00:01:06,760 THEM WITH US AS WE HEAR 29 00:01:06,760 --> 00:01:08,600 DR. PALERMO'S LECTURE. 30 00:01:08,600 --> 00:01:09,480 DR. SHURTLEFF, PLEASE TAKE IT 31 00:01:09,480 --> 00:01:09,680 AWAY. 32 00:01:09,680 --> 00:01:11,320 >>WELL, THANK YOU, CATHERINE, 33 00:01:11,320 --> 00:01:14,320 AND WELCOME, EVERYONE, TO THE 34 00:01:14,320 --> 00:01:16,360 SECOND OF TWO LECTURES IN OUR 35 00:01:16,360 --> 00:01:17,560 SPRING 2023 SEASON IN THE 36 00:01:17,560 --> 00:01:19,760 INTEGRATIVE MEDICINE LECTURE 37 00:01:19,760 --> 00:01:25,200 SERIES HERE SPONSORED BY NCCIH. 38 00:01:25,200 --> 00:01:27,280 TODAY WE'RE DELIGHTED TO WELCOME 39 00:01:27,280 --> 00:01:29,160 DR. TONYA PALERMO WHO WILL SPEAK 40 00:01:29,160 --> 00:01:32,640 ON NEW INSIGHTS INTO PREVENTION 41 00:01:32,640 --> 00:01:33,600 AND MANAGEMENT OF CHRONIC PAIN 42 00:01:33,600 --> 00:01:34,520 IN CHILDREN AND ADOLESCENTS. 43 00:01:34,520 --> 00:01:37,000 JUST A NOTE, DR. PALERMO'S TOPIC 44 00:01:37,000 --> 00:01:38,120 REFLECTS AT LEAST A COUPLE 45 00:01:38,120 --> 00:01:40,080 CURRENT AREAS OF INTEREST AT 46 00:01:40,080 --> 00:01:41,080 NCCIH. 47 00:01:41,080 --> 00:01:43,040 THE FIRST INCLUDES OUR INTEREST 48 00:01:43,040 --> 00:01:45,120 IN SYMPTOM MANAGEMENT, INCLUDING 49 00:01:45,120 --> 00:01:46,000 NON-PHARMACOLOGICAL APPROACHES 50 00:01:46,000 --> 00:01:48,520 TO MANAGE AND TREAT OR PREVENT 51 00:01:48,520 --> 00:01:50,800 CHRONIC PAIN. 52 00:01:50,800 --> 00:01:52,280 CLEARLY A PUBLIC HEALTH CRISIS 53 00:01:52,280 --> 00:01:53,000 IN THE UNITED STATES. 54 00:01:53,000 --> 00:01:56,280 IT AFFECTS 18% OF U.S. ADULTS, 55 00:01:56,280 --> 00:01:57,920 HAVE CHRONIC PAIN, ABOUT 56 00:01:57,920 --> 00:01:59,680 40 MILLION U.S. ADULTS IN THE 57 00:01:59,680 --> 00:02:00,120 UNITED STATES. 58 00:02:00,120 --> 00:02:02,160 AND AS WE WILL LEARN FROM 59 00:02:02,160 --> 00:02:02,880 DR. PALERMO, CHRONIC PAIN 60 00:02:02,880 --> 00:02:04,800 AFFECTS UP TO 40% OF CHILDREN 61 00:02:04,800 --> 00:02:08,840 AND ADOLESCENTS WORLDWIDE, 62 00:02:08,840 --> 00:02:10,360 CLEARLY A GLOBAL HEALTH EPIDEMIC 63 00:02:10,360 --> 00:02:12,920 IN SOME RESPECTS. 64 00:02:12,920 --> 00:02:14,520 OPIOIDS AND DRUGS CAN BE 65 00:02:14,520 --> 00:02:15,960 EFFECTIVE IN SOME CASES, BUT AS 66 00:02:15,960 --> 00:02:17,480 WE ALL KNOW, THEY CARRY RISKS 67 00:02:17,480 --> 00:02:19,440 AND CAN HAVE ADVERSE EFFECTS, 68 00:02:19,440 --> 00:02:21,240 INCLUDING OVERDOSE AND DEATH. 69 00:02:21,240 --> 00:02:23,600 OTHER OPTIONS ARE NEEDED, 70 00:02:23,600 --> 00:02:25,680 INCLUDING NON-PHARMACOLOGIC, 71 00:02:25,680 --> 00:02:26,480 BEHAVIORAL INTERVENTIONS THAT 72 00:02:26,480 --> 00:02:27,560 ADDRESS THIS PUBLIC HEALTH 73 00:02:27,560 --> 00:02:29,080 CRISIS, AND I KNOW DR. PALERMO 74 00:02:29,080 --> 00:02:31,040 WILL GIVE US MORE INFORMATION ON 75 00:02:31,040 --> 00:02:33,560 THIS VERY TOPIC. 76 00:02:33,560 --> 00:02:35,880 TODAY'S TOPIC IS ALSO RELATED TO 77 00:02:35,880 --> 00:02:37,160 NCCIH'S INTEREST IN RESILIENCE 78 00:02:37,160 --> 00:02:39,280 IN THE CONTEXT OF THIS LECTURE, 79 00:02:39,280 --> 00:02:40,720 RESILIENCE CAN BE DEFINED AS THE 80 00:02:40,720 --> 00:02:43,080 CAPACITY TO ADAPT, RECOVER, 81 00:02:43,080 --> 00:02:44,600 BOUNCE BACK OR GROW FROM A 82 00:02:44,600 --> 00:02:46,720 PAINFUL INJURY OR DISEASE. 83 00:02:46,720 --> 00:02:48,440 AND WE ALL KNOW RESILIENCE 84 00:02:48,440 --> 00:02:50,320 INVOLVES MANY FACTORS COVERED 85 00:02:50,320 --> 00:02:52,520 UNDER THE NCCIH OVERARCHING 86 00:02:52,520 --> 00:02:55,360 FRAMEWORK OF WHOLE PERSON HEALTH 87 00:02:55,360 --> 00:02:55,640 RESEARCH. 88 00:02:55,640 --> 00:02:57,960 THOSE FACTORS INCLUDED IN THE 89 00:02:57,960 --> 00:02:58,840 FRAMEWORK INCLUDE AN 90 00:02:58,840 --> 00:03:00,840 INDIVIDUAL'S SOCIAL SUPPORT 91 00:03:00,840 --> 00:03:02,680 SYSTEM, COMMUNITY AND 92 00:03:02,680 --> 00:03:04,120 CONNECTION, EMOTIONAL AND 93 00:03:04,120 --> 00:03:05,920 BEHAVIORAL FLEXIBILITY, AND AN 94 00:03:05,920 --> 00:03:07,360 INDIVIDUAL'S MOLECULAR, 95 00:03:07,360 --> 00:03:08,680 CELLULAR, PHYSIOLOGICAL AND 96 00:03:08,680 --> 00:03:11,520 ORGAN SYSTEMS WITHIN THE WHOLE 97 00:03:11,520 --> 00:03:12,040 PERSON. 98 00:03:12,040 --> 00:03:13,600 YOU CAN FIND OUT MORE ABOUT 99 00:03:13,600 --> 00:03:15,240 WHOLE PERSON HEALTH RESEARCH AND 100 00:03:15,240 --> 00:03:16,640 OUR INTERESTS IN INTEGRATING 101 00:03:16,640 --> 00:03:18,200 ACROSS SYSTEMS AND DISCIPLINES 102 00:03:18,200 --> 00:03:20,960 ON OUR WEBSITE, AND IN OUR 103 00:03:20,960 --> 00:03:22,360 STRATEGIC PLAN. 104 00:03:22,360 --> 00:03:27,080 NOW IT'S MY GREAT PLEASURE TO 105 00:03:27,080 --> 00:03:30,480 INTRODUCE AND WELCOME DR. TONYA 106 00:03:30,480 --> 00:03:31,680 PALERMO, PROFESSOR AND VICE 107 00:03:31,680 --> 00:03:33,280 CHAIR OF RESEARCH IN THE 108 00:03:33,280 --> 00:03:34,640 DEPARTMENT OF ANESTHESIOLOGY AND 109 00:03:34,640 --> 00:03:35,800 PAIN MEDICINE. 110 00:03:35,800 --> 00:03:38,640 SHE'S ALSO THE HUGHES M. AND 111 00:03:38,640 --> 00:03:39,400 KATHERINE BLAKE ENDOWED 112 00:03:39,400 --> 00:03:41,400 PROFESSOR IN HEALTH PSYCHOLOGY 113 00:03:41,400 --> 00:03:43,160 AND AN ADJUNCT PROFESSOR OF 114 00:03:43,160 --> 00:03:45,760 PEDIATRICS AND PSYCHIATRY. 115 00:03:45,760 --> 00:03:46,640 DR. PALERMO ALSO HOLDS 116 00:03:46,640 --> 00:03:47,760 APPOINTMENTS AT SEATTLE 117 00:03:47,760 --> 00:03:49,480 CHILDREN'S RESEARCH INSTITUTE, 118 00:03:49,480 --> 00:03:51,600 AS ASSOCIATE DIRECTOR OF THE 119 00:03:51,600 --> 00:03:53,960 CENTER FOR CHILD HEALTH, 120 00:03:53,960 --> 00:03:55,000 BEHAVIORAL AND DEVELOPMENT AND 121 00:03:55,000 --> 00:03:56,240 DIRECTOR OF THE PEDIATRIC PAIN 122 00:03:56,240 --> 00:03:58,880 AND SLEEP INNOVATIONS LAB. 123 00:03:58,880 --> 00:04:00,200 SHE'S EDITOR-IN-CHIEF OF A 124 00:04:00,200 --> 00:04:02,000 JOURNAL WE ALL KNOW WELL, THE 125 00:04:02,000 --> 00:04:05,040 JOURNAL OF PAIN, AND DR. PALERMO 126 00:04:05,040 --> 00:04:06,440 COMPLETED HER UNDERGRADUATE 127 00:04:06,440 --> 00:04:09,280 TRAINING IN PSYCHOLOGY AT THE 128 00:04:09,280 --> 00:04:10,280 UNIVERSITY OF CALIFORNIA 129 00:04:10,280 --> 00:04:12,760 LOS ANGELES, UCLA, AND HER PH.D. 130 00:04:12,760 --> 00:04:14,760 IN CLINICAL PSYCHOLOGY AT CASE 131 00:04:14,760 --> 00:04:15,360 WESTERN RESERVE UNIVERSITY. 132 00:04:15,360 --> 00:04:18,520 IN ADDITION TO OVER 300 ARTICLES 133 00:04:18,520 --> 00:04:20,120 IN PEER REVIEWED JOURNALS, 134 00:04:20,120 --> 00:04:21,840 DR. PALERMO HAS AUTHORED TWO 135 00:04:21,840 --> 00:04:23,280 BOOKS MANAGING YOUR CHILD'S 136 00:04:23,280 --> 00:04:27,240 CHRONIC PAIN, AND COGNITIVE 137 00:04:27,240 --> 00:04:28,720 THERAPY FOR CHRONIC PAIN IN 138 00:04:28,720 --> 00:04:30,480 CHILDREN AND ADOLESCENTS. 139 00:04:30,480 --> 00:04:32,240 MANY NIH INSTITUTES AND CENTERS 140 00:04:32,240 --> 00:04:33,680 HAVE FUNDED HER RESEARCH, 141 00:04:33,680 --> 00:04:35,440 INCLUDING THE EUNICE KENNEDY 142 00:04:35,440 --> 00:04:37,200 SHRIVER NATIONAL INSTITUTE ON 143 00:04:37,200 --> 00:04:38,360 CHILD HEALTH AND HUMAN 144 00:04:38,360 --> 00:04:39,280 DEVELOPMENT, THE NATIONAL 145 00:04:39,280 --> 00:04:42,640 INSTITUTE ON GENERAL MEDICAL 146 00:04:42,640 --> 00:04:44,160 SCIENCES, THE NATIONAL INSTITUTE 147 00:04:44,160 --> 00:04:45,520 OF DIABETES AND DIGESTIVE AND 148 00:04:45,520 --> 00:04:47,200 KIDNEY DISEASES, AND THE 149 00:04:47,200 --> 00:04:48,560 NATIONAL INSTITUTE OF 150 00:04:48,560 --> 00:04:49,760 NEUROLOGICAL DISORDERS AND 151 00:04:49,760 --> 00:04:50,880 STROKE. 152 00:04:50,880 --> 00:04:53,680 SO NOW I WANT TO WELCOME YOU 153 00:04:53,680 --> 00:04:54,440 AGAIN, DR. PALERMO, AND I'LL 154 00:04:54,440 --> 00:04:55,120 TURN THE MIC OVER TO YOU. 155 00:04:55,120 --> 00:04:57,960 THANK YOU. 156 00:04:57,960 --> 00:04:59,680 >>THANK YOU SO MUCH FOR THE 157 00:04:59,680 --> 00:05:01,760 NICE INTRODUCTION, AND FOR THE 158 00:05:01,760 --> 00:05:04,400 INVITATION TO PRESENT TODAY. 159 00:05:04,400 --> 00:05:06,800 IT'S A PLEASURE AND OPPORTUNITY 160 00:05:06,800 --> 00:05:08,360 TO SHARE MY WORK ON PREVENTION 161 00:05:08,360 --> 00:05:11,080 AND MANAGEMENT OF CHRONIC PAIN 162 00:05:11,080 --> 00:05:12,560 IN CHILDREN AND 163 00:05:12,560 --> 00:05:13,680 ADOLESCENTS. 164 00:05:13,680 --> 00:05:15,400 THIS SHOWS MY DISCLOSURES. 165 00:05:15,400 --> 00:05:17,880 AS MENTIONED MY SUPPORT FROM 166 00:05:17,880 --> 00:05:18,800 NATIONAL INSTITUTES OF HEALTH AS 167 00:05:18,800 --> 00:05:20,320 WELL AS ROYALTIES THROUGH OXFORD 168 00:05:20,320 --> 00:05:23,600 UNIVERSITY PRESS. 169 00:05:23,600 --> 00:05:25,560 MY GOAL TODAY IS TO ANSWER THESE 170 00:05:25,560 --> 00:05:27,200 FOUR QUESTIONS: WHY DOES PAIN 171 00:05:27,200 --> 00:05:29,440 IN CHILDREN MATTER? 172 00:05:29,440 --> 00:05:31,040 DO CHILDREN GROW OUT OF PAIN? 173 00:05:31,040 --> 00:05:33,400 CAN WE PREVENT PAIN AND CHRONIC 174 00:05:33,400 --> 00:05:34,320 DISABILITY? 175 00:05:34,320 --> 00:05:36,160 AND, WHAT IS THE ROLE OF 176 00:05:36,160 --> 00:05:41,440 PSYCHOLOGICAL INTERVENTIONS? 177 00:05:41,440 --> 00:05:42,840 TO BEGIN TO ADDRESS WHY PAIN IN 178 00:05:42,840 --> 00:05:44,160 CHILDREN MATTERS, IT'S IMPORTANT 179 00:05:44,160 --> 00:05:46,040 TO UNDERSTAND SOME EPIDEMIOLOGY 180 00:05:46,040 --> 00:05:49,880 OF PEDIATRIC CHRONIC PAIN. 181 00:05:49,880 --> 00:05:52,800 GLOBALLY, A HIGH PREVALENCE OF 182 00:05:52,800 --> 00:05:55,080 ADOLESCENTS DESCRIBE CHRONIC 183 00:05:55,080 --> 00:05:57,800 WEEKLY PAIN, OVER 40%. 184 00:05:57,800 --> 00:06:01,560 IF WE EXAMINE ESTIMATES THAT 185 00:06:01,560 --> 00:06:03,400 INCLUDE A DEFINITION OF HAVING 186 00:06:03,400 --> 00:06:04,600 PAIN THAT'S ACCOMPANIED BY 187 00:06:04,600 --> 00:06:06,360 MODERATE TO SEVERE DISABILITY, 188 00:06:06,360 --> 00:06:09,080 THE ESTIMATES ARE ABOUT 5 TO 8% 189 00:06:09,080 --> 00:06:10,840 OF YOUNG PEOPLE. 190 00:06:10,840 --> 00:06:13,680 WE KNOW THAT THE MOST COMMON 191 00:06:13,680 --> 00:06:15,760 TYPE OF PAIN IN CHILDHOOD IS A 192 00:06:15,760 --> 00:06:19,040 PRIMARY PAIN CONDITION INVOLVING 193 00:06:19,040 --> 00:06:20,680 THESE LOCATIONS HERE, THE HEAD, 194 00:06:20,680 --> 00:06:23,280 THE ABDOMEN AND MUSCULOSKELETAL 195 00:06:23,280 --> 00:06:24,240 LOCATIONS. 196 00:06:24,240 --> 00:06:27,360 BUT CHILDREN ALSO HAVE 197 00:06:27,360 --> 00:06:29,320 DISEASE-RELATED PAIN. 198 00:06:29,320 --> 00:06:30,840 WE KNOW SIMILAR TO ADULTS THAT 199 00:06:30,840 --> 00:06:32,160 MULTIPLE BODILY LOCATIONS OF 200 00:06:32,160 --> 00:06:33,600 PAIN ARE QUITE COMMON. 201 00:06:33,600 --> 00:06:35,560 THIS IS TRUE IN CHILDHOOD, WHERE 202 00:06:35,560 --> 00:06:37,080 MANY CHILDREN HAVE MORE THAN ONE 203 00:06:37,080 --> 00:06:41,920 SITE OR LOCATION OF PAIN. 204 00:06:41,920 --> 00:06:44,000 AND DURING CHILDHOOD, THERE'S A 205 00:06:44,000 --> 00:06:47,160 PEAK RISE POST PUBERTY IN THE 206 00:06:47,160 --> 00:06:48,800 ONSET OF CHRONIC PAIN, WHERE WE 207 00:06:48,800 --> 00:06:50,240 ALSO SEE THAT GIRLS HAVE A 208 00:06:50,240 --> 00:06:51,880 GREATER INCIDENT OF MOST FORMS 209 00:06:51,880 --> 00:06:55,880 OF CHRONIC PAIN, AND THE 210 00:06:55,880 --> 00:06:57,880 MECHANISMS THAT ACCOUNT FOR THE 211 00:06:57,880 --> 00:06:59,400 CHANGES DURING PUBERTY THAT 212 00:06:59,400 --> 00:07:01,160 MIGHT ACCOUNT FOR THIS ARE NOT 213 00:07:01,160 --> 00:07:04,000 WELL UNDERSTOOD, BUT IS AN 214 00:07:04,000 --> 00:07:05,200 IMPORTANT AND ACTIVE AREA OF 215 00:07:05,200 --> 00:07:07,960 RESEARCH. 216 00:07:07,960 --> 00:07:09,920 PAIN IN CHILDREN ALSO MATTERS 217 00:07:09,920 --> 00:07:12,760 BECAUSE PAIN CAN IMPACT MANY 218 00:07:12,760 --> 00:07:14,520 ASPECTS OF EVERYDAY LIVING FOR 219 00:07:14,520 --> 00:07:15,800 CHILDREN, INCLUDING THEIR 220 00:07:15,800 --> 00:07:17,800 ABILITY TO ATTEND SCHOOL, TO 221 00:07:17,800 --> 00:07:21,720 PERFORM AT SCHOOL, THEIR SOCIAL 222 00:07:21,720 --> 00:07:24,120 FUNCTIONING, THEIR PHYSICAL 223 00:07:24,120 --> 00:07:27,680 ACTIVITIES, THEIR ABILITY TO 224 00:07:27,680 --> 00:07:29,480 SLEEP, AS WELL AS PSYCHOLOGICAL 225 00:07:29,480 --> 00:07:34,200 AND BEHAVIORAL FUNCTIONING. 226 00:07:34,200 --> 00:07:35,920 PAIN IN CHILDREN MATTERS BECAUSE 227 00:07:35,920 --> 00:07:37,240 IT ALSO IMPACTS PARENTS AND 228 00:07:37,240 --> 00:07:38,280 FAMILIES. 229 00:07:38,280 --> 00:07:39,560 WE KNOW THAT PARENTS DESCRIBE A 230 00:07:39,560 --> 00:07:40,760 HIGH LEVEL OF BURDEN IN CARING 231 00:07:40,760 --> 00:07:43,040 FOR A CHILD WITH CHRONIC PAIN. 232 00:07:43,040 --> 00:07:45,800 THEY CAN EXPERIENCE THEIR OWN 233 00:07:45,800 --> 00:07:47,840 FEELINGS AND SYMPTOMS OF 234 00:07:47,840 --> 00:07:49,120 DEPRESSION AND ANXIETY, AS WELL 235 00:07:49,120 --> 00:07:51,600 AS ANGER AND HOSTILITY. 236 00:07:51,600 --> 00:07:53,440 PARENTS REPORT FEELINGS OF BEING 237 00:07:53,440 --> 00:07:55,080 BLAMED BY HEALTHCARE 238 00:07:55,080 --> 00:07:55,640 PROFESSIONALS. 239 00:07:55,640 --> 00:07:57,400 AND THEY REPORT A SENSE OF 240 00:07:57,400 --> 00:07:59,240 ISOLATION AND A LACK OF SOCIAL 241 00:07:59,240 --> 00:08:01,200 SUPPORT. 242 00:08:01,200 --> 00:08:02,920 PARENTS ALSO DESCRIBE A 243 00:08:02,920 --> 00:08:04,040 FINANCIAL BURDEN, WHERE THEY 244 00:08:04,040 --> 00:08:06,160 INCUR A HIGH LEVEL OF OUT OF 245 00:08:06,160 --> 00:08:07,320 POCKET COST IN CARING FOR A 246 00:08:07,320 --> 00:08:12,600 CHILD WITH CHRONIC PAIN. 247 00:08:12,600 --> 00:08:14,440 INDEED, ESTIMATES OF PEDIATRIC 248 00:08:14,440 --> 00:08:16,000 CHRONIC PAIN DEMONSTRATE THAT 249 00:08:16,000 --> 00:08:17,840 PAIN IS COSTLY. 250 00:08:17,840 --> 00:08:26,360 THIS IS WORK DONE IN MY LAB WHO 251 00:08:26,360 --> 00:08:27,400 EXPLAINED HEALTHCARE 252 00:08:27,400 --> 00:08:29,320 EXPENDITURES ASSOCIATED WITH 253 00:08:29,320 --> 00:08:31,400 PEDIATRIC PAIN RELATED 254 00:08:31,400 --> 00:08:34,600 CONDITIONS, INCLUDING ADHD, 255 00:08:34,600 --> 00:08:35,440 ASTHMA AND OBESITY. 256 00:08:35,440 --> 00:08:38,720 AS YOU CAN SEE IN THE RED BAR, 257 00:08:38,720 --> 00:08:40,120 EXPENDITURES FOR PAIN-RELATED 258 00:08:40,120 --> 00:08:42,120 CONDITIONS ARE MUCH HIGHER 259 00:08:42,120 --> 00:08:43,000 COMPARED TO OTHER CONDITIONS. 260 00:08:43,000 --> 00:08:44,880 AS I'LL SHOW YOU IN A MOMENT, IF 261 00:08:44,880 --> 00:08:46,720 WE THINK ABOUT THE POTENTIAL FOR 262 00:08:46,720 --> 00:08:49,160 COST TO COMPOUND OVER THE 263 00:08:49,160 --> 00:08:51,000 LIFESPAN, THAT IF CHILDREN 264 00:08:51,000 --> 00:08:52,800 CONTINUE WITH CHRONIC PAIN INTO 265 00:08:52,800 --> 00:08:54,240 ADULTHOOD, THAT THESE COSTS WILL 266 00:08:54,240 --> 00:08:58,200 CONTINUE. 267 00:08:58,200 --> 00:09:00,240 WE ALSO KNOW THAT THERE ARE 268 00:09:00,240 --> 00:09:02,680 DISPARITIES IN THE MANAGEMENT OF 269 00:09:02,680 --> 00:09:04,520 CHILDREN'S PAIN BY RACE, 270 00:09:04,520 --> 00:09:05,640 ETHNICITY AND OTHER FACTORS. 271 00:09:05,640 --> 00:09:07,640 THIS IS A STUDY FROM COLLEAGUES 272 00:09:07,640 --> 00:09:09,880 AT UNIVERSITY OF WASHINGTON 273 00:09:09,880 --> 00:09:12,320 INCLUDING EMILY LAW WHO'S IN MY 274 00:09:12,320 --> 00:09:13,960 LAB, LOOKING SPECIFICALLY AT 275 00:09:13,960 --> 00:09:16,000 MANAGEMENT OF MIGRAINE IN THE 276 00:09:16,000 --> 00:09:17,000 EMERGENCY DEPARTMENT, AND WHAT 277 00:09:17,000 --> 00:09:19,320 THEY FOUND IS THAT CHILDREN FROM 278 00:09:19,320 --> 00:09:20,720 UNDERREPRESENTED RACIAL AND 279 00:09:20,720 --> 00:09:22,160 ETHNIC GROUPS AND THOSE WHOSE 280 00:09:22,160 --> 00:09:24,120 PARENTS HAD NON-ENGLISH LANGUAGE 281 00:09:24,120 --> 00:09:26,000 OF CARE WERE LESS LIKELY TO 282 00:09:26,000 --> 00:09:28,040 RECEIVE BEST PRACTICE MIGRAINE 283 00:09:28,040 --> 00:09:28,800 TREATMENT IN THE EMERGENCY 284 00:09:28,800 --> 00:09:31,200 DEPARTMENT. 285 00:09:31,200 --> 00:09:32,640 UNFORTUNATELY, THIS IS NOT 286 00:09:32,640 --> 00:09:34,280 ISOLATED TO MANAGEMENT OF 287 00:09:34,280 --> 00:09:35,400 MIGRAINE ONLY, BUT WE KNOW THAT 288 00:09:35,400 --> 00:09:37,440 THIS IS PART OF A PATTERN THAT'S 289 00:09:37,440 --> 00:09:40,960 BEEN OBSERVED WITH HAVING 290 00:09:40,960 --> 00:09:42,920 DIFFERENCES IN THE MANAGEMENT OF 291 00:09:42,920 --> 00:09:46,120 PAIN THAT'S BEEN IGNORED FOR 292 00:09:46,120 --> 00:09:51,680 CHILDREN OF COLOR. 293 00:09:51,680 --> 00:09:52,640 SO WE KNOW PAIN IN CHILDREN HAS 294 00:09:52,640 --> 00:09:53,760 NOT MATTERED ENOUGH. 295 00:09:53,760 --> 00:09:55,200 THIS IS SHOWN BY EVIDENCE OF 296 00:09:55,200 --> 00:09:56,920 COMMON FAILINGS IN PROVIDING 297 00:09:56,920 --> 00:09:58,120 ADEQUATE OR APPROPRIATE PAIN 298 00:09:58,120 --> 00:10:01,960 RELIEF IN CLINICAL PRACTICE. 299 00:10:01,960 --> 00:10:04,680 THIS HAS BEEN SEEN AS A REAL 300 00:10:04,680 --> 00:10:07,320 UNDERTROOTMENT OFTREATMENT OF PN 301 00:10:07,320 --> 00:10:07,640 CHILDREN. 302 00:10:07,640 --> 00:10:08,960 THIS MAY BE BECAUSE PAIN IS 303 00:10:08,960 --> 00:10:11,240 EXPECTED TO BE TRANSITORY DURING 304 00:10:11,240 --> 00:10:13,080 CHILDHOOD, OR WE DON'T 305 00:10:13,080 --> 00:10:14,280 APPRECIATE THE IMPACT IT HAS 306 00:10:14,280 --> 00:10:14,560 LONG TERM. 307 00:10:14,560 --> 00:10:16,400 THERE'S ALSO AN ABSENCE OF 308 00:10:16,400 --> 00:10:16,920 CHILDREN'S VOICE. 309 00:10:16,920 --> 00:10:17,800 CHILDREN DON'T HAVE THE SAME 310 00:10:17,800 --> 00:10:19,480 OPPORTUNITY AS ADULTS TO BE 311 00:10:19,480 --> 00:10:22,080 HEARD AROUND THEIR PAIN 312 00:10:22,080 --> 00:10:22,600 MANAGEMENT. 313 00:10:22,600 --> 00:10:23,400 THERE'S BEEN A LACK OF 314 00:10:23,400 --> 00:10:25,040 INVESTMENT IN RESEARCH AND 315 00:10:25,040 --> 00:10:26,440 SERVICES DEVOTED TO CHILDREN'S 316 00:10:26,440 --> 00:10:29,160 PAIN MANAGEMENT, AND INEQUITIES 317 00:10:29,160 --> 00:10:30,960 IN ACCESS TO EVIDENCE-BASED PAIN 318 00:10:30,960 --> 00:10:33,120 CARE FOR ALL CHILDREN. 319 00:10:33,120 --> 00:10:36,720 THIS HAS LED TO SOMEWHAT OF AN 320 00:10:36,720 --> 00:10:37,720 EXCLUSION FROM THE BROADER 321 00:10:37,720 --> 00:10:40,440 NARRATIVE REGARDING THE PUBLIC 322 00:10:40,440 --> 00:10:42,200 HEALTH IMPACT OF PAIN IN WHICH 323 00:10:42,200 --> 00:10:43,520 MOST OF THE FOCUS HAS BEEN ON 324 00:10:43,520 --> 00:10:46,120 ADULT CHRONIC PAIN. 325 00:10:46,120 --> 00:10:50,960 THIS SLIDE SHOWS A GRAPHIC FROM 326 00:10:50,960 --> 00:10:53,040 THE COMMISSION I HAD AN 327 00:10:53,040 --> 00:10:57,200 OPPORTUNITY TO CONTRIBUTE TO LED 328 00:10:57,200 --> 00:11:01,920 BY CHRIS ECCLESTON. 329 00:11:01,920 --> 00:11:03,960 IT ALSO IS ORGANIZED AROUND FOUR 330 00:11:03,960 --> 00:11:04,880 TRANSFORMATIVE GOALS THAT, IF 331 00:11:04,880 --> 00:11:06,360 THEY WERE TO BE ACHIEVED, WOULD 332 00:11:06,360 --> 00:11:07,760 MAKE A TREMENDOUS DIFFERENCE IN 333 00:11:07,760 --> 00:11:09,200 THE MANAGEMENT OF CHILDREN'S 334 00:11:09,200 --> 00:11:09,600 PAIN. 335 00:11:09,600 --> 00:11:10,960 AND THE FOUNDATIONAL GOAL IS 336 00:11:10,960 --> 00:11:15,240 REALLY MAKING PAIN MATTER, AND 337 00:11:15,240 --> 00:11:16,600 THAT IS THE EMPHASIS THAT I WANT 338 00:11:16,600 --> 00:11:17,760 TO PUT ON THE TALK TODAY, 339 00:11:17,760 --> 00:11:21,120 BECAUSE IF WE -- WE REALLY NEED 340 00:11:21,120 --> 00:11:22,360 TO DEMONSTRATE THAT PAIN MATTERS 341 00:11:22,360 --> 00:11:25,080 TO ALL STAKEHOLDERS, TO HEALTH 342 00:11:25,080 --> 00:11:27,720 PROFESSIONALS, TO POLICY MAKERS, 343 00:11:27,720 --> 00:11:28,680 FUNDERS, RESEARCHER, CLINICIANS 344 00:11:28,680 --> 00:11:30,000 AND SOCIETY AT LARGE SO THAT WE 345 00:11:30,000 --> 00:11:31,760 CAN ACHIEVE THESE OTHER GOALS OF 346 00:11:31,760 --> 00:11:33,640 MAKING PAIN UNDERSTOOD, MAKING 347 00:11:33,640 --> 00:11:36,000 PAIN VISIBLE, AND MAKING PAIN 348 00:11:36,000 --> 00:11:40,400 BETTER. 349 00:11:40,400 --> 00:11:43,360 SO ONE ASPECT OF THE MYTH THAT I 350 00:11:43,360 --> 00:11:44,920 THINK HAS LED TO UNDERTREATMENT 351 00:11:44,920 --> 00:11:46,440 OF PAIN IN CHILDREN THAT I WANT 352 00:11:46,440 --> 00:11:50,640 TO DISCUSS TODAY IS THAT 353 00:11:50,640 --> 00:11:52,320 CHILDREN HAD HISTORICALLY BEEN 354 00:11:52,320 --> 00:11:53,520 THOUGHT TO GROW OUT OF PAIN AND 355 00:11:53,520 --> 00:11:55,920 THE IDEA WAS THAT PAIN USUALLY 356 00:11:55,920 --> 00:11:57,320 RESOLVES DURING CHILDHOOD. 357 00:11:57,320 --> 00:11:59,760 THERE HAVE BEEN, OVER THE LAST 358 00:11:59,760 --> 00:12:02,360 10, 15 YEARS, SOME REALLY GOOD 359 00:12:02,360 --> 00:12:04,160 EVIDENCE THAT THIS IS NOT THE 360 00:12:04,160 --> 00:12:06,240 CASE, THAT INDEED, CHILDREN 361 00:12:06,240 --> 00:12:08,840 OFTEN CONTINUE TO HAVE PAIN INTO 362 00:12:08,840 --> 00:12:09,120 ADULTHOOD. 363 00:12:09,120 --> 00:12:10,160 THIS IS ONE OF THE FIRST STUDIES 364 00:12:10,160 --> 00:12:14,200 THAT CAME OUT OF LYNN WALKER'S 365 00:12:14,200 --> 00:12:16,040 GROUP AT VANDERBILT FOCUSED ON 366 00:12:16,040 --> 00:12:17,360 FUNCTIONAL ABDOMINAL PAIN IN 367 00:12:17,360 --> 00:12:18,880 CHILDHOOD AND THE RISK FOR NOT 368 00:12:18,880 --> 00:12:22,160 ONLY CONTINUED ABDOMINAL PAIN 369 00:12:22,160 --> 00:12:24,640 BUT OTHER FORMS OF CHRONIC PAIN 370 00:12:24,640 --> 00:12:25,560 IN ADULTHOOD. 371 00:12:25,560 --> 00:12:27,080 WHAT THEY FOUND IS THAT 35% OF 372 00:12:27,080 --> 00:12:28,720 PATIENTS WITH FUNCTIONAL 373 00:12:28,720 --> 00:12:29,840 ABDOMINAL PAIN HAD A 374 00:12:29,840 --> 00:12:31,280 CONTINUATION OF THESE SAME 375 00:12:31,280 --> 00:12:33,040 SYMPTOMS WHEN THEY WERE ADULTS, 376 00:12:33,040 --> 00:12:34,760 BUT IMPORTANTLY, A LARGE 377 00:12:34,760 --> 00:12:36,160 SUBGROUP ALSO HAD OTHER FORMS OF 378 00:12:36,160 --> 00:12:38,040 CHRONIC PAIN, INCLUDING HEADACHE 379 00:12:38,040 --> 00:12:40,560 AND OTHER SITES OF NON-ABDOMINAL 380 00:12:40,560 --> 00:12:40,760 PAIN. 381 00:12:40,760 --> 00:12:42,400 THERE WAS ALSO AN INCREASED RISK 382 00:12:42,400 --> 00:12:44,280 FOR ANXIETY AND DEPRESSION IN 383 00:12:44,280 --> 00:12:51,040 ADULTHOOD. 384 00:12:51,040 --> 00:12:54,840 SIMILARLY, KASHIKAR-ZUCK AND 385 00:12:54,840 --> 00:12:59,360 COLLEAGUES ALSO EXAMINED LONG 386 00:12:59,360 --> 00:13:01,120 TERM OUTCOMES OF ADOLESCENTS 387 00:13:01,120 --> 00:13:03,640 WITH JUVENILE-ONSET 388 00:13:03,640 --> 00:13:04,160 FIBROMYALGIA. 389 00:13:04,160 --> 00:13:05,360 THEY HAD A VERY HIGH RATE OF 390 00:13:05,360 --> 00:13:06,800 CONTINUATION OF SYMPTOMS INTO 391 00:13:06,800 --> 00:13:08,480 ADULTHOOD WITH ALMOST 60% 392 00:13:08,480 --> 00:13:10,840 CONTINUING TO MEET CRITERIA FOR 393 00:13:10,840 --> 00:13:12,160 FIBROMYALGIA AND THEY ALSO 394 00:13:12,160 --> 00:13:13,680 EXPERIENCED A WORSENING OF 395 00:13:13,680 --> 00:13:14,680 DEPRESSIVE SYMPTOMS FOR A 396 00:13:14,680 --> 00:13:15,880 SUBGROUP OF THE COHORT. 397 00:13:15,880 --> 00:13:18,400 SO PAIN DOES NOT SEEM TO GO AWAY 398 00:13:18,400 --> 00:13:19,040 ON ITS OWN. 399 00:13:19,040 --> 00:13:24,040 WE KNOW THAT IT CONTINUES FOR 400 00:13:24,040 --> 00:13:26,040 MANY ADOLESCENTS AND YOUNG 401 00:13:26,040 --> 00:13:26,840 ADULTS. 402 00:13:26,840 --> 00:13:28,360 ANOTHER WAY OF EXAMINING THIS 403 00:13:28,360 --> 00:13:29,640 EVIDENCE IS TO THINK ABOUT WHAT 404 00:13:29,640 --> 00:13:31,440 IS THE PREVALENCE SPECIFICALLY 405 00:13:31,440 --> 00:13:32,920 IN THE YOUNG ADULT AGE RANGE TO 406 00:13:32,920 --> 00:13:35,080 FILL IN THIS GAP OF KNOWLEDGE 407 00:13:35,080 --> 00:13:38,840 BETWEEN A PEDIATRIC LITERATURE 408 00:13:38,840 --> 00:13:43,200 AND THE ADULT LITERATURE. 409 00:13:43,200 --> 00:13:47,040 CAITLIN MURRAY UNDERTOOK THIS 410 00:13:47,040 --> 00:13:48,360 SYSTEMATIC REVIEW OF 411 00:13:48,360 --> 00:13:49,480 META-ANALYSIS WHERE SHE LOOKED 412 00:13:49,480 --> 00:13:51,120 AT THE PREVALENCE ESTIMATES OF 413 00:13:51,120 --> 00:13:52,320 THE VARIOUS FORMS OF CHRONIC 414 00:13:52,320 --> 00:13:54,720 PAIN IN YOUNG ADULTS, AGES 18 TO 415 00:13:54,720 --> 00:13:55,040 29 YEARS. 416 00:13:55,040 --> 00:13:57,400 AND WHAT SHE FOUND ACROSS 43 417 00:13:57,400 --> 00:13:58,520 STUDIES WAS THAT THE PREVALENCE 418 00:13:58,520 --> 00:14:00,480 OF CHRONIC PAIN IN YOUNG ADULTS 419 00:14:00,480 --> 00:14:02,680 SPECIFICALLY WAS 12%, WHICH IS 420 00:14:02,680 --> 00:14:04,440 SIMILAR TO ADULT ESTIMATES. 421 00:14:04,440 --> 00:14:06,280 AND SHE ALSO FOUND THAT THERE 422 00:14:06,280 --> 00:14:07,400 WERE SOME CONDITIONS FOR WHICH 423 00:14:07,400 --> 00:14:08,880 THERE ARE NO PREVALENCE 424 00:14:08,880 --> 00:14:11,440 ESTIMATES IN YOUNG ADULTS, SO I 425 00:14:11,440 --> 00:14:14,080 IDENTIFIED SOME GAPS IN 426 00:14:14,080 --> 00:14:19,880 KNOWLEDGE. 427 00:14:19,880 --> 00:14:21,520 CAITLIN ALSO ASKED SOME 428 00:14:21,520 --> 00:14:24,440 QUESTIONS ABOUT WHAT ARE THE 429 00:14:24,440 --> 00:14:26,600 ACTUAL LONG-TERM OUTCOMES IN A 430 00:14:26,600 --> 00:14:28,200 POPULATION-BASED SAMPLE WHO HAD 431 00:14:28,200 --> 00:14:33,320 CHRONIC PAIN IN ADOLESCENCE. 432 00:14:33,320 --> 00:14:34,840 AND SHE HAS A HEALTH DATASET TO 433 00:14:34,840 --> 00:14:38,640 HELP ANSWER THE QUESTION WHETHER 434 00:14:38,640 --> 00:14:39,680 OR NOT WHAT HAPPENS DURING THIS 435 00:14:39,680 --> 00:14:40,120 IMPORTANT TRANSITION. 436 00:14:40,120 --> 00:14:42,880 WE KNOW THAT DURING ADOLESCENCE 437 00:14:42,880 --> 00:14:43,960 AND YOUNG ADULTHOOD, MANY 438 00:14:43,960 --> 00:14:44,480 CHANGES OCCUR. 439 00:14:44,480 --> 00:14:47,760 THIS IS WHEN NEXT STEPS IN 440 00:14:47,760 --> 00:14:49,160 EDUCATION AND EMPLOYMENT ARE 441 00:14:49,160 --> 00:14:51,840 TAKEN, THIS IS ALSO IMPORTANT 442 00:14:51,840 --> 00:14:53,360 SOCIALLY IN TERMS OF 443 00:14:53,360 --> 00:14:59,360 RELATIONSHIP DEVELOPMENT. 444 00:14:59,360 --> 00:15:02,360 SO IN THIS DATASET, THERE WAS 445 00:15:02,360 --> 00:15:04,920 3,000 YOUTH WHO HAD CHRONIC PAIN 446 00:15:04,920 --> 00:15:06,360 DURING ADOLESCENCE, WHEN THEY 447 00:15:06,360 --> 00:15:08,320 WERE 11 TO 17 YEARS, AND 11,600 448 00:15:08,320 --> 00:15:09,640 THAT DID NOT HAVE CHRONIC PAIN 449 00:15:09,640 --> 00:15:11,160 IN ADOLESCENCE. 450 00:15:11,160 --> 00:15:12,680 AND IN COMPARING WHAT THEIR 451 00:15:12,680 --> 00:15:14,000 OUTCOMES WERE DURING THE YOUNG 452 00:15:14,000 --> 00:15:17,880 ADULT YEARS FROM AGES 24 TO 453 00:15:17,880 --> 00:15:18,720 32 YEARS, WHAT THEY FOUND WAS 454 00:15:18,720 --> 00:15:21,600 THAT IN TERMS OF EDUCATION, IF 455 00:15:21,600 --> 00:15:23,400 YOU HAD ADOLESCENT CHRONIC PAIN, 456 00:15:23,400 --> 00:15:25,280 YOU WERE LESS LIKELY TO RECEIVE 457 00:15:25,280 --> 00:15:26,920 EITHER A HIGH SCHOOL DIPLOMA OR 458 00:15:26,920 --> 00:15:28,880 A BACHELOR'S DEGREE BY THE TIME 459 00:15:28,880 --> 00:15:30,880 YOU WERE A YOUNG ADULT. 460 00:15:30,880 --> 00:15:32,680 IN TERMS OF VOCATIONAL 461 00:15:32,680 --> 00:15:34,600 FUNCTIONING, THERE WERE ALSO 462 00:15:34,600 --> 00:15:37,320 IMPACTS SHOWING IN TERMS OF 463 00:15:37,320 --> 00:15:40,160 LOWER LIKELIHOOD OF RECEIVING 464 00:15:40,160 --> 00:15:42,320 EMPLOYER-PROVIDED INSURANCE 465 00:15:42,320 --> 00:15:44,240 BENEFITS, INDICATING A LESS 466 00:15:44,240 --> 00:15:46,360 STABLE FORM OF EMPLOYMENT, AND 467 00:15:46,360 --> 00:15:47,920 AN INCREASED LIKELIHOOD OF 468 00:15:47,920 --> 00:15:50,200 RECEIVING PUBLIC ASSISTANCE OR 469 00:15:50,200 --> 00:15:52,080 DISABILITY FOR THOSE WHO HAD 470 00:15:52,080 --> 00:15:53,080 ADOLESCENT CHRONIC PAIN COMPARED 471 00:15:53,080 --> 00:15:55,440 TO THOSE WHO DID NOT. 472 00:15:55,440 --> 00:15:57,640 AND IN TERMS OF SOCIAL OUTCOMES, 473 00:15:57,640 --> 00:15:59,600 THERE WERE ALSO EFFECTS SEEN 474 00:15:59,600 --> 00:16:03,680 WITH EARLIER PREGNANCY AND 475 00:16:03,680 --> 00:16:04,640 PARENTHOOD AS WELL AS LIKELIHOOD 476 00:16:04,640 --> 00:16:10,160 OF HAVING LOWER RELATIONSHIP 477 00:16:10,160 --> 00:16:11,400 SATISFACTION IN THE PRESENCE OF 478 00:16:11,400 --> 00:16:12,440 ADOLESCENT CHRONIC PAIN. 479 00:16:12,440 --> 00:16:14,600 SO TAKEN TOGETHER, WE'RE SEEING 480 00:16:14,600 --> 00:16:18,880 REALLY IMPORTANT RISK OF 481 00:16:18,880 --> 00:16:20,040 NEGATIVE DEVELOPMENTAL OUTCOMES 482 00:16:20,040 --> 00:16:21,600 ACROSS A RANGE OF ASPECTS OF 483 00:16:21,600 --> 00:16:27,080 YOUNG ADULT LIFE. 484 00:16:27,080 --> 00:16:28,280 SO ONE HYPOTHESIS WE HAD WAS 485 00:16:28,280 --> 00:16:30,040 THAT PERHAPS YOUNG ADULTS AREN'T 486 00:16:30,040 --> 00:16:31,320 CONTINUING TO RECEIVE CARE FOR 487 00:16:31,320 --> 00:16:33,840 THEIR CHRONIC PAIN DURING THIS 488 00:16:33,840 --> 00:16:35,040 TRANSITION PERIOD. 489 00:16:35,040 --> 00:16:36,480 WE KNOW THAT IN OTHER 490 00:16:36,480 --> 00:16:38,800 POPULATIONS AS WELL, AND EVEN 491 00:16:38,800 --> 00:16:40,960 AMONG HEALTHY YOUNG ADULTS, THAT 492 00:16:40,960 --> 00:16:44,200 THE RATE OF MEDICAL CARE IS 493 00:16:44,200 --> 00:16:45,760 LOWER IN THIS AGE GROUP. 494 00:16:45,760 --> 00:16:48,400 WE ALSO FOUND IN THIS MIXED 495 00:16:48,400 --> 00:16:51,400 METHODS STUDY THAT 42% OF OUR 496 00:16:51,400 --> 00:16:53,680 SAMPLE WHO HAD RECEIVED 497 00:16:53,680 --> 00:16:54,960 INTERDISCIPLINARY PAIN CARE 498 00:16:54,960 --> 00:16:56,600 DURING CHILDHOOD, DURING THIS 499 00:16:56,600 --> 00:16:59,960 TRANSITION TO YOUNG ADULTHOOD, 500 00:16:59,960 --> 00:17:01,840 42% WERE NOT ENGAGED TO ANY FORM 501 00:17:01,840 --> 00:17:03,720 OF HEALTHCARE FOR THEIR PAIN 502 00:17:03,720 --> 00:17:04,800 MANAGEMENT, SO INDEED THERE DOES 503 00:17:04,800 --> 00:17:06,120 SEEM TO BE A DROPOFF IN 504 00:17:06,120 --> 00:17:07,680 RECEIVING CARE FOR CHRONIC PAIN 505 00:17:07,680 --> 00:17:09,960 DURING THE YOUNG ADULT YEARS. 506 00:17:09,960 --> 00:17:12,240 IN QUALITATIVE INTERVIEWS, YOUNG 507 00:17:12,240 --> 00:17:14,600 ADULTS ALSO IDENTIFIED SEVERAL 508 00:17:14,600 --> 00:17:15,520 BARRIERS TO TRANSITION, 509 00:17:15,520 --> 00:17:17,480 INCLUDING HAVING LOW PREPARATION 510 00:17:17,480 --> 00:17:19,640 FROM THEIR PEDIATRIC PAIN 511 00:17:19,640 --> 00:17:22,200 PROVIDERS, AND ALSO HAVING SOME 512 00:17:22,200 --> 00:17:23,720 NEGATIVE PATIENT-PROVIDER 513 00:17:23,720 --> 00:17:25,880 RELATIONSHIPS IN ADULT CARE. 514 00:17:25,880 --> 00:17:27,560 THEY ALSO IDENTIFIED SOME 515 00:17:27,560 --> 00:17:28,560 FACILITATORS OF HEALTHCARE 516 00:17:28,560 --> 00:17:32,120 TRANSITION, INCLUDING HAVING 517 00:17:32,120 --> 00:17:32,760 INCREASED SELF-EFFICACY AROUND 518 00:17:32,760 --> 00:17:35,520 THEIR PAIN MANAGEMENT DURING 519 00:17:35,520 --> 00:17:36,280 CHILDHOOD, AS WELL AS ACCEPTANCE 520 00:17:36,280 --> 00:17:40,360 OF PAIN. 521 00:17:40,360 --> 00:17:41,560 SO WE KNOW THAT PAIN DURING 522 00:17:41,560 --> 00:17:44,160 CHILDHOOD MATTERS, BUT IT IS 523 00:17:44,160 --> 00:17:47,360 IMPORTANT FOR THE LIFESPAN, AND 524 00:17:47,360 --> 00:17:50,600 THIS WAS A PAPER THAT REFLECTS 525 00:17:50,600 --> 00:17:55,120 ON HOW CAN WE USE CHILDHOOD AS A 526 00:17:55,120 --> 00:17:57,160 POINT OF EARLY IDENTIFICATION 527 00:17:57,160 --> 00:18:01,240 AND TREATMENT TO PREVENT PAIN 528 00:18:01,240 --> 00:18:03,000 AND DISABILITY, AND ALSO THE 529 00:18:03,000 --> 00:18:05,200 CONTINUATION OF PAIN AND 530 00:18:05,200 --> 00:18:09,320 NEGATIVE IMPACTS FROM CHILD TO D 531 00:18:09,320 --> 00:18:11,600 TO ADULTHOOD. 532 00:18:11,600 --> 00:18:15,120 THIS PAPER OF THE DEVELOPMENTAL 533 00:18:15,120 --> 00:18:18,520 LIFESPAN MODEL OF PEDIATRIC 534 00:18:18,520 --> 00:18:19,720 PAIN, WANT TO HIGHLIGHT THAT 535 00:18:19,720 --> 00:18:22,440 THERE ARE A RANGE OF FACTORS, 536 00:18:22,440 --> 00:18:23,640 INCLUDING EMOTIONAL FACTORS SUCH 537 00:18:23,640 --> 00:18:27,480 AS MOOD, PAIN COPING, HEALTH 538 00:18:27,480 --> 00:18:29,360 BEHAVIOR FACTORS SUCH AS SLEEP, 539 00:18:29,360 --> 00:18:30,880 PHYSICAL ACTIVITY, AND SOCIAL 540 00:18:30,880 --> 00:18:35,040 AND FAMILY FACTORS SUCH AS 541 00:18:35,040 --> 00:18:35,800 PARENT BEHAVIOR OR FAMILY 542 00:18:35,800 --> 00:18:38,960 FUNCTIONING IN AND PEER 543 00:18:38,960 --> 00:18:39,640 RELATIONSHIPS. 544 00:18:39,640 --> 00:18:40,840 THERE'S VULNERABILITIES AS WELL 545 00:18:40,840 --> 00:18:42,040 AS RESILIENCY FACTORS WITHIN 546 00:18:42,040 --> 00:18:43,480 EACH OF THESE DOMAINS THAT ARE 547 00:18:43,480 --> 00:18:45,960 NOT ONLY IMPORTANT DURING 548 00:18:45,960 --> 00:18:48,160 CHILDHOOD FOR UNDERSTANDING RISK 549 00:18:48,160 --> 00:18:49,840 AND RESILIENCE AGAINST CHILDHOOD 550 00:18:49,840 --> 00:18:51,440 CHRONIC PAIN, BUT ALSO HAVE 551 00:18:51,440 --> 00:18:53,400 EVIDENCE FOR PREDICTING ADULT 552 00:18:53,400 --> 00:18:55,480 OUTCOMES INCLUDING ADULT PAIN, 553 00:18:55,480 --> 00:18:56,800 AS WELL AS DEVELOPMENTAL AND 554 00:18:56,800 --> 00:18:59,080 HEALTH OUTCOMES. 555 00:18:59,080 --> 00:19:00,840 ONE OF THE ADVANTAGES OF USING 556 00:19:00,840 --> 00:19:02,520 LIFESPAN APPROACHES IS IT REALLY 557 00:19:02,520 --> 00:19:04,040 CAN CONNECT THE PEDIATRIC 558 00:19:04,040 --> 00:19:07,000 RESEARCH TO ADULTERY SEARCH, AND 559 00:19:07,000 --> 00:19:08,400 HOPEFULLY ENCOURAGE THE TYPE OF 560 00:19:08,400 --> 00:19:11,480 COLLABORATIONS THAT HELP US 561 00:19:11,480 --> 00:19:13,760 UNDERSTAND REALLY WHAT CAN WE DO 562 00:19:13,760 --> 00:19:15,920 TO PREVENT PAIN OVER THE 563 00:19:15,920 --> 00:19:22,840 LIFESPAN. 564 00:19:22,840 --> 00:19:24,480 SO MY BACKGROUND IS IN CLINICAL 565 00:19:24,480 --> 00:19:27,000 PSYCHOLOGY AND I'VE USED KIND OF 566 00:19:27,000 --> 00:19:27,760 BEHAVIORAL INTERVENTIONS FOR 567 00:19:27,760 --> 00:19:28,840 CHRONIC PAIN BECAUSE IT REALLY 568 00:19:28,840 --> 00:19:32,920 CAN TARGET THE DOMAINS THAT ARE 569 00:19:32,920 --> 00:19:34,200 IMPORTANT IN CHRONIC PAIN 570 00:19:34,200 --> 00:19:36,080 MANAGEMENT, INCLUDING THESE 571 00:19:36,080 --> 00:19:37,720 EMOTIONAL SOCIAL FAMILY AND 572 00:19:37,720 --> 00:19:40,440 HEALTH BEHAVIOR DOMAINS, AND WE 573 00:19:40,440 --> 00:19:43,080 KNOW THAT THERE'S MANY DIFFERENT 574 00:19:43,080 --> 00:19:44,680 INTERVENTIONS WITHIN COGNITIVE 575 00:19:44,680 --> 00:19:45,720 BEHAVIORAL THERAPY FRAME WORKS. 576 00:19:45,720 --> 00:19:47,920 THESE ARE BASED ON THEORIES OF 577 00:19:47,920 --> 00:19:49,880 BEHAVIOR, COGNITION, EMOTION AND 578 00:19:49,880 --> 00:19:50,400 SOCIAL LEARNING, DIFFERENT 579 00:19:50,400 --> 00:19:53,680 ASPECTS CAN BE EMPHASIZED, AND 580 00:19:53,680 --> 00:19:55,000 I'LL SHOW YOU SOME COMPONENTS 581 00:19:55,000 --> 00:19:59,920 THAT WE'VE USED IN OUR WORK. 582 00:19:59,920 --> 00:20:00,800 PSYCHOLOGICAL THERAPIES AS A 583 00:20:00,800 --> 00:20:02,640 WHOLE HAS A PRETTY ROBUST 584 00:20:02,640 --> 00:20:03,760 EVIDENCE BASE FOR THE MANAGEMENT 585 00:20:03,760 --> 00:20:06,480 OF CHRONIC AND RECURRENT PAIN IN 586 00:20:06,480 --> 00:20:07,360 CHILDREN AND ADOLESCENTS. 587 00:20:07,360 --> 00:20:09,640 THIS WAS OUR COCHRANE REVIEW 588 00:20:09,640 --> 00:20:11,720 THAT WE PUBLISHED ABOUT FIVE 589 00:20:11,720 --> 00:20:12,280 YEARS AGO. 590 00:20:12,280 --> 00:20:14,880 AT THAT TIME, THERE WERE 591 00:20:14,880 --> 00:20:16,080 43 RANDOMIZED CONTROL TRIALS OF 592 00:20:16,080 --> 00:20:17,720 PSYCHOLOGICAL TREATMENT. 593 00:20:17,720 --> 00:20:21,480 MOST OF THESE WERE KIND OF 594 00:20:21,480 --> 00:20:22,120 BEHAVIORAL THERAPY INTERVENTIONS 595 00:20:22,120 --> 00:20:23,640 AND THERE WERE SMALL TO MODERATE 596 00:20:23,640 --> 00:20:26,080 EFFECTS FOR REDUCING PAIN 597 00:20:26,080 --> 00:20:28,480 INTENSITY AND FREQUENCY, AND 598 00:20:28,480 --> 00:20:30,640 DISABILITY AND ANXIETY. 599 00:20:30,640 --> 00:20:32,280 AT THIS TIME MOST OF THE 600 00:20:32,280 --> 00:20:33,960 EVIDENCE WAS AT POST-TREATMENT 601 00:20:33,960 --> 00:20:35,800 ONLY, AND THERE WERE MORE 602 00:20:35,800 --> 00:20:37,640 LIMITED DATA ON THE LONGER TERM 603 00:20:37,640 --> 00:20:38,760 IMPACT ON PSYCHOLOGICAL 604 00:20:38,760 --> 00:20:40,720 THERAPIES FOR CHRONIC PAIN 605 00:20:40,720 --> 00:20:43,120 MANAGEMENT. 606 00:20:43,120 --> 00:20:46,520 SO DESPITE HAVING A ROBUST 607 00:20:46,520 --> 00:20:47,400 EVIDENCE BASE, ONE OF THE 608 00:20:47,400 --> 00:20:51,000 PRIMARY PROBLEMS IS THAT MOST 609 00:20:51,000 --> 00:20:52,080 CHILDREN AND MOST COMMUNITIES 610 00:20:52,080 --> 00:20:53,640 CANNOT RECEIVE ACCESS TO 611 00:20:53,640 --> 00:20:55,560 PSYCHOLOGICAL TREATMENT FOR PAIN 612 00:20:55,560 --> 00:20:56,120 MANAGEMENT. 613 00:20:56,120 --> 00:20:57,960 THERE'S A REAL SHORTAGE OF 614 00:20:57,960 --> 00:20:59,320 INTERDISCIPLINARY PAIN CLINICS 615 00:20:59,320 --> 00:21:01,280 FOR CHILDREN. 616 00:21:01,280 --> 00:21:03,160 THERE'S APPROXIMATELY ONE PER 617 00:21:03,160 --> 00:21:04,240 STATE, SO FOR MANY FAMILIES 618 00:21:04,240 --> 00:21:07,400 THERE'S A GREAT GEOGRAPHIC 619 00:21:07,400 --> 00:21:08,800 DISTANCE TO CARE. 620 00:21:08,800 --> 00:21:09,680 THERE'S ALSO STIGMA ASSOCIATED 621 00:21:09,680 --> 00:21:11,800 WITH RECEIVING PSYCHOLOGICAL 622 00:21:11,800 --> 00:21:13,560 TREATMENT THAT MAY PREVENT 623 00:21:13,560 --> 00:21:14,640 ENGAGEMENT. 624 00:21:14,640 --> 00:21:17,480 BECAUSE OF THE LIMITED NUMBER OF 625 00:21:17,480 --> 00:21:19,320 CLINICS, THERE'S TYPICALLY LONG 626 00:21:19,320 --> 00:21:20,720 WAITING LISTS. 627 00:21:20,720 --> 00:21:23,120 THIS MAY BE THREE TO SIX MONTHS 628 00:21:23,120 --> 00:21:25,800 IN MOST LOCATIONS, AND OUR OWN 629 00:21:25,800 --> 00:21:27,920 GROUP AND OTHERS HAVE STUDIED 630 00:21:27,920 --> 00:21:30,560 PATIENT FUNCTIONING WHILE 631 00:21:30,560 --> 00:21:33,360 WAITING TO BE SEEN FOR PAIN 632 00:21:33,360 --> 00:21:34,880 CLINIC, FINDING THAT PATIENT 633 00:21:34,880 --> 00:21:36,920 FUNCTIONING OFTEN DETERIORATE. 634 00:21:36,920 --> 00:21:40,080 SO THE REAL TAKE-HOME MESSAGE 635 00:21:40,080 --> 00:21:43,920 WAS THAT ACCESSIBLE OPTIONS TO 636 00:21:43,920 --> 00:21:45,440 PROVIDE THIS TYPE OF CARE ARE 637 00:21:45,440 --> 00:21:50,680 URBURGENTLY NEEDED. 638 00:21:50,680 --> 00:21:54,240 A LOT OF MY WORK USES DIGITAL 639 00:21:54,240 --> 00:21:55,760 HEALTH TREATMENTS TO ADDRESS THE 640 00:21:55,760 --> 00:21:57,080 PROBLEM OF ACCESSIBILITY. 641 00:21:57,080 --> 00:21:58,920 THIS CAN BE DELIVERED IN A 642 00:21:58,920 --> 00:22:01,960 VARIETY OF FORMATS. 643 00:22:01,960 --> 00:22:03,600 STARTING WITH TELEHEALTH AND 644 00:22:03,600 --> 00:22:06,920 TELEMEDICINE, WHICH WE SUE A SAA 645 00:22:06,920 --> 00:22:08,000 HUGE INCREASE OF DURING THE 646 00:22:08,000 --> 00:22:08,280 PANDEMIC. 647 00:22:08,280 --> 00:22:09,840 THIS IS THE MOST RESTRICTIVE AND 648 00:22:09,840 --> 00:22:10,960 STILL REQUIRES AN APPOINTMENT 649 00:22:10,960 --> 00:22:13,960 WITH A HEALTHCARE PROFESSIONAL 650 00:22:13,960 --> 00:22:16,760 TO MORE FLEXIBLE FORMS THAT ARE 651 00:22:16,760 --> 00:22:18,480 SELF-GUIDED SUCH AS E-HEALTH OR 652 00:22:18,480 --> 00:22:20,360 INTERNET INTERVENTIONS AND 653 00:22:20,360 --> 00:22:22,360 M-HEALTH SMARTPHONE APPS. 654 00:22:22,360 --> 00:22:23,400 THE PURPOSE IS VARIED. 655 00:22:23,400 --> 00:22:25,840 IT CAN REPLACE IN-PERSON CARE, 656 00:22:25,840 --> 00:22:28,320 IT CAN SUPPLEMENT IN-PERSON CARE 657 00:22:28,320 --> 00:22:30,440 OR SERVE AS A BOOSTER OR 658 00:22:30,440 --> 00:22:32,320 MAINTENANCE AFTER FINISHING AN 659 00:22:32,320 --> 00:22:36,440 IN-PERSON PROGRAM. 660 00:22:36,440 --> 00:22:38,480 I'VE WORKED FOR ABOUT 15 YEARS 661 00:22:38,480 --> 00:22:40,760 ON DIGITAL HEALTH TREATMENTS FOR 662 00:22:40,760 --> 00:22:41,440 PEDIATRIC CHRONIC PAIN. 663 00:22:41,440 --> 00:22:43,880 EARLY ON WE DEVELOPED AN 664 00:22:43,880 --> 00:22:45,600 INTERNET COGNITIVE BEHAVIORAL 665 00:22:45,600 --> 00:22:47,400 THERAPY PROGRAM THAT WE CALLED 666 00:22:47,400 --> 00:22:48,680 WEB-BASED MANAGEMENT OF 667 00:22:48,680 --> 00:22:50,600 ADOLESCENT PAIN OR WEBMAP. 668 00:22:50,600 --> 00:22:52,640 THIS WAS CO-DESIGNED WITH 669 00:22:52,640 --> 00:22:55,240 ADOLESCENTS AND THEIR PARENTS, 670 00:22:55,240 --> 00:22:58,080 AND WAS INTENDED TO PROVIDE BOTH 671 00:22:58,080 --> 00:23:01,160 SKILLS TRAINING FOR THE CHILD 672 00:23:01,160 --> 00:23:04,520 DIRECTLY AROUND SKILLS THAT 673 00:23:04,520 --> 00:23:07,280 INCLUDE BOTH BEHAVIORAL DOMAINS 674 00:23:07,280 --> 00:23:11,760 AS WELL AS COGNITIVE TYPES OF 675 00:23:11,760 --> 00:23:12,120 INTERVENTIONS. 676 00:23:12,120 --> 00:23:14,280 WE ALSO HAVE A BIG FOCUS ON 677 00:23:14,280 --> 00:23:16,360 SLEEP AND PROMOTING PHYSICAL 678 00:23:16,360 --> 00:23:18,880 ACTIVITY IN OUR INTERVENTIONS. 679 00:23:18,880 --> 00:23:20,160 WE FELT IT WAS IMPORTANT FOR 680 00:23:20,160 --> 00:23:22,800 PARENTS TO HAVE THEIR OWN 681 00:23:22,800 --> 00:23:24,560 PROGRAM AND SPENT TIME WORKING 682 00:23:24,560 --> 00:23:26,280 ON DEVELOPING A PROGRAM THAT 683 00:23:26,280 --> 00:23:29,240 COULD FIT THE NEEDS OF PARENTS 684 00:23:29,240 --> 00:23:32,080 AROUND COMMUNICATION, MODELING, 685 00:23:32,080 --> 00:23:33,080 CHANGING BEHAVIORAL RESPONSES 686 00:23:33,080 --> 00:23:34,120 AND SUPPORTING CHILDREN'S 687 00:23:34,120 --> 00:23:34,720 SKILLS. 688 00:23:34,720 --> 00:23:37,120 EARLY ON, WE WERE INTERESTED IN 689 00:23:37,120 --> 00:23:38,680 JUST UNDERSTANDING THE 690 00:23:38,680 --> 00:23:40,680 FEASIBILITY OF ENGAGING CHILDREN 691 00:23:40,680 --> 00:23:43,120 AND FAMILIES IN THIS MODE OF 692 00:23:43,120 --> 00:23:46,960 INTERVENTION DELIVERY AND FOUND 693 00:23:46,960 --> 00:23:50,280 HIGH ACCEPTABILITY AROUND BOTH 694 00:23:50,280 --> 00:23:51,640 PARENT AND CHILD INVOLVEMENT IN 695 00:23:51,640 --> 00:23:52,320 THE INTERVENTIONS. 696 00:23:52,320 --> 00:23:55,080 LATER ON, WE WENT TO STUDY THE 697 00:23:55,080 --> 00:23:56,160 EFFICACY IN A NUMBER OF 698 00:23:56,160 --> 00:23:57,840 DIFFERENT POPULATIONS, AND I'LL 699 00:23:57,840 --> 00:23:59,040 JUST SHOW A FEW HIGHLIGHTS OF 700 00:23:59,040 --> 00:24:04,640 THAT WORK. 701 00:24:04,640 --> 00:24:09,640 THIS WAS A RANDOMIZED CONTROLLED 702 00:24:09,640 --> 00:24:11,360 TRIAL OF YOUTH WITH CHRONIC PAIN 703 00:24:11,360 --> 00:24:12,680 CONDITIONS THAT RECEIVED EITHER 704 00:24:12,680 --> 00:24:15,840 OUR INTERNET CBT VERSUS AN 705 00:24:15,840 --> 00:24:16,720 INTERNET EDUCATION CONDITION, 706 00:24:16,720 --> 00:24:19,360 AND AT SIX-MONTH FOLLOW-UP, WE 707 00:24:19,360 --> 00:24:21,320 FOUND SMALL TO MODERATE EFFECTS 708 00:24:21,320 --> 00:24:23,840 FOR REDUCTIONS IN ADOLESCENT 709 00:24:23,840 --> 00:24:24,800 PAIN-RELATED DISABILITY, 710 00:24:24,800 --> 00:24:26,800 DEPRESSION AND ANXIETY SYMPTOMS, 711 00:24:26,800 --> 00:24:29,200 AND IMPORTANTLY ALSO SHOWED 712 00:24:29,200 --> 00:24:31,600 IMPROVEMENTS IN PARENT BEHAVIORS 713 00:24:31,600 --> 00:24:32,600 AND REDUCTIONS IN THE IMPACT 714 00:24:32,600 --> 00:24:34,240 THAT PARENTS PERCEIVED FROM 715 00:24:34,240 --> 00:24:37,400 CHRONIC PAIN. 716 00:24:37,400 --> 00:24:39,760 THIS SLIDE SHOWS OUR LONG-TERM 717 00:24:39,760 --> 00:24:42,520 EFFECTS UP TO 12 MONTHS AFTER 718 00:24:42,520 --> 00:24:42,920 INTERVENTION. 719 00:24:42,920 --> 00:24:45,720 THESE ARE SMALL EFFECTS I WILL 720 00:24:45,720 --> 00:24:48,120 HIGHLIGHT, BUT AT THE POPULATION 721 00:24:48,120 --> 00:24:49,240 LEVEL, IMPACT OF AN INTERVENTION 722 00:24:49,240 --> 00:24:53,560 IS REALLY THE COMBINATION OF THE 723 00:24:53,560 --> 00:24:54,800 REACH TIMES THE EFFECT, AND 724 00:24:54,800 --> 00:24:55,960 GIVEN THE WIDE REACH THAT THE 725 00:24:55,960 --> 00:24:57,520 INTERVENTION CAN HAVE, WE FEEL 726 00:24:57,520 --> 00:25:01,000 LIKE THIS IS A PROMISING 727 00:25:01,000 --> 00:25:02,800 INTERVENTION FOR DELIVERING AT A 728 00:25:02,800 --> 00:25:08,040 VERY WIDE SCALE LEVEL. 729 00:25:08,040 --> 00:25:09,120 WE'VE ALSO BEEN INTERESTED OVER 730 00:25:09,120 --> 00:25:12,040 THE YEARS IN HOW COMORBIDITIES 731 00:25:12,040 --> 00:25:13,280 MAY INFLUENCE RESPONSE TO 732 00:25:13,280 --> 00:25:13,680 TREATMENT. 733 00:25:13,680 --> 00:25:17,320 A BIG FOCUS IN MY LAB IS ON THE 734 00:25:17,320 --> 00:25:18,080 INTERRELATIONSHIP OF SLEEP AND 735 00:25:18,080 --> 00:25:19,400 PAIN, AND WE'VE LOOKED 736 00:25:19,400 --> 00:25:22,480 SPECIFICALLY AT HOW DOES SLEEP 737 00:25:22,480 --> 00:25:24,240 DEFICIENCY AFFECT AN 738 00:25:24,240 --> 00:25:26,400 ADOLESCENT'S RESPONSE TO 739 00:25:26,400 --> 00:25:28,800 INTERNET CBT. 740 00:25:28,800 --> 00:25:34,040 THIS WAS A STUDY WHERE WE 741 00:25:34,040 --> 00:25:36,400 EXAMINED BOTH ACTIVITY MEASURED 742 00:25:36,400 --> 00:25:38,320 SLEEP DOMAINS AS WELL AS 743 00:25:38,320 --> 00:25:39,640 SELF-REPORTED SLEEP INCLUDING 744 00:25:39,640 --> 00:25:40,240 INSOMNIA SYMPTOMS. 745 00:25:40,240 --> 00:25:42,040 WE DID FIND AT BASELINE, IF 746 00:25:42,040 --> 00:25:43,560 ADOLESCENTS HAD HIGHER RATES OF 747 00:25:43,560 --> 00:25:46,760 SLEEP DEFICIENCY ACROSS THESE 748 00:25:46,760 --> 00:25:48,920 DOMAINS, THAT INDEED THEIR 749 00:25:48,920 --> 00:25:50,240 PAIN-RELATED OUTCOMES WERE 750 00:25:50,240 --> 00:25:51,040 WORSE. 751 00:25:51,040 --> 00:25:53,440 SHOWING REDUCED EFFECTIVENESS OF 752 00:25:53,440 --> 00:25:54,720 OUR CBT TREATMENT. 753 00:25:54,720 --> 00:25:56,120 AND WHAT THIS REALLY SUGGESTS IS 754 00:25:56,120 --> 00:25:59,000 THAT WE MAY NEED TO TREAT SLEEP 755 00:25:59,000 --> 00:26:01,520 DISTURBANCES BEFORE DELIVERING 756 00:26:01,520 --> 00:26:04,240 OTHER COMPONENTS OF CBT FOR PAIN 757 00:26:04,240 --> 00:26:06,880 SELF-MANAGEMENT. 758 00:26:06,880 --> 00:26:08,200 THIS IS EXACTLY WHAT ONE OF MY 759 00:26:08,200 --> 00:26:09,800 COLLEAGUES IS DOING NOW. 760 00:26:09,800 --> 00:26:12,160 THIS IS A STUDY THAT EMILY LAW 761 00:26:12,160 --> 00:26:13,880 IS CARRYING OUT TO TEST THE 762 00:26:13,880 --> 00:26:15,720 OPTIMAL SEQUENCE OF SLEEP 763 00:26:15,720 --> 00:26:18,600 INTERVENTION AND PAIN 764 00:26:18,600 --> 00:26:20,680 INTERVENTION IN YOUTH WHO HAVE 765 00:26:20,680 --> 00:26:22,200 CO-MORBID MIGRAINE AND INSOMNIA. 766 00:26:22,200 --> 00:26:24,560 THIS SLIDE SHOWS AN INTERVENTION 767 00:26:24,560 --> 00:26:27,440 THAT SHE HAS DEVELOPED TO TREAT 768 00:26:27,440 --> 00:26:30,160 INSOMNIA IN ADOLESCENTS THAT IS 769 00:26:30,160 --> 00:26:31,840 BASED ON COGNITIVE BEHAVIORAL 770 00:26:31,840 --> 00:26:36,760 THERAPY FOR INSOMNIA. 771 00:26:36,760 --> 00:26:38,560 SO ONE OF THE PROBLEMS THAT'S 772 00:26:38,560 --> 00:26:40,120 EMERGED OVER THESE YEARS AS 773 00:26:40,120 --> 00:26:41,320 THESE DIGITAL INTERVENTIONS ARE 774 00:26:41,320 --> 00:26:43,040 BEING DEVELOPED IN RESEARCH 775 00:26:43,040 --> 00:26:45,040 STUDIES IS THAT MOST ARE NOT 776 00:26:45,040 --> 00:26:47,120 ACCESSIBLE AT THE END OF THE 777 00:26:47,120 --> 00:26:49,640 STUDY TO THE USERS WHO COULD 778 00:26:49,640 --> 00:26:52,160 BENEFIT FROM THEM. 779 00:26:52,160 --> 00:26:54,320 THIS WAS A SYSTEMATIC REVIEW 780 00:26:54,320 --> 00:26:56,480 CONDUCTED BY HIGGINS AND 781 00:26:56,480 --> 00:26:58,400 COLLEAGUES IN ABOUT 50 782 00:26:58,400 --> 00:26:59,120 INTERVENTIONS THAT WERE 783 00:26:59,120 --> 00:27:00,560 DEVELOPED FOR PEDIATRIC PAIN. 784 00:27:00,560 --> 00:27:02,760 THEY FOUND THAT ONLY 28% WERE 785 00:27:02,760 --> 00:27:06,040 AVAILABLE TO END USERS. 786 00:27:06,040 --> 00:27:07,360 THEY FOUND MANY BARRIERS THAT 787 00:27:07,360 --> 00:27:09,640 WERE CITED FOR NOT MAKING 788 00:27:09,640 --> 00:27:10,320 INTERVENTIONS AVAILABLE AT THE 789 00:27:10,320 --> 00:27:14,000 END OF THE STUDY, MOSTLY AROUND 790 00:27:14,000 --> 00:27:15,200 FUNDING AND CHANGES IN 791 00:27:15,200 --> 00:27:16,560 TECHNOLOGY AND UPKEEP. 792 00:27:16,560 --> 00:27:19,280 AND REALLY, THE CONCLUSION WAS 793 00:27:19,280 --> 00:27:20,600 THAT WE NEED TO USE STUDY 794 00:27:20,600 --> 00:27:22,640 DESIGNS THAT FACILITATE THE 795 00:27:22,640 --> 00:27:24,520 STUDY OF IMPLEMENTATION OUTCOMES 796 00:27:24,520 --> 00:27:29,880 EARLIER IN THE RESEARCH PROCESS. 797 00:27:29,880 --> 00:27:31,480 ONE OF THE MAJOR TECHNOLOGY 798 00:27:31,480 --> 00:27:32,840 CHANGES THAT OCCURRED OVER THE 799 00:27:32,840 --> 00:27:35,320 COURSE OF OUR WORK WITH OUR 800 00:27:35,320 --> 00:27:36,680 DIGITAL HEALTH INTERVENTIONS IS 801 00:27:36,680 --> 00:27:39,840 THAT THERE WAS A HUGE TRANSITION 802 00:27:39,840 --> 00:27:43,000 IN HOW PEOPLE ACCESS THE 803 00:27:43,000 --> 00:27:45,240 INTERNET FROM THE COMPUTER TO A 804 00:27:45,240 --> 00:27:45,640 SMARTPHONE. 805 00:27:45,640 --> 00:27:47,720 THIS IS PARTICULARLY TRUE FOR 806 00:27:47,720 --> 00:27:49,360 YOUNGER AGE GROUPS, SO 807 00:27:49,360 --> 00:27:52,040 ADOLESCENTS IN PARTICULAR HAVE 808 00:27:52,040 --> 00:27:53,520 VERY LOW RATES OF USING A 809 00:27:53,520 --> 00:27:55,480 COMPUTER TO ACCESS THE INTERNET, 810 00:27:55,480 --> 00:27:57,800 AND HAVE AN ALMOST EXCLUSIVE USE 811 00:27:57,800 --> 00:27:59,280 OF THE INTERNET THROUGH MOBILE 812 00:27:59,280 --> 00:28:01,200 DEVICES, SO AT THIS POINT, THIS 813 00:28:01,200 --> 00:28:03,560 IS OUTDATED FROM THE PEW 814 00:28:03,560 --> 00:28:05,680 RESEARCH CENTER, BUT EVEN IN 815 00:28:05,680 --> 00:28:07,720 2018, 95% OF TEENS WERE USING A 816 00:28:07,720 --> 00:28:12,120 MOBILE DEVICE. 817 00:28:12,120 --> 00:28:13,360 SO IT WAS REALLY IMPORTANT TO US 818 00:28:13,360 --> 00:28:14,440 IN THINKING ABOUT HOW TO MAKE 819 00:28:14,440 --> 00:28:15,720 OUR INTERVENTIONS MORE 820 00:28:15,720 --> 00:28:19,200 ACCESSIBLE AND AVAILABLE, SO WE 821 00:28:19,200 --> 00:28:21,000 TRANSFORMED OUR INTERNET-BASED 822 00:28:21,000 --> 00:28:26,000 VERSION OF WEBMAP INTO A MOBILE 823 00:28:26,000 --> 00:28:26,520 APPLICATION AND TOOK THE 824 00:28:26,520 --> 00:28:28,840 OPPORTUNITY TO ALSO STUDY 825 00:28:28,840 --> 00:28:31,040 IMPLEMENTATION USING A HYBRID 826 00:28:31,040 --> 00:28:32,800 EFFECTIVENESS IMPLEMENTATION 827 00:28:32,800 --> 00:28:36,600 RANDOMIZED TRIAL. 828 00:28:36,600 --> 00:28:37,880 THIS SLIDE SHOWS SOME SCREEN 829 00:28:37,880 --> 00:28:41,120 SHOTS FROM OUR WEBMAP MOBILE 830 00:28:41,120 --> 00:28:41,880 INTERVENTION. 831 00:28:41,880 --> 00:28:44,600 WE DESIGNED THIS TO COVER THE 832 00:28:44,600 --> 00:28:45,920 SAME GENERAL TREATMENT 833 00:28:45,920 --> 00:28:48,120 COMPONENTS AS OUR INTERNET-BASED 834 00:28:48,120 --> 00:28:49,960 VERSION, SO REALLY FOCUSING ON 835 00:28:49,960 --> 00:28:53,160 SOME EDUCATION ABOUT PAIN, 836 00:28:53,160 --> 00:28:55,320 STRESS, EMOTIONS AND THOUGHTS, 837 00:28:55,320 --> 00:28:56,400 TEACHING SEVERAL DIFFERENT 838 00:28:56,400 --> 00:28:59,000 RELAXATION METHODS, SOME 839 00:28:59,000 --> 00:29:00,360 LIFESTYLE AND SCHOOL 840 00:29:00,360 --> 00:29:01,760 INTERVENTIONS INCLUDING SLEEP, 841 00:29:01,760 --> 00:29:03,120 STAYING ACTIVE, AND MAINTENANCE 842 00:29:03,120 --> 00:29:06,480 AND RELAPSE PREVENTION. 843 00:29:06,480 --> 00:29:07,880 I WANT TO JUST HIGHLIGHT THAT WE 844 00:29:07,880 --> 00:29:11,160 HAVE A GREAT LOCAL PARTNER, 845 00:29:11,160 --> 00:29:13,600 2MORROW, A COMPANY BASED IN 846 00:29:13,600 --> 00:29:18,600 SEATTLE, WHO DESPI DESIGNS BEHAL 847 00:29:18,600 --> 00:29:20,680 BASED APPS AND THEY'VE BEEN A 848 00:29:20,680 --> 00:29:22,240 WONDERFUL PARTNER IN HELPING US 849 00:29:22,240 --> 00:29:23,120 MAINTAIN AND DESIGN THESE 850 00:29:23,120 --> 00:29:23,400 PROGRAMS. 851 00:29:23,400 --> 00:29:25,480 PART OF HOW WE PERSONALIZE AND 852 00:29:25,480 --> 00:29:27,040 TAILOR THE PROGRAM IS THROUGH A 853 00:29:27,040 --> 00:29:30,320 PROFILE THAT USERS SET UP. 854 00:29:30,320 --> 00:29:31,800 WE HAVE ADDED SOME TAILORING 855 00:29:31,800 --> 00:29:33,680 BASED ON RESPONSES TO SCREENING 856 00:29:33,680 --> 00:29:36,080 QUESTIONS ABOUT INSOMNIA AND LOW 857 00:29:36,080 --> 00:29:38,920 MOOD, AND ARE ABLE TO DELIVER A 858 00:29:38,920 --> 00:29:41,040 FEW ADDITIONAL TAILORED MODULES 859 00:29:41,040 --> 00:29:45,400 BASED ON THEIR RESPONSES. 860 00:29:45,400 --> 00:29:47,080 THIS SHOWS SEVERAL SCREEN SHOTS 861 00:29:47,080 --> 00:29:48,480 OF THE VARIOUS COMPONENTS OF OUR 862 00:29:48,480 --> 00:29:50,200 APP, INCLUDING THE LESSONS. 863 00:29:50,200 --> 00:29:53,160 WE HAVE A LIBRARY WITH SKILLS, 864 00:29:53,160 --> 00:29:59,960 TEENS CAN EARN REWARDS FOR 865 00:29:59,960 --> 00:30:00,600 PROGRESS THROUGH DIFFERENT PARTS 866 00:30:00,600 --> 00:30:01,800 OF THE INTERVENTION. 867 00:30:01,800 --> 00:30:05,400 THERE'S AN OPTION TO DO DAILY 868 00:30:05,400 --> 00:30:06,640 CHECK-INS, AND THERE'S ALSO 869 00:30:06,640 --> 00:30:07,840 OPPORTUNITY TO TRACK SKILLS ONCE 870 00:30:07,840 --> 00:30:08,840 A SKILL IS LEARNED IN THE 871 00:30:08,840 --> 00:30:13,520 PROGRAM. 872 00:30:13,520 --> 00:30:14,400 BECAUSE WE WERE INTERESTED IN 873 00:30:14,400 --> 00:30:16,520 NOT ONLY THE EFFECTIVENESS OF 874 00:30:16,520 --> 00:30:19,200 THE MOBILE APP VERSION OF THE 875 00:30:19,200 --> 00:30:22,160 PROGRAM, WE ALSO WANTED TO STUDY 876 00:30:22,160 --> 00:30:23,080 IMPLEMENTATION DURING THE 877 00:30:23,080 --> 00:30:23,680 MAINTENANCE PERIOD, SO AT THE 878 00:30:23,680 --> 00:30:26,960 END OF OUR RANDOMIZED CONTROL 879 00:30:26,960 --> 00:30:29,560 TRIAL, WE HAD -- ALL CLINICS 880 00:30:29,560 --> 00:30:31,680 HAVE ACCESS TO THE WEBMAP MOBILE 881 00:30:31,680 --> 00:30:34,000 APP AND PROVIDED A REFERRAL 882 00:30:34,000 --> 00:30:35,920 DOCUMENT THAT COULD BE USED, AND 883 00:30:35,920 --> 00:30:38,560 SO PROVIDERS COULD MAKE A 884 00:30:38,560 --> 00:30:42,280 REFERRAL TO THE APP BY GIVING 885 00:30:42,280 --> 00:30:43,840 YOUTH A FLYER WITH PROGRAM 886 00:30:43,840 --> 00:30:44,240 INFORMATION. 887 00:30:44,240 --> 00:30:46,320 SO WE WERE ABLE TO SEE 888 00:30:46,320 --> 00:30:47,200 SPECIFICALLY HOW MANY REFERRALS 889 00:30:47,200 --> 00:30:53,240 WERE MADE PER CLINIC, AND THE 890 00:30:53,240 --> 00:30:55,320 DOWNLOAD RATE BY NEW USERS OF 891 00:30:55,320 --> 00:30:57,720 THE APP. 892 00:30:57,720 --> 00:30:59,440 ALSO PERCEPTIONS ABOUT THE 893 00:30:59,440 --> 00:31:01,840 WEBMAP MOBILE APP. 894 00:31:01,840 --> 00:31:04,160 OUR IMPLEMENTATION RESULTS WERE 895 00:31:04,160 --> 00:31:04,920 POSITIVE. 896 00:31:04,920 --> 00:31:07,320 YOUTH AND PARENTS RATED THE 897 00:31:07,320 --> 00:31:09,080 PROGRAM AS MODERATELY TO HIGHLY 898 00:31:09,080 --> 00:31:09,600 ACCEPTABLE. 899 00:31:09,600 --> 00:31:10,800 PROVIDERS ALSO HAD A POSITIVE 900 00:31:10,800 --> 00:31:12,200 EXPERIENCE WITH MAKING REFERRALS 901 00:31:12,200 --> 00:31:13,800 TO THE INTERVENTION. 902 00:31:13,800 --> 00:31:16,200 WE HAD HIGH RATE OF ADOPTION. 903 00:31:16,200 --> 00:31:17,840 ALL OF THE INVITED CLINICS 904 00:31:17,840 --> 00:31:19,040 AGREED TO PARTICIPATE. 905 00:31:19,040 --> 00:31:20,320 THEY EACH MADE REFERRALS, AND 906 00:31:20,320 --> 00:31:21,520 DURING OUR MAINTENANCE PERIOD, 907 00:31:21,520 --> 00:31:23,280 WE HAD CONTINUED REFERRALS AND 908 00:31:23,280 --> 00:31:24,440 NEW PATIENTS DOWNLOADING THE 909 00:31:24,440 --> 00:31:27,680 APP. 910 00:31:27,680 --> 00:31:29,840 AT THE END OF THE STUDY, WE 911 00:31:29,840 --> 00:31:31,840 PUBLICLY RELEASED WEB MAP MOBILE 912 00:31:31,840 --> 00:31:33,680 IN SEPTEMBER OF 2019 FOR BOTH 913 00:31:33,680 --> 00:31:35,960 ANDROID AND IPHONE. 914 00:31:35,960 --> 00:31:38,720 AND WE HAVE WORKED THROUGH USING 915 00:31:38,720 --> 00:31:39,720 INSTITUTIONAL FUNDS TO MAINTAIN 916 00:31:39,720 --> 00:31:41,440 THESE PROGRAMS OVER THIS TIME 917 00:31:41,440 --> 00:31:44,520 PERIOD. 918 00:31:44,520 --> 00:31:46,040 OUR NEXT STEPS ARE TO MAKE SOME 919 00:31:46,040 --> 00:31:47,440 MODIFICATIONS TO INCREASE 920 00:31:47,440 --> 00:31:48,440 ENGAGEMENT, TECHNOLOGY CONTINUES 921 00:31:48,440 --> 00:31:50,320 TO CHANGE SO WE ALSO ARE WORKING 922 00:31:50,320 --> 00:31:53,600 ON SOME TECHNOLOGY UPDATES, AND 923 00:31:53,600 --> 00:31:56,440 IMPORTANTLY, WE'VE HAD A 924 00:31:56,440 --> 00:31:58,920 RELATIVELY LOW RATE OF DIVERSE 925 00:31:58,920 --> 00:32:00,440 YOUTH IN A NUMBER OF OUR 926 00:32:00,440 --> 00:32:01,560 CLINICAL TRIALS, SO WE REALLY 927 00:32:01,560 --> 00:32:03,960 WANT TO WORK ON MAKING THE 928 00:32:03,960 --> 00:32:08,040 PROGRAM MORE RELEVANT TO DIVERSE 929 00:32:08,040 --> 00:32:09,760 CULTURES, AND DESIGN SOME 930 00:32:09,760 --> 00:32:11,960 STUDIES THAT CAN INCREASE 931 00:32:11,960 --> 00:32:13,400 ENGAGEMENT ACROSS A BROADER 932 00:32:13,400 --> 00:32:17,240 POPULATION. 933 00:32:17,240 --> 00:32:19,000 SO I WANT TO TALK NOW ABOUT HOW 934 00:32:19,000 --> 00:32:21,520 DO WE TAKE THESE ACCESSIBLE 935 00:32:21,520 --> 00:32:26,880 DIGITAL HEALTH INTERVENTIONS TO 936 00:32:26,880 --> 00:32:28,840 PREVENT PAIN AND DISABILITY. 937 00:32:28,840 --> 00:32:30,760 THIS IS THE PREVENTION PIPELINE 938 00:32:30,760 --> 00:32:33,200 THAT REALLY SHOWS OPPORTUNITIES 939 00:32:33,200 --> 00:32:34,720 AT MULTIPLE TIME POINTS, AND WE 940 00:32:34,720 --> 00:32:36,480 CAN THINK ABOUT THIS BOTH ACROSS 941 00:32:36,480 --> 00:32:38,440 THE LIFESPAN AS WELL AS JUST 942 00:32:38,440 --> 00:32:40,760 ACROSS SHORTER PERIODS OF TIME 943 00:32:40,760 --> 00:32:43,680 DURING CHILDHOOD. 944 00:32:43,680 --> 00:32:45,560 SO PRIMARY PREVENTION APPROACHES 945 00:32:45,560 --> 00:32:47,400 HAVE BEEN RELATIVELY UNDERUSED 946 00:32:47,400 --> 00:32:50,040 IN PEDIATRIC PAIN TO DATE, BUT 947 00:32:50,040 --> 00:32:52,120 IN THEORY, WE COULD BE 948 00:32:52,120 --> 00:32:54,080 DELIVERING SCHOOL-BASED 949 00:32:54,080 --> 00:32:56,480 PROGRAMS, OTHER PROGRAMS IN THE 950 00:32:56,480 --> 00:32:59,920 COMMUNITY THAT ARE INTENDED FOR 951 00:32:59,920 --> 00:33:02,000 PAIN-FREE POPULATIONS TO REALLY 952 00:33:02,000 --> 00:33:04,520 TARGET THE PREVENTION OF PAIN. 953 00:33:04,520 --> 00:33:06,800 THESE COULD BE RESILIENCE-BASED 954 00:33:06,800 --> 00:33:09,840 APPROACHES THAT TEACH CHILDREN 955 00:33:09,840 --> 00:33:11,520 AND ADOLESCENTS HOW TO DEAL WITH 956 00:33:11,520 --> 00:33:13,760 EVERYDAY ACHES AND PAINS AND TO 957 00:33:13,760 --> 00:33:16,400 LEARN MORE ABOUT HOW THEY CAN 958 00:33:16,400 --> 00:33:18,560 USE HEALTHY AND POSITIVE PAIN 959 00:33:18,560 --> 00:33:21,880 COPING SKILLS. 960 00:33:21,880 --> 00:33:22,640 SECONDARY PREVENTION APPROACHES 961 00:33:22,640 --> 00:33:25,920 REALLY COULD BE TARGETED TOWARD 962 00:33:25,920 --> 00:33:29,120 ACUTE PAIN AND IN THAT CONTEXT, 963 00:33:29,120 --> 00:33:30,840 THE GOAL IS TO PREVENT THE 964 00:33:30,840 --> 00:33:32,240 TRANSITION TO CHRONIC PAIN, SO 965 00:33:32,240 --> 00:33:34,000 THIS COULD BE APPLIED TO 966 00:33:34,000 --> 00:33:36,640 POPULATIONS THAT HAVE AN ACUTE 967 00:33:36,640 --> 00:33:38,640 INJURY OR ARE UNDERGOING EVENTS 968 00:33:38,640 --> 00:33:40,920 THAT ARE EXPECTED TO CAUSE ACUTE 969 00:33:40,920 --> 00:33:42,760 PAIN SUCH AS SURGERY. 970 00:33:42,760 --> 00:33:45,040 AND LAST, AT THE TERTIARY 971 00:33:45,040 --> 00:33:46,960 PREVENTION LEVEL, THIS IS REALLY 972 00:33:46,960 --> 00:33:48,080 FOCUSING ON POPULATIONS THAT 973 00:33:48,080 --> 00:33:50,320 ALREADY HAVE CHRONIC PAIN, SUCH 974 00:33:50,320 --> 00:33:51,920 AS CHILDREN WHO HAVE PAIN IN THE 975 00:33:51,920 --> 00:33:54,160 CONTEXT OF A CHRONIC DISEASE 976 00:33:54,160 --> 00:33:55,600 WHERE THE GOAL IS TO PREVENT 977 00:33:55,600 --> 00:33:56,560 CHRONIC DISABILITY. 978 00:33:56,560 --> 00:33:58,320 SO I'M GOING TO SHARE SOME 979 00:33:58,320 --> 00:34:00,280 EXAMPLES OF ONGOING WORK IN EACH 980 00:34:00,280 --> 00:34:05,440 OF THESE AREAS TO HIGHLIGHT 981 00:34:05,440 --> 00:34:08,800 TEUBTS TOPPORTUNITIES THAT ARE 982 00:34:08,800 --> 00:34:09,120 AVAILABLE. 983 00:34:09,120 --> 00:34:10,680 SO THE FIRST ONGOING STUDY I 984 00:34:10,680 --> 00:34:12,080 WANT TO TALK ABOUT IS CALLED 985 00:34:12,080 --> 00:34:13,640 REACH. 986 00:34:13,640 --> 00:34:16,040 THIS IS A PRIMARY PREVENTION 987 00:34:16,040 --> 00:34:17,920 FOCUSED TRIAL IN PARENTS WHO 988 00:34:17,920 --> 00:34:19,760 HAVE IRRITABLE BOWEL SYNDROME. 989 00:34:19,760 --> 00:34:23,240 THIS IS WORK I'M UNDERTAKING 990 00:34:23,240 --> 00:34:27,600 WITH RONA LEVY FROM THE SCHOOL 991 00:34:27,600 --> 00:34:28,000 OF SOCIAL WORK. 992 00:34:28,000 --> 00:34:30,800 THIS IS BASED ON THE OBSERVATION 993 00:34:30,800 --> 00:34:32,360 THAT CHILDREN OF PARENTS WITH 994 00:34:32,360 --> 00:34:34,440 IRRITABLE BOWEL SYNDROME ARE AT 995 00:34:34,440 --> 00:34:36,920 FOUR TIMES GREATER RISK FOR 996 00:34:36,920 --> 00:34:40,080 ABDOMINAL PAIN COMPARED TO 997 00:34:40,080 --> 00:34:41,520 PARENTS OF CHILDREN WITHOUT 998 00:34:41,520 --> 00:34:43,480 IRRITABLE BOWEL SYNDROME. 999 00:34:43,480 --> 00:34:46,960 WE KNOW IN SOME OF OUR WORK WITH 1000 00:34:46,960 --> 00:34:48,200 YOUTH WITH CHRONIC PAIN 1001 00:34:48,200 --> 00:34:49,400 CONDITIONS ALREADY, THERE ARE 1002 00:34:49,400 --> 00:34:50,840 ASPECTS OF PARENT MODELING AND 1003 00:34:50,840 --> 00:34:53,760 BEHAVIOR THAT CAN BE MODIFIED, 1004 00:34:53,760 --> 00:34:56,640 AND THAT IN THE CONTEXT OF 1005 00:34:56,640 --> 00:34:58,280 PREVENTION, OUR GOAL IS TO 1006 00:34:58,280 --> 00:35:01,480 MODIFY HOW PARENTS REACT TO 1007 00:35:01,480 --> 00:35:02,840 EVERYDAY SOMATIC SYMPTOMS SUCH 1008 00:35:02,840 --> 00:35:07,240 AS EVERYDAY ACHES AND PAINS. 1009 00:35:07,240 --> 00:35:08,440 SO OUR STUDY AIMS ARE TO 1010 00:35:08,440 --> 00:35:10,960 DETERMINE THE EFFICACY OF A 1011 00:35:10,960 --> 00:35:12,920 PREVENTIVE SOCIAL LEARNING AND 1012 00:35:12,920 --> 00:35:14,880 COGNITIVE BEHAVIORAL THERAPY 1013 00:35:14,880 --> 00:35:18,400 INTERVENTION IN REDUCING PARENT 1014 00:35:18,400 --> 00:35:20,560 SOLICITOUSNESS, ANXIETY, AS WELL 1015 00:35:20,560 --> 00:35:22,520 AS CHILD SYMPTOMS. 1016 00:35:22,520 --> 00:35:24,000 WE'RE ALSO INTERESTED IN 1017 00:35:24,000 --> 00:35:25,720 DETERMINING THE CONTRIBUTION OF 1018 00:35:25,720 --> 00:35:27,480 CHANGES IN PARENTAL RISK AND 1019 00:35:27,480 --> 00:35:28,920 PROTECTIVE FACTORS IN MEDIATING 1020 00:35:28,920 --> 00:35:30,120 TREATMENT EFFECTS. 1021 00:35:30,120 --> 00:35:32,640 AND LAST, DETERMINE COST SAVINGS 1022 00:35:32,640 --> 00:35:34,920 ON HEALTHCARE EXPENDITURES AND 1023 00:35:34,920 --> 00:35:36,160 RESOURCE UTILIZATION FOR 1024 00:35:36,160 --> 00:35:38,760 CHILDREN OVER A SUBSEQUENT 18 1025 00:35:38,760 --> 00:35:43,280 MONTH PERIOD. 1026 00:35:43,280 --> 00:35:44,640 THIS SLIDE SHOWS A FEW SCREEN 1027 00:35:44,640 --> 00:35:45,720 SHOTS FROM OUR INTERNET PROGRAM 1028 00:35:45,720 --> 00:35:51,000 THAT WE AR ARE CURRENTLY UNDERGG 1029 00:35:51,000 --> 00:35:52,000 SOME USER TESTING. 1030 00:35:52,000 --> 00:35:53,320 IT GETTING CLOSE TO BEING 1031 00:35:53,320 --> 00:35:54,920 FINISHED AND READY TO USE IN OUR 1032 00:35:54,920 --> 00:35:55,320 TRIAL. 1033 00:35:55,320 --> 00:35:57,480 AND THE GOAL IS TO REALLY TEACH 1034 00:35:57,480 --> 00:36:01,760 PARENTS HOW TO FOCUS ON WELLNESS 1035 00:36:01,760 --> 00:36:04,800 BEHAVIORS IN THE CONTEXT OF 1036 00:36:04,800 --> 00:36:08,000 EVERYDAY ACHES AND PAINS. 1037 00:36:08,000 --> 00:36:11,600 SO THIS IS A RANDOMIZED 1038 00:36:11,600 --> 00:36:12,800 CONTROLLED TRIAL WITH 1039 00:36:12,800 --> 00:36:14,360 460 PARENTS WITH IRRITABLE BOWEL 1040 00:36:14,360 --> 00:36:15,440 SYNDROME WHO HAVE YOUNG CHILDREN 1041 00:36:15,440 --> 00:36:17,240 WHO ARE AGES 4 TO 7 YEARS, WHO 1042 00:36:17,240 --> 00:36:18,880 DO NOT YET HAVE ANY PROBLEMS 1043 00:36:18,880 --> 00:36:22,000 WITH ABDOMINAL PAIN. 1044 00:36:22,000 --> 00:36:23,080 THEY'RE RANDOMIZED TO EITHER A 1045 00:36:23,080 --> 00:36:25,200 SOCIAL LEARNING OR AN EDUCATION 1046 00:36:25,200 --> 00:36:30,200 CONTROL WEBSITE, AND WE'RE 1047 00:36:30,200 --> 00:36:32,480 UNDERTAKING A MULTIPRONGED 1048 00:36:32,480 --> 00:36:33,600 RECRUITMENT APPROACH, WE WILL BE 1049 00:36:33,600 --> 00:36:35,120 RECRUITING FROM IBS SUPPORT 1050 00:36:35,120 --> 00:36:36,640 GROUPS, FROM SCHOOL DISTRIBUTION 1051 00:36:36,640 --> 00:36:40,480 LISTS, AND OTHER LARGE 1052 00:36:40,480 --> 00:36:41,240 EMPLOYER-BASED DISTRIBUTION 1053 00:36:41,240 --> 00:36:42,240 LISTS THAT CAN GO DIRECTLY TO 1054 00:36:42,240 --> 00:36:44,880 PARENTS. 1055 00:36:44,880 --> 00:36:46,720 WE'RE ON TARGET TO LAUNCH THE 1056 00:36:46,720 --> 00:36:48,280 TRIAL THIS SUMMER, AND WE'LL 1057 00:36:48,280 --> 00:36:49,800 HAVE HOPEFULLY SOME RESULTS TO 1058 00:36:49,800 --> 00:36:56,680 SHARE WITH YOU IN A FEW YEARS. 1059 00:36:56,680 --> 00:36:58,200 SO MOVING ON TO SECONDARY 1060 00:36:58,200 --> 00:36:59,840 PREVENTION, I WANT TO JUST 1061 00:36:59,840 --> 00:37:01,080 HIGHLIGHT AN ONGOING TRIAL THAT 1062 00:37:01,080 --> 00:37:03,480 IS CALLED SURGERYPAL. 1063 00:37:03,480 --> 00:37:05,280 THIS IS A MULTI-SITE CLINICAL 1064 00:37:05,280 --> 00:37:08,400 TRIAL TESTING THE EFFECTIVENESS 1065 00:37:08,400 --> 00:37:10,360 OF A MOBILE APP INTERVENTION 1066 00:37:10,360 --> 00:37:13,120 THAT WE CALL SURGERYPAL TO 1067 00:37:13,120 --> 00:37:17,040 IMPROVE ACUTE AND CHRONIC PAIN 1068 00:37:17,040 --> 00:37:19,640 AND HEALTH OUTCOMES AFTER 1069 00:37:19,640 --> 00:37:20,200 ADOLESCENT SPINAL FUSION 1070 00:37:20,200 --> 00:37:20,440 SURGERY. 1071 00:37:20,440 --> 00:37:21,560 THE GOAL IS TO PREVENT THE 1072 00:37:21,560 --> 00:37:23,280 TRANSITION FROM ACUTE TO CHRONIC 1073 00:37:23,280 --> 00:37:24,480 POST SURGICAL PAIN. 1074 00:37:24,480 --> 00:37:28,000 THIS IS DESIGNED AS A TWO-PHASE 1075 00:37:28,000 --> 00:37:28,320 INTERVENTION. 1076 00:37:28,320 --> 00:37:30,520 WE'RE INTERESTED IN 1077 00:37:30,520 --> 00:37:33,240 UNDERSTANDING WHETHER 1078 00:37:33,240 --> 00:37:34,560 INTERVENTION SHOULD BE DELIVERED 1079 00:37:34,560 --> 00:37:36,200 DURING A PRE-SURGERY PHASE 1080 00:37:36,200 --> 00:37:38,360 AND/OR A POST SURGERY PHASE OR 1081 00:37:38,360 --> 00:37:38,600 BOTH. 1082 00:37:38,600 --> 00:37:42,760 SO YOU CAN SEE OUR TIMELINE 1083 00:37:42,760 --> 00:37:44,080 HERE, WHO ARE RANDOMIZED TO GET 1084 00:37:44,080 --> 00:37:45,400 A PRE-SURGERY INTERVENTION WILL 1085 00:37:45,400 --> 00:37:47,040 RECEIVE THAT AT 4 TO 8 WEEKS 1086 00:37:47,040 --> 00:37:49,000 BEFORE SURGERY, AND YOUTH WHO 1087 00:37:49,000 --> 00:37:51,400 ARE RANDOMIZED TO GET A 1088 00:37:51,400 --> 00:37:52,600 POST-SURGERY INTERVENTION WILL 1089 00:37:52,600 --> 00:37:55,760 RECEIVE THAT AT ABOUT 3 WEEKS 1090 00:37:55,760 --> 00:38:00,480 AFTER SURGERY. 1091 00:38:00,480 --> 00:38:03,640 WE'RE COLLECTING BOTH ACUTE PAIN 1092 00:38:03,640 --> 00:38:10,000 OUTCOMES AND IMMEDIATE PAIN 1093 00:38:10,000 --> 00:38:11,520 OUTCOMES IN THE THREE AND SIX 1094 00:38:11,520 --> 00:38:13,400 MONTHS POST SURGERY. 1095 00:38:13,400 --> 00:38:23,960 THIS IS A HEAL-FUNDED TRIAL WITH 1096 00:38:24,720 --> 00:38:29,040 RABBITTS, PAIN, AS WELL AS 1097 00:38:29,040 --> 00:38:31,360 OPIOID USE, QUALITY OF LIFE AND 1098 00:38:31,360 --> 00:38:32,760 PSYCHOSOCIAL DISTRESS. 1099 00:38:32,760 --> 00:38:34,720 THE MOBILE APP IS BASED ON 1100 00:38:34,720 --> 00:38:35,560 CONTENT THAT IS TARGETING 1101 00:38:35,560 --> 00:38:36,720 SEVERAL AREAS THAT HAVE BEEN 1102 00:38:36,720 --> 00:38:38,280 FOUND TO BE ASSOCIATED WITH BOTH 1103 00:38:38,280 --> 00:38:40,000 ACUTE AND CHRONIC PAIN AFTER 1104 00:38:40,000 --> 00:38:41,120 SURGERY IN CHILDREN. 1105 00:38:41,120 --> 00:38:44,320 SO WE'RE TARGETING CHILD 1106 00:38:44,320 --> 00:38:47,360 ANXIETY, CHILD SLEEP BEFORE 1107 00:38:47,360 --> 00:38:50,080 SURGERY, ACUTE PAIN COPING 1108 00:38:50,080 --> 00:38:50,840 SKILLS, AS WELL AS PARENT 1109 00:38:50,840 --> 00:38:51,800 DISTRESS. 1110 00:38:51,800 --> 00:38:53,920 AND WE HAVE SIMILAR TARGETS 1111 00:38:53,920 --> 00:38:54,680 POST-SURGERY. 1112 00:38:54,680 --> 00:38:55,880 THIS IS A BRIEF INTERVENTION 1113 00:38:55,880 --> 00:38:58,400 WHICH IS THREE WEEKS BEFORE 1114 00:38:58,400 --> 00:38:59,600 SURGERY AND THREE WEEKS AFTER 1115 00:38:59,600 --> 00:39:04,720 SURGERY. 1116 00:39:04,720 --> 00:39:06,160 THIS SLIDE JUST SHOWS THE 1117 00:39:06,160 --> 00:39:06,600 ENROLLMENT SITES. 1118 00:39:06,600 --> 00:39:09,000 WE ARE ABOUT HALFWAY -- A LITTLE 1119 00:39:09,000 --> 00:39:10,560 OVER HALFWAY THROUGH THIS 1120 00:39:10,560 --> 00:39:13,400 ENROLLMENT PERIOD WITH 263 1121 00:39:13,400 --> 00:39:15,240 ADOLESCENTS RECRUITED TO DATE. 1122 00:39:15,240 --> 00:39:18,640 THERE ARE 34 REFERRING SITES 1123 00:39:18,640 --> 00:39:21,840 THAT HAVE BEEN HIGHLY ENGAGED IN 1124 00:39:21,840 --> 00:39:24,920 REFERRING PARTICIPANTS TO THE 1125 00:39:24,920 --> 00:39:26,080 PROJECT. 1126 00:39:26,080 --> 00:39:27,600 AND WE'RE EXCITED TO FINISH THIS 1127 00:39:27,600 --> 00:39:30,440 STUDY UP OVER THE NEXT YEAR TO 1128 00:39:30,440 --> 00:39:31,920 18 MONTHS AND BE ABLE TO ANSWER 1129 00:39:31,920 --> 00:39:38,680 SOME OF THESE QUESTIONS. 1130 00:39:38,680 --> 00:39:40,000 AND THEN I WANT TO HIGHLIGHT IN 1131 00:39:40,000 --> 00:39:41,320 THE CONTEXT OF TERTIARY 1132 00:39:41,320 --> 00:39:42,720 PREVENTION A TRIAL THAT WAS 1133 00:39:42,720 --> 00:39:45,360 RECENTLY COMPLETED IN A 1134 00:39:45,360 --> 00:39:47,000 POPULATION OF ADOLESCENTS WITH 1135 00:39:47,000 --> 00:39:50,600 SICKLE CELL DISEASE PAIN THAT WE 1136 00:39:50,600 --> 00:39:52,280 CALL I CAN COPE. 1137 00:39:52,280 --> 00:39:56,120 THIS WAS A STUDY UNDERTAKEN WITH 1138 00:39:56,120 --> 00:39:59,480 CARLTON DAMPIER FROM EMORY AND 1139 00:39:59,480 --> 00:40:01,240 JENNIFER STINSON FROM THE 1140 00:40:01,240 --> 00:40:02,160 HOSPITAL FOR SICK KIDS. 1141 00:40:02,160 --> 00:40:04,000 THE BACKGROUND AND RATIONALE FOR 1142 00:40:04,000 --> 00:40:05,600 COMPLETING THIS STUDY WAS THAT 1143 00:40:05,600 --> 00:40:07,040 THERE'S LIMITED EVIDENCE TO 1144 00:40:07,040 --> 00:40:08,440 SUPPORT TREATMENT 1145 00:40:08,440 --> 00:40:09,800 RECOMMENDATIONS FOR SICKLE CELL 1146 00:40:09,800 --> 00:40:11,360 DISEASE PAIN IN ADOLESCENTS. 1147 00:40:11,360 --> 00:40:14,480 WE KNOW THAT C BT PAIN 1148 00:40:14,480 --> 00:40:15,280 INTERVENTIONS ARE USEFUL IN 1149 00:40:15,280 --> 00:40:17,320 OTHER POPULATIONS, BUT THERE 1150 00:40:17,320 --> 00:40:20,880 REALLY WAS VERY LIMITED EVIDENCE 1151 00:40:20,880 --> 00:40:23,360 IN SICKLE CELL DISEASE 1152 00:40:23,360 --> 00:40:23,960 POPULATIONS SPECIFICALLY. 1153 00:40:23,960 --> 00:40:26,960 WE AIMED TO DETERMINE THE 1154 00:40:26,960 --> 00:40:28,440 EFFICACY OF A DIGITAL HEALTH 1155 00:40:28,440 --> 00:40:30,560 INTERVENTION THAT WE CALL I CAN 1156 00:40:30,560 --> 00:40:33,600 COPE WITH SCD FOR TEACHING CBT 1157 00:40:33,600 --> 00:40:36,200 SKILLS FOR PAIN MANAGEMENT FOR 1158 00:40:36,200 --> 00:40:37,320 ADOLESCENTS WITH SICKLE CELL 1159 00:40:37,320 --> 00:40:37,760 DISEASE. 1160 00:40:37,760 --> 00:40:40,720 AND WE HYPOTHESIZED THAT THE 1161 00:40:40,720 --> 00:40:43,000 GROUP RECEIVING COGNITIVE 1162 00:40:43,000 --> 00:40:43,720 BEHAVIORAL THERAPY INTERVENTION 1163 00:40:43,720 --> 00:40:45,200 WOULD HAVE INCREASED ADAPTIVE 1164 00:40:45,200 --> 00:40:47,280 COPING STRATEGIES, REDUCED PAIN 1165 00:40:47,280 --> 00:40:49,120 SEVERITY AND ACTIVITY 1166 00:40:49,120 --> 00:40:52,280 LIMITATIONS COMPARED TO A GROUP 1167 00:40:52,280 --> 00:40:52,920 RECEIVING SICKLE CELL EDUCATION 1168 00:40:52,920 --> 00:40:56,160 ONLY. 1169 00:40:56,160 --> 00:40:58,320 THIS WAS A MULTICENTER 1170 00:40:58,320 --> 00:40:59,760 RANDOMIZED CONTROL TRIAL WITH 1171 00:40:59,760 --> 00:41:03,040 SEVEN DIFFERENT SITES. 1172 00:41:03,040 --> 00:41:05,240 WE ENROLLED YOUTH AGES 12 TO 18 1173 00:41:05,240 --> 00:41:08,080 YEARS AND ENDED UP RANDOMIZING 1174 00:41:08,080 --> 00:41:09,400 111 YOUTH TO EITHER THE I CAN 1175 00:41:09,400 --> 00:41:12,800 COPE OR EDUCATION CONTROL GROUP. 1176 00:41:12,800 --> 00:41:14,680 THEY COMPLETED A BASELINE 1177 00:41:14,680 --> 00:41:15,240 ASSESSMENT. 1178 00:41:15,240 --> 00:41:18,200 OUR TREATMENT WAS ABOUT 8 WEEKS, 1179 00:41:18,200 --> 00:41:20,600 AND THEY COMPLETED BOTH A 1180 00:41:20,600 --> 00:41:21,680 POST-TREATMENT AS WELL AS A 1181 00:41:21,680 --> 00:41:22,880 6-MONTH FOLLOW-UP ASSESSMENT. 1182 00:41:22,880 --> 00:41:24,000 WE HAD REALLY EXCELLENT 1183 00:41:24,000 --> 00:41:25,520 RETENTION IN THIS TRIAL. 1184 00:41:25,520 --> 00:41:27,520 92% OF YOUTH COMPLETED A 1185 00:41:27,520 --> 00:41:30,440 POST-TREATMENT ASSESSMENT, AND 1186 00:41:30,440 --> 00:41:32,000 88% COMPLETED THE 6-MONTH 1187 00:41:32,000 --> 00:41:34,600 FOLLOW-UP. 1188 00:41:34,600 --> 00:41:35,760 THIS SLIDE SHOWS SOME SCREEN 1189 00:41:35,760 --> 00:41:38,000 SHOTS FROM OUR INTERVENTION. 1190 00:41:38,000 --> 00:41:40,000 THIS WAS A TWO-COMPONENT 1191 00:41:40,000 --> 00:41:42,040 INTERVENTION. 1192 00:41:42,040 --> 00:41:45,200 THERE WAS A MOBILE APP THAT 1193 00:41:45,200 --> 00:41:47,080 ALLOWED FOR SOME DAILY 1194 00:41:47,080 --> 00:41:48,440 INFORMATION ON HOW TO CHECK IN, 1195 00:41:48,440 --> 00:41:49,720 A LIBRARY, AS WELL AS A 1196 00:41:49,720 --> 00:41:51,400 COMMUNITY SECTION, AND THEN WE 1197 00:41:51,400 --> 00:41:52,920 HAD A WEBSITE THAT ALLOWED FOR 1198 00:41:52,920 --> 00:41:55,560 MORE EXTENDED LEARNING AROUND 1199 00:41:55,560 --> 00:41:59,600 PARTICULAR SKILLS. 1200 00:41:59,600 --> 00:42:03,320 THIS TABLE SHOWS EFFECTS OF OUR 1201 00:42:03,320 --> 00:42:05,320 CBT INTERVENTION COMPARED TO 1202 00:42:05,320 --> 00:42:06,800 EDUCATION CONTROL ON OUR PAIN 1203 00:42:06,800 --> 00:42:08,600 AND COPING OUTCOMES. 1204 00:42:08,600 --> 00:42:11,440 AND WE DID FIND SIGNIFICANT 1205 00:42:11,440 --> 00:42:14,280 EFFECTS FOR REDUCTIONS IN 1206 00:42:14,280 --> 00:42:15,840 AVERAGE DAILY PAIN AND NUMBER OF 1207 00:42:15,840 --> 00:42:17,720 DAYS WITH PAIN, AS WELL AS FOR 1208 00:42:17,720 --> 00:42:23,920 INCREASES IN COPING ATTEMPTS. 1209 00:42:23,920 --> 00:42:25,440 THIS IS A STUDY WE JUST RECENTLY 1210 00:42:25,440 --> 00:42:28,080 HAD ACCEPTED IN PAIN SO IT WILL 1211 00:42:28,080 --> 00:42:29,320 BE PUBLISHED IN THE COMING 1212 00:42:29,320 --> 00:42:29,680 MONTHS. 1213 00:42:29,680 --> 00:42:34,040 THIS SLIDE JUST HIGHLIGHTS THE 1214 00:42:34,040 --> 00:42:36,680 REDUCTIONS IN PAIN DAYS AND PAIN 1215 00:42:36,680 --> 00:42:36,920 INTENSITY. 1216 00:42:36,920 --> 00:42:39,280 AND YOU CAN SEE THAT OVER TIME, 1217 00:42:39,280 --> 00:42:42,360 THESE EFFECTS INCREASED SO THAT 1218 00:42:42,360 --> 00:42:46,240 WE HAD AT 6 MONTHS A SIGNIFICANT 1219 00:42:46,240 --> 00:42:47,320 DIFFERENCE BETWEEN OUR TREATMENT 1220 00:42:47,320 --> 00:42:52,320 CONDITIONS. 1221 00:42:52,320 --> 00:42:53,960 RM I WANT TO TAKE A MOMENT JUST 1222 00:42:53,960 --> 00:42:55,680 TO HIGHLIGHT THAT THIS TRIAL WAS 1223 00:42:55,680 --> 00:42:58,600 A GOOD OPPORTUNITY TO THINK 1224 00:42:58,600 --> 00:43:02,080 ABOUT HOW TO DESIGN STUDIES THAE 1225 00:43:02,080 --> 00:43:04,280 MORE INCLUSIVE, THAT ADDRESS 1226 00:43:04,280 --> 00:43:09,120 BARRIERS THAT MIGHT PREVENT MORE 1227 00:43:09,120 --> 00:43:09,760 DIVERSE INDIVIDUALS FROM 1228 00:43:09,760 --> 00:43:10,320 PARTICIPATING. 1229 00:43:10,320 --> 00:43:11,640 I WANT TO HIGHLIGHT THIS ARTICLE 1230 00:43:11,640 --> 00:43:14,160 FROM MARY JANEVIC THAT WAS 1231 00:43:14,160 --> 00:43:15,160 PUBLISHED LAST YEAR IN THE 1232 00:43:15,160 --> 00:43:16,480 JOURNAL OF PAIN THAT PROVIDES A 1233 00:43:16,480 --> 00:43:19,320 REALLY WONDERFUL OVERVIEW OF HOW 1234 00:43:19,320 --> 00:43:22,240 TO PRACTICALLY ADDRESS BARRIERS 1235 00:43:22,240 --> 00:43:23,800 TO INCLUSION THROUGH SOME 1236 00:43:23,800 --> 00:43:26,640 PRACTICAL STRATEGIES. 1237 00:43:26,640 --> 00:43:30,240 FOR EXAMPLE, REFRAMING THE STUDY 1238 00:43:30,240 --> 00:43:32,120 DESIGN AND PROCEDURES TO FIT 1239 00:43:32,120 --> 00:43:32,640 PARTICIPANTS' LIVES. 1240 00:43:32,640 --> 00:43:34,760 FOR EXAMPLE, IN OUR I-CAN-COPE 1241 00:43:34,760 --> 00:43:36,480 TRIAL, THIS WAS ENTIRELY REMOTE, 1242 00:43:36,480 --> 00:43:39,360 WE HAD NO IN-PERSON PROCEDURES, 1243 00:43:39,360 --> 00:43:41,680 AND REALLY FELT THAT THIS MADE 1244 00:43:41,680 --> 00:43:45,280 THE TRIAL MUCH MORE ACCESSIBLE 1245 00:43:45,280 --> 00:43:47,040 TO ALL. 1246 00:43:47,040 --> 00:43:48,800 WE ALSO -- ANOTHER SUGGESTION IS 1247 00:43:48,800 --> 00:43:50,760 TO USE APPROACHES TO RECRUITMENT 1248 00:43:50,760 --> 00:43:53,040 THAT DO NOT RELY ON CLINIC 1249 00:43:53,040 --> 00:43:55,200 CONTACT ONLY. 1250 00:43:55,200 --> 00:43:58,640 THIS CAN INCLUDE CONTACTS THAT 1251 00:43:58,640 --> 00:44:00,440 OCCUR OUTSIDE OF CLINIC THROUGH 1252 00:44:00,440 --> 00:44:02,280 COMMUNITY ORGANIZATIONS AND 1253 00:44:02,280 --> 00:44:05,240 COMMUNITY PARTNERSHIPS. 1254 00:44:05,240 --> 00:44:06,560 AND THEN LAST, BUILDING 1255 00:44:06,560 --> 00:44:07,520 ENGAGEMENT WITH STAKEHOLDER 1256 00:44:07,520 --> 00:44:08,080 PARTNERSHIP. 1257 00:44:08,080 --> 00:44:08,880 THIS IS SOMETHING WE'VE ALWAYS 1258 00:44:08,880 --> 00:44:11,080 DONE IN OUR DIGITAL HEALTH 1259 00:44:11,080 --> 00:44:12,040 INTERVENTIONS, BUT THERE ARE 1260 00:44:12,040 --> 00:44:13,480 MANY GOOD STRATEGIES AND 1261 00:44:13,480 --> 00:44:14,920 SUGGESTIONS IN THIS ARTICLE FOR 1262 00:44:14,920 --> 00:44:21,160 HOW TO BUILD ENGAGEMENT. 1263 00:44:21,160 --> 00:44:22,760 AND I THOUGHT IT WAS IMPORTANT 1264 00:44:22,760 --> 00:44:24,560 TO CLOSE WITH SOME THOUGHTS 1265 00:44:24,560 --> 00:44:27,000 ABOUT OUTCOMES. 1266 00:44:27,000 --> 00:44:29,400 WHEN WE ARE THINKING ABOUT HOW 1267 00:44:29,400 --> 00:44:32,000 TO DEVELOP INTERVENTIONS THAT 1268 00:44:32,000 --> 00:44:34,840 CAN HELP CHILDREN WITH CHRONIC 1269 00:44:34,840 --> 00:44:35,640 PAIN, AN IMPORTANT COMPONENT OF 1270 00:44:35,640 --> 00:44:38,480 THAT IS BEING ABLE TO PRODUCE AN 1271 00:44:38,480 --> 00:44:40,040 EVIDENCE BASE THAT SHOWS US 1272 00:44:40,040 --> 00:44:41,880 WHICH TREATMENTS WORK. 1273 00:44:41,880 --> 00:44:45,360 WE NEED RELIABLE, VALID OUT COME 1274 00:44:45,360 --> 00:44:46,360 ASSESSMENT TOOLS IN ORDER TO DO 1275 00:44:46,360 --> 00:44:46,760 THIS. 1276 00:44:46,760 --> 00:44:49,640 THIS WAS WORK THAT WE'VE 1277 00:44:49,640 --> 00:44:56,560 RECENTLY FINISHED THAT REALLY 1278 00:44:56,560 --> 00:44:58,680 COMES FROM PRIOR WORK THAT WAS 1279 00:44:58,680 --> 00:45:00,360 DONE ALMOST 20 YEARS AGO. 1280 00:45:00,360 --> 00:45:01,160 OUR FIRST STEP WAS TO UPDATE 1281 00:45:01,160 --> 00:45:06,520 THIS WORK BY CONDUCTING A NEW 1282 00:45:06,520 --> 00:45:07,840 DELPHI POLL AND CONSENSUS 1283 00:45:07,840 --> 00:45:10,040 MEETING TO DEVELOP A NEW CORE 1284 00:45:10,040 --> 00:45:16,360 OUTSOME SET FOR PEDIATRIC 1285 00:45:16,360 --> 00:45:17,720 CHRONIC PAIN. 1286 00:45:17,720 --> 00:45:19,480 WE DID A DELPHI POLL WITH 1287 00:45:19,480 --> 00:45:20,560 ADOLESCENTS AND PARENTS 1288 00:45:20,560 --> 00:45:21,320 DIRECTLY, AS WELL AS WITH 1289 00:45:21,320 --> 00:45:22,640 HEALTHCARE PROVIDERS. 1290 00:45:22,640 --> 00:45:25,520 AND FROM THAT, WE WERE ABLE TO 1291 00:45:25,520 --> 00:45:28,800 ACHIEVE CONSENSUS ON MANDATORY 1292 00:45:28,800 --> 00:45:30,160 DOMAINS THAT SHOULD BE USED IN 1293 00:45:30,160 --> 00:45:33,960 ALL TRIALS OF PEDIATRIC CHRONIC 1294 00:45:33,960 --> 00:45:35,760 PAIN, IMPORTANT OPTIONAL DOMAINS 1295 00:45:35,760 --> 00:45:37,000 THAT SHOULD BE USED IN SOME BUT 1296 00:45:37,000 --> 00:45:38,280 MAYBE NOT ALL TRIALS, AS WELL AS 1297 00:45:38,280 --> 00:45:41,080 A RESEARCH AGENDA. 1298 00:45:41,080 --> 00:45:43,840 SO THE COMMITTEE USED THE 1299 00:45:43,840 --> 00:45:45,200 FRAMEWORK YOU SEE HERE TO FIT 1300 00:45:45,200 --> 00:45:46,480 THESE VARIOUS DOMAINS, AND AS 1301 00:45:46,480 --> 00:45:49,120 YOU CAN SEE PAIN SEVERITY, PAIN 1302 00:45:49,120 --> 00:45:51,320 INTERFERENCE WITH DAILY LIVING, 1303 00:45:51,320 --> 00:45:58,520 OVERALL COPLIVING -- OVERALL WED 1304 00:45:58,520 --> 00:46:00,760 ADVERSE EVENTS WERE INCLUDED IN 1305 00:46:00,760 --> 00:46:01,480 ALL TRIALS. 1306 00:46:01,480 --> 00:46:03,760 EMOTIONAL FUNCTIONING, PHYSICAL 1307 00:46:03,760 --> 00:46:04,760 FUNCTIONING AND SLEEP WERE 1308 00:46:04,760 --> 00:46:06,080 RECOMMENDED IN MANY TRIALS AS 1309 00:46:06,080 --> 00:46:06,960 OPTIONAL DOMAINS. 1310 00:46:06,960 --> 00:46:08,400 BUILDING FROM THIS, OUR NEXT 1311 00:46:08,400 --> 00:46:11,000 PHASE OF WORK WAS TO SELECT 1312 00:46:11,000 --> 00:46:15,480 OUTCOME MEASURES THAT COULD FIT 1313 00:46:15,480 --> 00:46:16,680 EACH OF THESE DOMAINS. 1314 00:46:16,680 --> 00:46:19,000 WE USED A MULTIPHASE APPROACH, 1315 00:46:19,000 --> 00:46:21,960 WE DID A DELPHI STUDY OF EXPERTS 1316 00:46:21,960 --> 00:46:23,960 TO IDENTIFY CANDIDATE MEASURES 1317 00:46:23,960 --> 00:46:25,800 AND THEN DID A REVIEW PHASE TO 1318 00:46:25,800 --> 00:46:27,800 GATHER EVIDENCE FOR MEASUREMENT 1319 00:46:27,800 --> 00:46:29,240 PROPERTIES OF EACH OF THESE 1320 00:46:29,240 --> 00:46:32,600 CANDIDATE MEASURES. 1321 00:46:32,600 --> 00:46:34,840 AND THEN LAST, A CONSENSUS 1322 00:46:34,840 --> 00:46:35,920 CONFERENCE TO MAKE FINAL 1323 00:46:35,920 --> 00:46:36,280 RECOMMENDATIONS. 1324 00:46:36,280 --> 00:46:39,080 SO THIS PROCESS REALLY ALLOWED 1325 00:46:39,080 --> 00:46:41,200 US TO MAKE INFORMED 1326 00:46:41,200 --> 00:46:42,440 RECOMMENDATIONS ON MEASURES FOR 1327 00:46:42,440 --> 00:46:46,120 THE NEW CORE OUTCOME SET. 1328 00:46:46,120 --> 00:46:48,040 AND THE NEXT STEP OF THIS IS 1329 00:46:48,040 --> 00:46:49,160 REALLY TO MAKE THIS ACCESSIBLE, 1330 00:46:49,160 --> 00:46:51,840 SO THAT WE CAN, AS A COMMUNITY, 1331 00:46:51,840 --> 00:46:55,880 BE ABLE TO ACCESS THESE TOOLS 1332 00:46:55,880 --> 00:46:56,200 EASILY. 1333 00:46:56,200 --> 00:46:59,120 I WANT TO GIVE A SHOUT OUT TO 1334 00:46:59,120 --> 00:47:00,560 RAY LEE, ONE OF MY COLLEAGUES 1335 00:47:00,560 --> 00:47:04,640 WHO HAS DONE TREMENDOUS WORK ON 1336 00:47:04,640 --> 00:47:07,800 REALLY NOT ONLY REVIEWING THE 1337 00:47:07,800 --> 00:47:09,360 EVIDENCE LEVEL FOR THE OUTCOME 1338 00:47:09,360 --> 00:47:10,360 MEASURES, BUT ALSO THINKING 1339 00:47:10,360 --> 00:47:13,960 THROUGH HOW TO DISSEMINATE THIS 1340 00:47:13,960 --> 00:47:14,600 INFORMATION NOW. 1341 00:47:14,600 --> 00:47:16,800 OUR GOAL IS TO BE ABLE TO HAVE 1342 00:47:16,800 --> 00:47:19,000 ACCESSIBLE ENGLISH AND SPANISH 1343 00:47:19,000 --> 00:47:20,520 MEASURES FOR EACH DOMAIN, AS 1344 00:47:20,520 --> 00:47:23,080 WELL AS TO HAVE CONTENT THAT 1345 00:47:23,080 --> 00:47:25,480 HELPS WITH UNDERSTANDING HOW TO 1346 00:47:25,480 --> 00:47:26,880 DO -- HOW TO REACH OTHER 1347 00:47:26,880 --> 00:47:33,360 MEASURES THAT ARE RECOMMENDED. 1348 00:47:33,360 --> 00:47:37,120 SO QUICK SUMMARY, I HOPE AT THE 1349 00:47:37,120 --> 00:47:38,960 END OF THIS LECTURE THAT YOU'VE 1350 00:47:38,960 --> 00:47:40,160 UNDERSTOOD THAT PAIN IN CHILDREN 1351 00:47:40,160 --> 00:47:40,840 DOES MATTER. 1352 00:47:40,840 --> 00:47:46,000 IT'S A COMMON PROBLEM IN 1353 00:47:46,000 --> 00:47:47,080 CHILDREN AND ADOLESCENTS, AND WE 1354 00:47:47,080 --> 00:47:48,560 KNOW PAIN HAS A SIGNIFICANT 1355 00:47:48,560 --> 00:47:50,040 IMPACT DURING CHILDHOOD AND CAN 1356 00:47:50,040 --> 00:47:52,200 HAVE A REAL LASTING IMPACT INTO 1357 00:47:52,200 --> 00:47:55,440 ADULTHOOD AS WELL. 1358 00:47:55,440 --> 00:47:58,760 PSYCHOLOGICAL INTERVENTIONS MAY 1359 00:47:58,760 --> 00:48:01,040 HELP TO PREVENT PAIN AND 1360 00:48:01,040 --> 00:48:02,440 DISABILITY IN CHILDHOOD AS WELL 1361 00:48:02,440 --> 00:48:03,280 AS DURING ADULTHOOD. 1362 00:48:03,280 --> 00:48:04,800 THEY COULD BE USED ACROSS THE 1363 00:48:04,800 --> 00:48:06,280 PREVENTION PIPELINE AND I SHOWED 1364 00:48:06,280 --> 00:48:07,520 SEVERAL EXAMPLES OF HOW THAT CAN 1365 00:48:07,520 --> 00:48:09,920 BE DONE, BUT THERE'S LOTS OF 1366 00:48:09,920 --> 00:48:11,720 OPPORTUNITIES FOR CONTINUED 1367 00:48:11,720 --> 00:48:13,680 APPLICATIONS. 1368 00:48:13,680 --> 00:48:15,960 TECHNOLOGY DELIVERED 1369 00:48:15,960 --> 00:48:17,080 INTERVENTIONS CAN ADDRESS 1370 00:48:17,080 --> 00:48:19,720 BARRIERS TO ACCESS AND MAY 1371 00:48:19,720 --> 00:48:24,080 EVENTUALLY BE ABLE TO IMPROVE 1372 00:48:24,080 --> 00:48:25,760 EQUITY IN ACCESS TO PAIN CARE. 1373 00:48:25,760 --> 00:48:28,480 WE KNOW THAT HARMONIZING 1374 00:48:28,480 --> 00:48:29,720 MEASURES IN CLINICAL TRIALS FOR 1375 00:48:29,720 --> 00:48:31,480 CHRONIC PAIN CAN HELP US ADVANCE 1376 00:48:31,480 --> 00:48:33,080 KNOWLEDGE OF CLINICAL 1377 00:48:33,080 --> 00:48:37,080 INTERVENTIONS. 1378 00:48:37,080 --> 00:48:38,560 SO SOME FUTURE DIRECTIONS. 1379 00:48:38,560 --> 00:48:41,520 AS MENTIONED, DEVELOPMENTAL OR 1380 00:48:41,520 --> 00:48:42,920 LIFESPAN MODELS OF CHRONIC PAIN 1381 00:48:42,920 --> 00:48:46,120 CAN REALLY HELP US TO CONNECT 1382 00:48:46,120 --> 00:48:48,480 CHILDHOOD AND ADULT PAIN AND 1383 00:48:48,480 --> 00:48:50,360 HELP BETTER DEFINE INTERVENTION 1384 00:48:50,360 --> 00:48:50,960 TARGETS. 1385 00:48:50,960 --> 00:48:53,840 IF WE THINK FORWARD OF WHAT ARE 1386 00:48:53,840 --> 00:48:56,200 THOSE OUTCOMES IN ADULTHOOD THAT 1387 00:48:56,200 --> 00:48:58,480 WE'RE STRIVING FOR, WE MAY 1388 00:48:58,480 --> 00:49:00,200 DESIGN PEDIATRIC INTERVENTIONS A 1389 00:49:00,200 --> 00:49:03,440 LITTLE DIFFERENTLY. 1390 00:49:03,440 --> 00:49:05,400 AS MENTIONED, I THINK WE NEED TO 1391 00:49:05,400 --> 00:49:07,800 CONTINUE TO TEST PSYCHOLOGICAL 1392 00:49:07,800 --> 00:49:08,880 INTERVENTIONS ACROSS THE 1393 00:49:08,880 --> 00:49:10,320 PREVENTION PIPELINE, AND REALLY 1394 00:49:10,320 --> 00:49:11,480 UNDERSTAND WHAT ARE THOSE 1395 00:49:11,480 --> 00:49:14,920 WINDOWS OF OPPORTUNITY FOR 1396 00:49:14,920 --> 00:49:15,960 DELIVERING INTERVENTIONS THAT 1397 00:49:15,960 --> 00:49:18,120 CAN BOTH PROMOTE RESILIENCY AS 1398 00:49:18,120 --> 00:49:23,160 WELL AS ADDRESS RISK FACTORS. 1399 00:49:23,160 --> 00:49:24,720 YOUNG ADULTS IN PARTICULAR HAVE 1400 00:49:24,720 --> 00:49:28,120 BEEN LEFT OUT OF SOME OF THE 1401 00:49:28,120 --> 00:49:31,200 RESEARCH TO DATE, ESPECIALLY 1402 00:49:31,200 --> 00:49:32,400 AROUND DEVELOPMENT OF 1403 00:49:32,400 --> 00:49:32,680 TREATMENTS. 1404 00:49:32,680 --> 00:49:34,200 WE HAVE A PRETTY GOOD 1405 00:49:34,200 --> 00:49:37,360 UNDERSTANDING OF TREATMENTS THAT 1406 00:49:37,360 --> 00:49:38,600 CAN BE EFFECTIVE IN THE 1407 00:49:38,600 --> 00:49:39,960 PEDIATRIC POPULATION, AS WELL AS 1408 00:49:39,960 --> 00:49:41,560 THE ADULT POPULATION, BUT 1409 00:49:41,560 --> 00:49:43,640 THERE'S BEEN REAL LIMITED FOCUS 1410 00:49:43,640 --> 00:49:45,600 ON TREATMENTS SPECIFICALLY 1411 00:49:45,600 --> 00:49:47,000 DESIGNED FOR YOUNG ADULTS. 1412 00:49:47,000 --> 00:49:48,720 AND THAT'S AN IMPORTANT FUTURE 1413 00:49:48,720 --> 00:49:53,960 OPPORTUNITY. 1414 00:49:53,960 --> 00:49:54,720 IT'S ALSO OPPORTUNITIES TO 1415 00:49:54,720 --> 00:49:56,000 IDENTIFY THE BEST WAYS TO 1416 00:49:56,000 --> 00:49:59,200 DISSEMINATE AND IMPLEMENT 1417 00:49:59,200 --> 00:49:59,920 TECHNOLOGY-DELIVERED 1418 00:49:59,920 --> 00:50:00,240 INTERVENTIONS. 1419 00:50:00,240 --> 00:50:01,080 WE STILL HAVE A LOT TO LEARN 1420 00:50:01,080 --> 00:50:03,840 ABOUT HOW TO GET THESE 1421 00:50:03,840 --> 00:50:05,200 INTERVENTIONS TO THE PEOPLE WHO 1422 00:50:05,200 --> 00:50:06,680 NEED THEM MOST AND CAN BENEFIT 1423 00:50:06,680 --> 00:50:08,840 FROM THEM, AS WELL AS LEARNING 1424 00:50:08,840 --> 00:50:11,840 HOW CAN WE MAKE PARTNERSHIPS TO 1425 00:50:11,840 --> 00:50:13,040 SUSTAIN THESE PROGRAMS OVER 1426 00:50:13,040 --> 00:50:15,800 TIME. 1427 00:50:15,800 --> 00:50:18,720 AND LAST, THERE ARE MANY 1428 00:50:18,720 --> 00:50:20,360 PROMISES OF BEING ABLE TO 1429 00:50:20,360 --> 00:50:21,320 PERSONALIZE TREATMENT WITH 1430 00:50:21,320 --> 00:50:22,520 TECHNOLOGY, BUT WE REALLY 1431 00:50:22,520 --> 00:50:24,560 HAVEN'T REALIZED THAT IN OUR 1432 00:50:24,560 --> 00:50:28,080 PAIN INTERVENTIONS TO DATE. 1433 00:50:28,080 --> 00:50:29,560 BUT THERE'S MANY WAYS WE CAN 1434 00:50:29,560 --> 00:50:30,400 THINK ABOUT HOW TO DELIVER THE 1435 00:50:30,400 --> 00:50:32,840 RIGHT TREATMENT AT THE RIGHT 1436 00:50:32,840 --> 00:50:38,680 TIME TO THOSE WHO NEED IT. 1437 00:50:38,680 --> 00:50:43,360 I WANT TO THANK MY WONDERFUL 1438 00:50:43,360 --> 00:50:44,680 COLLEAGUES IN THE PEDIATRIC PAIN 1439 00:50:44,680 --> 00:50:46,560 AND SLEEP INNOVATIONS LAB WHO 1440 00:50:46,560 --> 00:50:49,000 HAVE MADE ALL OF THE WORK 1441 00:50:49,000 --> 00:50:50,400 POSSIBLE THAT I TALKED WITH YOU 1442 00:50:50,400 --> 00:50:52,600 TODAY. 1443 00:50:52,600 --> 00:50:57,080 AND LAST, HERE'S MY CONTACT 1444 00:50:57,080 --> 00:50:57,520 INFORMATION. 1445 00:50:57,520 --> 00:50:59,080 I AM HAPPY TO ANSWER QUESTIONS 1446 00:50:59,080 --> 00:51:00,400 IN A MOMENT BUT IF I CAN'T GET 1447 00:51:00,400 --> 00:51:01,760 TO YOUR QUESTION TODAY, PLEASE 1448 00:51:01,760 --> 00:51:03,280 FEEL FREE TO REACH OUT TO ME 1449 00:51:03,280 --> 00:51:05,480 DIRECTLY. 1450 00:51:05,480 --> 00:51:08,760 THANK YOU. 1451 00:51:08,760 --> 00:51:10,600 >>THANK YOU SO MUCH, 1452 00:51:10,600 --> 00:51:11,160 DR. PALERMO. 1453 00:51:11,160 --> 00:51:16,400 WE REALLY APPRECIATED THAT TALK. 1454 00:51:16,400 --> 00:51:19,240 AND HELENE, EMILY AND 1455 00:51:19,240 --> 00:51:20,360 DR. SHURTLEFF, I SEE YOU ALL 1456 00:51:20,360 --> 00:51:20,920 COMING ON. 1457 00:51:20,920 --> 00:51:23,240 I KNOW THAT DR. LANGEVIN HAS TO 1458 00:51:23,240 --> 00:51:24,880 JUMP TO ANOTHER MEETING VERY 1459 00:51:24,880 --> 00:51:25,320 QUICKLY. 1460 00:51:25,320 --> 00:51:28,520 SO I'M GOING TO GIVE HELENE THE 1461 00:51:28,520 --> 00:51:30,120 OPPORTUNITY TO ASK YOU A FIRST 1462 00:51:30,120 --> 00:51:31,240 QUESTION, DR. PALERMO, AS WE 1463 00:51:31,240 --> 00:51:33,000 HEAD INTO OUR Q & A SESSION. 1464 00:51:33,000 --> 00:51:34,680 AND RIGHT BEFORE I DO THAT, 1465 00:51:34,680 --> 00:51:36,960 REMINDER TO ALL OF OUR VIDEOCAST 1466 00:51:36,960 --> 00:51:38,760 VIEWERS, USE THAT LIVE FEEDBACK 1467 00:51:38,760 --> 00:51:40,720 FORM TO ASK YOUR QUESTIONS. 1468 00:51:40,720 --> 00:51:42,200 THAT LINK IS RIGHT BELOW THE 1469 00:51:42,200 --> 00:51:44,000 SCREEN WHERE YOU ARE SEEING 1470 00:51:44,000 --> 00:51:44,440 LIVESTREAM. 1471 00:51:44,440 --> 00:51:45,440 SO HELENE, DO YOU HAVE A 1472 00:51:45,440 --> 00:51:46,960 QUESTION TO KICK US OFF FOR THE 1473 00:51:46,960 --> 00:51:48,120 Q & A? 1474 00:51:48,120 --> 00:51:50,080 >>YES, SO FIRST OF ALL, BRAVO, 1475 00:51:50,080 --> 00:51:54,000 I MEAN, I REALLY SO APPRECIATE 1476 00:51:54,000 --> 00:51:56,760 THE FACT THAT YOU'RE FOCUSING ON 1477 00:51:56,760 --> 00:52:00,920 EASILY DELIVERABLE, SIMPLE 1478 00:52:00,920 --> 00:52:01,800 INTERVENTIONS THAT ARE SO 1479 00:52:01,800 --> 00:52:02,280 NEEDED. 1480 00:52:02,280 --> 00:52:04,040 I ALSO REALLY LIKE YOUR APPROACH 1481 00:52:04,040 --> 00:52:06,640 TO PRIMARY, SECONDARY AND 1482 00:52:06,640 --> 00:52:07,560 TERTIARY PREVENTION PIPELINE. 1483 00:52:07,560 --> 00:52:11,160 I'M A LITTLE CURIOUS ABOUT THE 1484 00:52:11,160 --> 00:52:11,960 SECONDARY PREVENTION, AND I KNOW 1485 00:52:11,960 --> 00:52:13,720 THIS IS SOMETHING YOU MUST HAVE 1486 00:52:13,720 --> 00:52:16,200 THOUGHT ABOUT A LOT, KIDS WHO 1487 00:52:16,200 --> 00:52:19,600 HAVE SPINAL SURGERY MUST -- IT 1488 00:52:19,600 --> 00:52:20,840 DEPENDS ON WHY THEY HAD THE 1489 00:52:20,840 --> 00:52:22,360 SPINAL SURGERY, BUT DID A LOT OF 1490 00:52:22,360 --> 00:52:23,600 THEM ALREADY HAVE PAIN BEFORE 1491 00:52:23,600 --> 00:52:26,360 THE SURGERY, IN WHICH CASE IT 1492 00:52:26,360 --> 00:52:27,560 WOULD BE MORE LIKE ALREADY A 1493 00:52:27,560 --> 00:52:28,800 CHRONIC PAIN SITUATION, OR HOW 1494 00:52:28,800 --> 00:52:30,640 DID YOU FACTOR THAT IN? 1495 00:52:30,640 --> 00:52:32,280 >>YEAH, NO, IT'S INTERESTING, 1496 00:52:32,280 --> 00:52:34,480 AND REALLY A LOT OF THIS WORK IS 1497 00:52:34,480 --> 00:52:38,200 INFORMED BY JENNIFER RABBITZ' 1498 00:52:38,200 --> 00:52:40,160 OBSERVATIONAL STUDIES. 1499 00:52:40,160 --> 00:52:41,160 SPINAL FUSION SURGERY IS DONE 1500 00:52:41,160 --> 00:52:43,320 FOR CHILDREN FOR DIFFERENT 1501 00:52:43,320 --> 00:52:44,400 REASONS THAN ADULTS AND 1502 00:52:44,400 --> 00:52:46,160 PRIMARILY THESE SURGERIES ARE 1503 00:52:46,160 --> 00:52:48,000 DONE IN CHILDREN WHO DO NOT HAVE 1504 00:52:48,000 --> 00:52:48,400 PAIN. 1505 00:52:48,400 --> 00:52:51,800 IT'S NOT DONE FOR PAIN. 1506 00:52:51,800 --> 00:52:54,840 AND SO THE POPULATION DOES, IN 1507 00:52:54,840 --> 00:52:57,520 GENERAL, START OFF BEING 1508 00:52:57,520 --> 00:52:59,280 PAIN-FREE, AND OUR FOCUS IS ON 1509 00:52:59,280 --> 00:53:00,600 REALLY WHAT HAPPENS AFTER 1510 00:53:00,600 --> 00:53:01,760 SURGERY. 1511 00:53:01,760 --> 00:53:03,240 JENNIFER HAS FOUND THAT UP TO 1512 00:53:03,240 --> 00:53:06,960 20% OF ADOLESCENTS HAVE CHRONIC 1513 00:53:06,960 --> 00:53:08,280 PAIN AFTER SPINAL FUSION 1514 00:53:08,280 --> 00:53:09,840 SURGERY, SO IT'S A GROUP THAT WE 1515 00:53:09,840 --> 00:53:10,840 KNOW IS AT RISK. 1516 00:53:10,840 --> 00:53:13,120 IT'S A PRETTY MAJOR SURGERY, SO 1517 00:53:13,120 --> 00:53:15,040 IT'S AN IMPORTANT ONE FOR US TO 1518 00:53:15,040 --> 00:53:15,640 START WITH. 1519 00:53:15,640 --> 00:53:17,000 I THINK EVENTUALLY, THE GOAL 1520 00:53:17,000 --> 00:53:19,320 WOULD BE TO UNDERSTAND WHETHER 1521 00:53:19,320 --> 00:53:20,960 THIS MIGHT TRANSLATE TO OTHER 1522 00:53:20,960 --> 00:53:22,680 SURGICAL POPULATIONS IN TERMS OF 1523 00:53:22,680 --> 00:53:24,480 AN APPROACH TO PREVENT THE ACUTE 1524 00:53:24,480 --> 00:53:25,440 TO CHRONIC TRANSITION. 1525 00:53:25,440 --> 00:53:27,520 >>WHAT IS IT, IS IT MOSTLY 1526 00:53:27,520 --> 00:53:29,200 SCOLIOSIS OR WHERE ARE MOST -- 1527 00:53:29,200 --> 00:53:31,360 AND THEY DON'T HAVE PAIN? 1528 00:53:31,360 --> 00:53:34,680 >>WE DO SCREEN THEM FOR CHRONIC 1529 00:53:34,680 --> 00:53:37,720 MUSCULOSKELETAL PAIN, AND THAT 1530 00:53:37,720 --> 00:53:39,440 IS AN EXCLUSION CRITERIA. 1531 00:53:39,440 --> 00:53:41,400 BUT MOST OF THEM DO NOT. 1532 00:53:41,400 --> 00:53:43,240 >>OKAY. 1533 00:53:43,240 --> 00:53:44,520 AND WORSE AFTER SURGERY, WHICH 1534 00:53:44,520 --> 00:53:46,520 IS SAD. 1535 00:53:46,520 --> 00:53:47,960 >>YEAH. 1536 00:53:47,960 --> 00:53:48,520 >>THANK YOU. 1537 00:53:48,520 --> 00:53:49,480 >>YOU'RE WELCOME. 1538 00:53:49,480 --> 00:53:50,840 >>DAVID, DID YOU HAVE A 1539 00:53:50,840 --> 00:53:52,640 QUESTION YOU WANTED TO KICK OFF 1540 00:53:52,640 --> 00:53:54,600 WITH IN THE Q & A SESSION? 1541 00:53:54,600 --> 00:53:57,120 >>SO MANY BUT I'LL JUST TRY TO 1542 00:53:57,120 --> 00:53:58,360 LIMIT TO ONE TO START. 1543 00:53:58,360 --> 00:54:01,440 VERY INTERESTED IN YOUR PRIMARY 1544 00:54:01,440 --> 00:54:05,280 PREVENTION STRATEGY. 1545 00:54:05,280 --> 00:54:06,920 HELENE ALLUDED TO THE REACH 1546 00:54:06,920 --> 00:54:07,320 PROGRAM. 1547 00:54:07,320 --> 00:54:08,920 IT SEEMS AS THOUGH YOU MENTIONED 1548 00:54:08,920 --> 00:54:10,200 THE EMPHASIS ON WELLNESS. 1549 00:54:10,200 --> 00:54:11,640 I'M JUST WONDERING, IN ADDITION 1550 00:54:11,640 --> 00:54:15,160 TO LOOKING AT IBS OUTCOME, THE 1551 00:54:15,160 --> 00:54:16,720 PAIN OUTCOMES, IF YOU'RE LOOKING 1552 00:54:16,720 --> 00:54:18,840 AT SECONDARY OUTCOMES RELATED TO 1553 00:54:18,840 --> 00:54:21,440 OTHER DISORDERS SUCH AS -- WHICH 1554 00:54:21,440 --> 00:54:22,560 I'M THINKING ABOUT ADOLESCENTS 1555 00:54:22,560 --> 00:54:25,360 AS WE ALL KNOW, EARLY -- LATER 1556 00:54:25,360 --> 00:54:27,160 CHILDHOOD, IS SUCH A CRITICAL 1557 00:54:27,160 --> 00:54:29,400 STAGE FOR A LOT OF DEVELOPMENTAL 1558 00:54:29,400 --> 00:54:31,000 DISORDERS, WHETHER IT'S 1559 00:54:31,000 --> 00:54:32,280 DEPRESSION, ANXIETY, MENTAL 1560 00:54:32,280 --> 00:54:35,120 HEALTH DISORDERS, PHYSICAL 1561 00:54:35,120 --> 00:54:35,440 DISORDERS. 1562 00:54:35,440 --> 00:54:38,400 ARE YOU ABLE TO CAPTURE IF THIS 1563 00:54:38,400 --> 00:54:39,640 INTERVENTION MAYBE GOES MORE 1564 00:54:39,640 --> 00:54:41,720 BROADLY THAN JUST A PAIN 1565 00:54:41,720 --> 00:54:42,000 CONDITION? 1566 00:54:42,000 --> 00:54:45,680 ARE YOU CAPTURING ANY OF THOSE 1567 00:54:45,680 --> 00:54:46,280 MEASURES? 1568 00:54:46,280 --> 00:54:47,360 JUST CURIOUS, I THINK IT WOULD 1569 00:54:47,360 --> 00:54:49,440 BE A GREAT OPPORTUNITY BECAUSE I 1570 00:54:49,440 --> 00:54:51,600 IMAGINE IT WOULD AFFECT A 1571 00:54:51,600 --> 00:54:52,840 VARIETY OF CONDITIONS BEYOND 1572 00:54:52,840 --> 00:54:53,040 PAIN. 1573 00:54:53,040 --> 00:54:54,240 >>ABSOLUTELY, GREAT QUESTION, 1574 00:54:54,240 --> 00:54:55,600 AND OUR TEAM HAS TALKED A LOT 1575 00:54:55,600 --> 00:54:57,840 ABOUT THIS VERY ISSUE BECAUSE 1576 00:54:57,840 --> 00:54:59,000 INDEED, THESE CHILDREN DON'T 1577 00:54:59,000 --> 00:55:00,800 HAVE PAIN YET, AND WE DIDN'T 1578 00:55:00,800 --> 00:55:02,680 WANT TO EXCLUSIVELY FOCUS ON 1579 00:55:02,680 --> 00:55:02,880 PAIN. 1580 00:55:02,880 --> 00:55:05,520 SO WE ARE ALL -- ALSO ARE 1581 00:55:05,520 --> 00:55:07,280 COLLECTING SOME OTHER 1582 00:55:07,280 --> 00:55:08,480 PSYCHOLOGICAL OUTCOMES AS WELL 1583 00:55:08,480 --> 00:55:09,960 AS BROADER HEALTH-RELATED 1584 00:55:09,960 --> 00:55:11,720 QUALITY OF LIFE OUTCOMES, SO 1585 00:55:11,720 --> 00:55:15,560 HOPEFULLY WE'LL HAVE A BETTER 1586 00:55:15,560 --> 00:55:17,200 CONTEXT AROUND POSSIBLE BENEFIT 1587 00:55:17,200 --> 00:55:20,640 IN OTHER AREAS. 1588 00:55:20,640 --> 00:55:22,160 >>OKAY, THANK YOU. 1589 00:55:22,160 --> 00:55:24,320 DAVID, ANY FOLLOW-UP TO THAT 1590 00:55:24,320 --> 00:55:25,440 OR -- EMILY, MIGHT YOU HAVE A 1591 00:55:25,440 --> 00:55:25,960 QUICK QUESTION? 1592 00:55:25,960 --> 00:55:30,640 I KNOW YOU TWO HAV TOO HAVE A VY 1593 00:55:30,640 --> 00:55:31,000 SCHEDULE TODAY. 1594 00:55:31,000 --> 00:55:32,600 >>I JUST WANTED TO COMMENT ON 1595 00:55:32,600 --> 00:55:35,240 THE STUDY THAT YOU HAD WITH THE 1596 00:55:35,240 --> 00:55:39,200 ADOLESCENTS WITH SICKLE CELL. 1597 00:55:39,200 --> 00:55:41,840 ARE YOU PLANNING ON DOING A 1598 00:55:41,840 --> 00:55:43,480 STUDY WHERE YOU START EARLIER? 1599 00:55:43,480 --> 00:55:46,360 BECAUSE, I MEAN, CHILDREN WITH 1600 00:55:46,360 --> 00:55:49,800 SICKLE CELL PAIN, THE IDEA TO 1601 00:55:49,800 --> 00:55:52,720 START EARLY MIGHT POTENTIALLY 1602 00:55:52,720 --> 00:55:53,840 PREVENT, YOU KNOW, THE 1603 00:55:53,840 --> 00:55:55,600 DEVELOPMENT OF CHRONICITY. 1604 00:55:55,600 --> 00:55:56,720 SO IS THERE ANY PLANNING ON 1605 00:55:56,720 --> 00:55:58,760 THAT? 1606 00:55:58,760 --> 00:56:00,640 >>IT'S A GREAT QUESTION, AND 1607 00:56:00,640 --> 00:56:01,760 IT'S SIMILAR TO ONE WE'VE 1608 00:56:01,760 --> 00:56:02,960 THOUGHT OF IN ANOTHER POPULATION 1609 00:56:02,960 --> 00:56:05,160 I WORK WITH, WHICH IS FOR 1610 00:56:05,160 --> 00:56:08,720 CHRONIC PAN KREE T PANCREATITISE 1611 00:56:08,720 --> 00:56:11,080 THERE'S A BALANCE BETWEEN WILL A 1612 00:56:11,080 --> 00:56:13,000 CHILD ENGAGE IF THEY DON'T HAVE 1613 00:56:13,000 --> 00:56:14,960 FREQUENT ENOUGH SYMPTOMS, BUT WE 1614 00:56:14,960 --> 00:56:16,520 WANT TO PREVENT THE MORE 1615 00:56:16,520 --> 00:56:17,640 FREQUENT SYMPTOMS BUT IT'S HARD 1616 00:56:17,640 --> 00:56:20,200 TO KNOW IF THAT WINDOW OF 1617 00:56:20,200 --> 00:56:20,760 OPPORTUNITY. 1618 00:56:20,760 --> 00:56:22,440 WE'VE LEARNED FROM SOME OF OUR 1619 00:56:22,440 --> 00:56:24,160 OTHER STUDIES THAT IF PAIN IS 1620 00:56:24,160 --> 00:56:26,520 NOT FREQUENT, THE ENGAGEMENT HAS 1621 00:56:26,520 --> 00:56:28,120 DECLINED IN THE INTERVENTION 1622 00:56:28,120 --> 00:56:29,560 ITSELF, SO I THINK WE NEED TO 1623 00:56:29,560 --> 00:56:32,280 LEARN MORE ABOUT WHAT IS THE 1624 00:56:32,280 --> 00:56:33,680 OPTIMAL TIME TO DELIVER 1625 00:56:33,680 --> 00:56:34,880 SOMETHING, AND MAYBE WE'RE 1626 00:56:34,880 --> 00:56:37,160 TRYING TO DELIVER TOO MUCH. 1627 00:56:37,160 --> 00:56:38,560 MAYBE THE PREVENTIVE FOCUS NEEDS 1628 00:56:38,560 --> 00:56:42,600 TO BE BRIEFER AND -- OR MORE 1629 00:56:42,600 --> 00:56:46,760 FLEXIBLE IN ITS DELIVERY. 1630 00:56:46,760 --> 00:56:49,600 >>THANK YOU, EMMELINE. 1631 00:56:49,600 --> 00:56:51,840 WE WANT TO MOVE TO A QUESTION 1632 00:56:51,840 --> 00:56:52,920 FROM THE AUDIENCE. 1633 00:56:52,920 --> 00:56:54,960 THE PERSON WATCHING ON VIDEOCAST 1634 00:56:54,960 --> 00:56:56,480 SAYS, COULD YOU PLEASE COMMENT 1635 00:56:56,480 --> 00:56:59,480 ON HOW YOU'VE RECRUITED AND 1636 00:56:59,480 --> 00:57:01,160 RETAINED UNDERREPRESENTED YOUTH 1637 00:57:01,160 --> 00:57:04,320 IN YOUR STUDIES OR ANY BARRIERS 1638 00:57:04,320 --> 00:57:05,800 YOU MAY HAVE FACED? 1639 00:57:05,800 --> 00:57:08,760 >>YEAH, YOU KNOW, IT'S REALLY 1640 00:57:08,760 --> 00:57:09,760 POPULATION-SPECIFIC IN THE 1641 00:57:09,760 --> 00:57:11,560 STUDIES WHERE WE'VE RECRUITED 1642 00:57:11,560 --> 00:57:14,520 FROM PEDIATRIC PAIN CLINICS. 1643 00:57:14,520 --> 00:57:16,800 UNFORTUNATELY THERE'S A VERY LOW 1644 00:57:16,800 --> 00:57:20,240 REPRESENTATION OF DIVERSE GROUPS 1645 00:57:20,240 --> 00:57:21,640 BECAUSE IT REFLECTS THE CLINIC 1646 00:57:21,640 --> 00:57:22,080 POPULATION. 1647 00:57:22,080 --> 00:57:24,840 FOR MANY REASONS, PEDIATRIC 1648 00:57:24,840 --> 00:57:27,680 TERTIARY PAIN CLINICS ARE NOT 1649 00:57:27,680 --> 00:57:29,040 REPRESENTATIVE, AND WE KNOW WHEN 1650 00:57:29,040 --> 00:57:30,440 WE GO TO THE COMMUNITY, THE 1651 00:57:30,440 --> 00:57:33,920 POPULATIONS ARE VERY DIFFERENT. 1652 00:57:33,920 --> 00:57:35,000 SO ONE I THINK JUST IMPORTANT 1653 00:57:35,000 --> 00:57:36,280 LEARNING IS THAT THERE ARE -- 1654 00:57:36,280 --> 00:57:37,360 THERE IS A REALLY IMPORTANT NEED 1655 00:57:37,360 --> 00:57:40,680 TO GO TO THE COMMUNITY WHEN 1656 00:57:40,680 --> 00:57:42,240 WE'RE DELIVERING INTERVENTIONS 1657 00:57:42,240 --> 00:57:44,320 SO THAT WE DON'T LEARN ONLY 1658 00:57:44,320 --> 00:57:48,160 ABOUT BENEFITS IN THESE CLINIC 1659 00:57:48,160 --> 00:57:48,800 POPULATIONS. 1660 00:57:48,800 --> 00:57:50,240 BUT I APPRECIATE THE QUESTION 1661 00:57:50,240 --> 00:57:53,760 BECAUSE I THINK THERE'S A LOT OF 1662 00:57:53,760 --> 00:57:55,080 ROOM FOR OPPORTUNITY IN THAT 1663 00:57:55,080 --> 00:57:56,400 AREA, ESPECIALLY IN PEDIATRIC 1664 00:57:56,400 --> 00:58:00,880 PAIN. 1665 00:58:00,880 --> 00:58:03,080 >>WE HAD A COUPLE OF OTHER 1666 00:58:03,080 --> 00:58:06,400 QUESTIONS THAT CAME IN. 1667 00:58:06,400 --> 00:58:09,920 WE HAD ONE THAT WAS ABOUT 1668 00:58:09,920 --> 00:58:15,160 VIRTUAL REALITY TECHNIQUES. 1669 00:58:15,160 --> 00:58:16,360 THE PERSON WAS ASKING, IT SEEMS 1670 00:58:16,360 --> 00:58:18,160 THAT VIRTUAL REALITY TECHNIQUES 1671 00:58:18,160 --> 00:58:21,760 COULD ENHANCE DIGITAL COGNITIVE 1672 00:58:21,760 --> 00:58:23,560 BEHAVIORAL THERAPY OR CBT 1673 00:58:23,560 --> 00:58:24,080 EFFECTS. 1674 00:58:24,080 --> 00:58:26,280 HAS ANY WORK BEEN DONE IN THAT 1675 00:58:26,280 --> 00:58:28,400 AREA? 1676 00:58:28,400 --> 00:58:29,680 >>THAT'S A GREAT QUESTION. 1677 00:58:29,680 --> 00:58:31,280 I KNOW THERE'S A LOT OF INTEREST 1678 00:58:31,280 --> 00:58:33,120 IN VIRTUAL REALITY, THERE'S 1679 00:58:33,120 --> 00:58:35,200 DEFINITELY BEEN APPLICATIONS IN 1680 00:58:35,200 --> 00:58:35,760 ADOLESCENTS. 1681 00:58:35,760 --> 00:58:37,520 IT'S NOT SOMETHING OUR GROUP 1682 00:58:37,520 --> 00:58:39,840 DOES DIRECTLY, BUT I THINK THAT 1683 00:58:39,840 --> 00:58:41,920 THERE'S CERTAINLY -- IT'S 1684 00:58:41,920 --> 00:58:47,280 IMPORTANT TO THINK ABOUT HOW TO 1685 00:58:47,280 --> 00:58:48,200 POTENTIALLY OPTIMIZE BOTH 1686 00:58:48,200 --> 00:58:49,960 INTERVENTIONS BY DELIVERING THEM 1687 00:58:49,960 --> 00:58:50,360 TOGETHER. 1688 00:58:50,360 --> 00:58:52,240 I THINK THAT BOTH THERE ARE 1689 00:58:52,240 --> 00:58:53,240 BENEFITS FROM SOME OF THE 1690 00:58:53,240 --> 00:58:55,080 STRATEGIES WE TEACH IN COGNITIVE 1691 00:58:55,080 --> 00:58:57,000 BEHAVIORAL THERAPY THAT CAN'T BE 1692 00:58:57,000 --> 00:58:58,240 ACHIEVED AS WELL FROM JUST 1693 00:58:58,240 --> 00:58:59,600 VIRTUAL REALITY AND VICE VERSA, 1694 00:58:59,600 --> 00:59:02,360 SO THERE MIGHT BE SOME IMPORTANT 1695 00:59:02,360 --> 00:59:02,960 SYNERGIES THAT WOULD BE 1696 00:59:02,960 --> 00:59:06,840 INTERESTING TO UNDERSTAND. 1697 00:59:06,840 --> 00:59:08,160 >>SO ANOTHER QUESTION THAT 1698 00:59:08,160 --> 00:59:10,040 WE'VE HAD HAS TO DO WITH THE 1699 00:59:10,040 --> 00:59:11,080 WORK THAT YOU'VE DONE IN SICKLE 1700 00:59:11,080 --> 00:59:13,840 CELL DISEASE. 1701 00:59:13,840 --> 00:59:15,320 THE PERSON ASKS, IN YOUR WORK 1702 00:59:15,320 --> 00:59:16,160 WITH SICKLE CELL DISEASE, HAVE 1703 00:59:16,160 --> 00:59:19,480 YOU INCORPORATED SPIRITUAL CARE 1704 00:59:19,480 --> 00:59:22,200 PRACTICES OR INTERVENTIONS INTO 1705 00:59:22,200 --> 00:59:25,440 PAIN COPING STRATEGIES? 1706 00:59:25,440 --> 00:59:27,080 THIS TOPIC OFTEN COMES UP IN 1707 00:59:27,080 --> 00:59:29,720 DISCUSSIONS OF SICKLE CELL 1708 00:59:29,720 --> 00:59:31,480 CAREGIVERS AND WARRIORS AS 1709 00:59:31,480 --> 00:59:33,200 IMPORTANT SUPPORT FOR THEM, THAT 1710 00:59:33,200 --> 00:59:35,440 THEY STARTED IN CHILDHOOD. 1711 00:59:35,440 --> 00:59:37,600 SO ANY THOUGHTS ABOUT THAT? 1712 00:59:37,600 --> 00:59:39,320 >>THAT'S A GREAT QUESTION, AND 1713 00:59:39,320 --> 00:59:42,280 I AGREE, YOU KNOW, ALTHOUGH THE 1714 00:59:42,280 --> 00:59:44,240 FAMILIES I WORK WITH CLINICALLY 1715 00:59:44,240 --> 00:59:46,680 ALSO IDENTIFY SPIRITUAL COPING 1716 00:59:46,680 --> 00:59:49,000 IS IMPORTANT, I THINK THE COPING 1717 00:59:49,000 --> 00:59:50,400 MEASURE WE USE DOES ASSESS THAT. 1718 00:59:50,400 --> 00:59:54,080 IN TERMS OF INTERVENTION ITSELF, 1719 00:59:54,080 --> 00:59:57,480 ONE OF THE THINGS THAT WE DID 1720 00:59:57,480 --> 01:00:01,600 WAS TO RECORD REAL -- IN YOUNG 1721 01:00:01,600 --> 01:00:04,200 ADULTS WITH SICKLE CELL THAT 1722 01:00:04,200 --> 01:00:05,040 TALK ABOUT THEIR LIVES AND I 1723 01:00:05,040 --> 01:00:06,080 THINK THAT GIVES IMPORTANT 1724 01:00:06,080 --> 01:00:07,200 CONTEXT AND THAT WAS ONE WAY TO 1725 01:00:07,200 --> 01:00:09,160 KIND OF INCREASE RELEVANCY, SO 1726 01:00:09,160 --> 01:00:10,440 WE DO HAVE, FOR EXAMPLE, IN ONE 1727 01:00:10,440 --> 01:00:12,080 OF THE VIDEOS SOMEONE TALKING 1728 01:00:12,080 --> 01:00:13,880 ABOUT SPIRITUAL FORMS OF COPING. 1729 01:00:13,880 --> 01:00:16,800 I THINK THOSE ARE SMALL WAYS TO 1730 01:00:16,800 --> 01:00:19,960 INTEGRATE KIND OF THE DOMAINS 1731 01:00:19,960 --> 01:00:22,760 THAT ARE IMPORTANT TO SPECIFIC 1732 01:00:22,760 --> 01:00:26,440 POPULATIONS, IS THROUGH USE OF 1733 01:00:26,440 --> 01:00:28,720 PEOPLE WHO HAVE LIVED EXPERIENCE 1734 01:00:28,720 --> 01:00:32,000 IN THE INTERVENTIONS AND IN BOTH 1735 01:00:32,000 --> 01:00:33,520 THE DESIGN AS WELL AS WHEN YOU 1736 01:00:33,520 --> 01:00:41,120 ARE ABLE TO SHOW SNIPPETS OF 1737 01:00:41,120 --> 01:00:42,080 REAL LIFE TO TAKE THOSE 1738 01:00:42,080 --> 01:00:42,440 OPPORTUNITIES. 1739 01:00:42,440 --> 01:00:44,400 WE'VE ALWAYS GOTTEN REAL 1740 01:00:44,400 --> 01:00:45,240 POSITIVE FEEDBACK WHEN WE SHOW 1741 01:00:45,240 --> 01:00:46,440 PEER MODELS IN OUR 1742 01:00:46,440 --> 01:00:46,760 INTERVENTIONS. 1743 01:00:46,760 --> 01:00:48,080 I THINK EVERYONE LIKES TO SEE 1744 01:00:48,080 --> 01:00:51,000 OTHER PEOPLE WHO ARE COPING WITH 1745 01:00:51,000 --> 01:00:56,680 SIMILAR ISSUES. 1746 01:00:56,680 --> 01:00:59,600 >>SO WHILE WE'RE -- I THINK WE 1747 01:00:59,600 --> 01:01:01,800 HAVE A COUPLE MORE Qs COMING 1748 01:01:01,800 --> 01:01:03,160 IN FROM THE AUDIENCE. 1749 01:01:03,160 --> 01:01:04,360 DAVID, DID YOU HAVE ANOTHER Q 1750 01:01:04,360 --> 01:01:05,760 THAT YOU WANTED TO POSE? 1751 01:01:05,760 --> 01:01:08,920 >>I THINK IT'S ALONG SIMILAR 1752 01:01:08,920 --> 01:01:11,200 LINES OF SOME OF THE QUESTIONS 1753 01:01:11,200 --> 01:01:13,800 ABOUT CBT, IT SEEMS IT'S 1754 01:01:13,800 --> 01:01:14,960 EFFECTIVE AND HAS REACH BUT IT, 1755 01:01:14,960 --> 01:01:16,720 I GUESS, A MODEST IMPACT MAYBE 1756 01:01:16,720 --> 01:01:19,840 IN SOME RESPECTS. 1757 01:01:19,840 --> 01:01:24,520 WE JUST HAD A PAIN CONSORTIUM 1758 01:01:24,520 --> 01:01:27,920 CONFERENCE AND THEY SPOKE WITH 1759 01:01:27,920 --> 01:01:29,680 SOME OF THESE MULTI-COMPONENTS, 1760 01:01:29,680 --> 01:01:31,640 CBT WAS A MAJOR COMPONENT, BUT 1761 01:01:31,640 --> 01:01:33,320 SHE ALSO ENGAGED WITH SPORTS 1762 01:01:33,320 --> 01:01:35,960 MEDICINE SPECIALISTS ON EXERCISE 1763 01:01:35,960 --> 01:01:39,040 PROGRAMS TARGETED TOWARDS THIS 1764 01:01:39,040 --> 01:01:41,400 POPULATION, TAKING INTO ACCOUNT 1765 01:01:41,400 --> 01:01:42,480 KIN ESTHETICS AND OTHER THINGS. 1766 01:01:42,480 --> 01:01:45,440 I'M JUST WONDERING, A COUPLE 1767 01:01:45,440 --> 01:01:48,440 QUESTIONS AROUND THE CBT. 1768 01:01:48,440 --> 01:01:49,800 IT'S THE DEVELOPMENTAL STAGE 1769 01:01:49,800 --> 01:01:52,400 THAT MAYBE IMPACTS THE ULTIMATE 1770 01:01:52,400 --> 01:01:55,000 EFFECTIVENESS OF THIS 1771 01:01:55,000 --> 01:01:55,360 INTERVENTION. 1772 01:01:55,360 --> 01:01:58,240 ARE THERE OTHER COMPONENTS SUCH 1773 01:01:58,240 --> 01:02:05,120 AS EXERCISE USING, SAY, ADVICE 1774 01:02:05,120 --> 01:02:07,960 FROM SPORTS MEDICINE EXPERTS OR 1775 01:02:07,960 --> 01:02:09,000 OTHER INTERVENTIONS YOU THINK IN 1776 01:02:09,000 --> 01:02:12,120 ADDITION TO CBT COULD BE HELPFUL 1777 01:02:12,120 --> 01:02:16,360 IN SORT OF MAYBE INCREASING THE 1778 01:02:16,360 --> 01:02:17,360 STIGMA -- OF THE INTERVENTION? 1779 01:02:17,360 --> 01:02:18,760 >>IT'S A REALLY GOOD QUESTION, 1780 01:02:18,760 --> 01:02:22,040 AND DEFINITELY CBT HAS SOME 1781 01:02:22,040 --> 01:02:22,840 PROMISE. 1782 01:02:22,840 --> 01:02:23,800 IT DEFINITELY DOESN'T WORK FOR 1783 01:02:23,800 --> 01:02:26,640 EVERYONE. 1784 01:02:26,640 --> 01:02:28,120 AND ONE OF THE MAIN OBSERVATIONS 1785 01:02:28,120 --> 01:02:30,120 I'LL MAKE IS THAT IT'S REALLY 1786 01:02:30,120 --> 01:02:32,080 TYPICALLY DELIVERED AS A ONE 1787 01:02:32,080 --> 01:02:34,480 SIZE FITS ALL INTERVENTION. 1788 01:02:34,480 --> 01:02:37,240 AND CLEARLY THAT'S NOT GOING TO 1789 01:02:37,240 --> 01:02:41,080 BE OF BENEFIT TO EVERYONE. 1790 01:02:41,080 --> 01:02:42,640 I THINK WE COULD DO A BETTER JOB 1791 01:02:42,640 --> 01:02:45,600 OF FIGURING OUT HOW TO TAILOR 1792 01:02:45,600 --> 01:02:48,240 AND PERSONALIZE CBT SO THAT 1793 01:02:48,240 --> 01:02:50,920 ADOLESCENTS ARE ACTUALLY 1794 01:02:50,920 --> 01:02:53,680 RECEIVING THE CONTENT THAT IS 1795 01:02:53,680 --> 01:02:55,360 MOST IMPORTANT TO THEIR 1796 01:02:55,360 --> 01:02:56,840 PARTICULAR SYMPTOMS, AND SO THAT 1797 01:02:56,840 --> 01:02:59,600 MIGHT BE A COMBINATION OF 1798 01:02:59,600 --> 01:03:03,120 SEQUENCING AS WELL AS CHANGING 1799 01:03:03,120 --> 01:03:04,360 CONTENT, BUT I AGREE THAT THERE 1800 01:03:04,360 --> 01:03:05,760 ARE MANY OTHER PROMISING 1801 01:03:05,760 --> 01:03:06,760 INTERVENTIONS THAT COULD BE 1802 01:03:06,760 --> 01:03:09,000 INCLUDED ALONGSIDE CBT, AND THAT 1803 01:03:09,000 --> 01:03:11,320 IS SOMETHING THAT ALSO HAS NOT 1804 01:03:11,320 --> 01:03:13,600 BEEN WELL STUDIED AS THESE 1805 01:03:13,600 --> 01:03:15,560 COMBINATIONS OF TREATMENTS. 1806 01:03:15,560 --> 01:03:17,840 SO I DO THINK THAT'S A REALLY 1807 01:03:17,840 --> 01:03:19,720 IMPORTANT AREA FOR UNDERSTANDING 1808 01:03:19,720 --> 01:03:23,520 HOW WE CAN MAXIMIZE THE VALUE OF 1809 01:03:23,520 --> 01:03:25,200 THIS TREATMENT TO THIS 1810 01:03:25,200 --> 01:03:28,520 POPULATION. 1811 01:03:28,520 --> 01:03:31,040 >>SO WE HAVE A FEW MORE COMING 1812 01:03:31,040 --> 01:03:33,160 IN FROM THE AUDIENCE. 1813 01:03:33,160 --> 01:03:34,600 ONE WE'VE HAD COMING IN IS, DID 1814 01:03:34,600 --> 01:03:36,080 THE PSYCHOLOGICAL INTERVENTIONS 1815 01:03:36,080 --> 01:03:39,320 THAT YOU AND YOUR TEAM TESTED 1816 01:03:39,320 --> 01:03:41,440 INCLUDE SOMATIC EXPERIENCING 1817 01:03:41,440 --> 01:03:44,920 EXERCISES? 1818 01:03:44,920 --> 01:03:46,680 >>HMMM. 1819 01:03:46,680 --> 01:03:48,440 THAT'S AN INTERESTING QUESTION. 1820 01:03:48,440 --> 01:03:52,200 I'M NOT SURE THAT THE DIGITAL 1821 01:03:52,200 --> 01:03:54,040 DELIVERY THAT WE DO OF OUR 1822 01:03:54,040 --> 01:03:55,480 INTERVENTIONS WOULD BE THE SAME 1823 01:03:55,480 --> 01:03:58,600 AS WHAT I'M IMAGINING THIS 1824 01:03:58,600 --> 01:04:01,040 QUESTION IS ABOUT. 1825 01:04:01,040 --> 01:04:02,640 THERE ARE, I THINK, 1826 01:04:02,640 --> 01:04:04,280 OPPORTUNITIES WHEN YOU HAVE 1827 01:04:04,280 --> 01:04:06,360 SOMEONE IN PERSON TO DO A LITTLE 1828 01:04:06,360 --> 01:04:09,280 MORE OF THESE TYPES OF 1829 01:04:09,280 --> 01:04:09,680 APPROACHES. 1830 01:04:09,680 --> 01:04:13,880 SO I WILL SAY THAT'S NOT BEEN A 1831 01:04:13,880 --> 01:04:16,040 MAJOR STRATEGY WE'VE USED IN OUR 1832 01:04:16,040 --> 01:04:17,360 DIGITAL INTERVENTIONS. 1833 01:04:17,360 --> 01:04:22,040 >>THANK YOU. 1834 01:04:22,040 --> 01:04:24,800 SO THE NEXT QUESTION, THE PERSON 1835 01:04:24,800 --> 01:04:27,200 SAID THANK YOU FOR A GREAT TALK. 1836 01:04:27,200 --> 01:04:29,080 I'D BE GLAD TO KNOW ABOUT THE 1837 01:04:29,080 --> 01:04:30,200 AVAILABILITY OF THE WEBMAP 1838 01:04:30,200 --> 01:04:31,000 MOBILE APP. 1839 01:04:31,000 --> 01:04:33,440 THERE ARE SOME OTHER CBT APPS 1840 01:04:33,440 --> 01:04:34,600 OUT THERE, CURABLE IS ONE. 1841 01:04:34,600 --> 01:04:36,040 DO YOU HAVE ANY THOUGHTS ON 1842 01:04:36,040 --> 01:04:37,920 THEIR UTILITY IN ADOLESCENTS 1843 01:04:37,920 --> 01:04:40,480 WITH CHRONIC PAIN? 1844 01:04:40,480 --> 01:04:42,360 CURABLE WAS DESIGNED FOR ADULTS, 1845 01:04:42,360 --> 01:04:43,240 THEY BELIEVE, SO THEY'RE NOT 1846 01:04:43,240 --> 01:04:46,040 SURE IF IT'S BEEN VALIDATED IN 1847 01:04:46,040 --> 01:04:48,760 ANY SPECIFIC POPULATION. 1848 01:04:48,760 --> 01:04:50,920 >>YEAH, IT'S A GREAT QUESTION, 1849 01:04:50,920 --> 01:04:52,800 AND THERE'S MANY, MANY MOBILE 1850 01:04:52,800 --> 01:04:58,560 APPS OUT THERE THAT ARE SOMEHOW 1851 01:04:58,560 --> 01:05:00,200 RELEVANT TO PAIN, WHETHER 1852 01:05:00,200 --> 01:05:02,480 THEY'RE FOCUSING ON MONITORING 1853 01:05:02,480 --> 01:05:06,080 OF PAIN OR TREATMENT OF PAIN, AS 1854 01:05:06,080 --> 01:05:10,240 WELL AS APPS FOR ANXIETY OR 1855 01:05:10,240 --> 01:05:10,800 DEPRESSIVE SYMPTOMS. 1856 01:05:10,800 --> 01:05:11,840 THERE ARE MANY, MANY 1857 01:05:11,840 --> 01:05:12,200 POSSIBILITIES. 1858 01:05:12,200 --> 01:05:15,440 ONE OF THE REAL BARRIERS IS 1859 01:05:15,440 --> 01:05:17,280 THERE AREN'T -- ISN'T A CLEAR 1860 01:05:17,280 --> 01:05:18,680 WAY OF LOOKING AT WHAT IS THE 1861 01:05:18,680 --> 01:05:20,240 EVIDENCE FOR THIS APP, WHAT'S 1862 01:05:20,240 --> 01:05:22,320 THE QUALITY OF IT, DOES IT -- 1863 01:05:22,320 --> 01:05:23,760 THEY DON'T HAVE A STAMP OF 1864 01:05:23,760 --> 01:05:25,520 APPROVAL THAT WE CAN EASILY SAY 1865 01:05:25,520 --> 01:05:27,280 THIS HAS A GOOD EVIDENCE BASE 1866 01:05:27,280 --> 01:05:29,200 AND WE KNOW IT'S BEEN USED IN 1867 01:05:29,200 --> 01:05:31,200 THIS DEVELOPMENTAL AGE RANGE AND 1868 01:05:31,200 --> 01:05:32,280 THIS PARTICULAR POPULATION, SO 1869 01:05:32,280 --> 01:05:34,160 THAT'S REALLY LIMITED THE 1870 01:05:34,160 --> 01:05:35,840 ABILITY TO SORT OF MAKE 1871 01:05:35,840 --> 01:05:36,760 RECOMMENDATIONS TO PATIENTS. 1872 01:05:36,760 --> 01:05:39,120 I THINK THAT'S BEEN REALLY HARD. 1873 01:05:39,120 --> 01:05:41,600 THERE'S A FEW TOOLS OUT THERE. 1874 01:05:41,600 --> 01:05:43,920 THERE'S A TOOL CALLED CYBER 1875 01:05:43,920 --> 01:05:47,920 GUIDE THAT IS A WAY OF LOOKING 1876 01:05:47,920 --> 01:05:49,880 UP THOSE PRODUCTS THAT HAVE AT 1877 01:05:49,880 --> 01:05:52,160 LEAST BEEN PUBLISHED ON AND HAVE 1878 01:05:52,160 --> 01:05:54,560 SOME DEM STRAYTIVE EFFECTS. 1879 01:05:54,560 --> 01:05:55,320 UNFORTUNATELY IT'S MOSTLY 1880 01:05:55,320 --> 01:05:57,400 FOCUSED ON ADULT APPS, BUT THERE 1881 01:05:57,400 --> 01:05:59,240 ARE SOME IN THAT GUIDE FOR KIDS 1882 01:05:59,240 --> 01:06:01,880 THAT YOU CAN LOOK AT. 1883 01:06:01,880 --> 01:06:03,480 SO HOPEFULLY OVER TIME, WE GET 1884 01:06:03,480 --> 01:06:07,080 BETTER AT FIGURING OUT HOW TO 1885 01:06:07,080 --> 01:06:09,400 GIVE SOME QUALITY RATINGS TO 1886 01:06:09,400 --> 01:06:10,760 PRODUCTS THAT COME OUT SO THAT 1887 01:06:10,760 --> 01:06:14,640 YOU CAN UNDERSTAND THEIR LEVEL 1888 01:06:14,640 --> 01:06:15,840 OF SCIENTIFIC EVIDENCE AND 1889 01:06:15,840 --> 01:06:16,120 VALUE. 1890 01:06:16,120 --> 01:06:17,800 BUT I THINK IN THE INTERIM, YOU 1891 01:06:17,800 --> 01:06:19,280 KNOW, I ALWAYS ENCOURAGE 1892 01:06:19,280 --> 01:06:21,120 PROVIDERS WHO WANT TO USE THESE 1893 01:06:21,120 --> 01:06:22,480 WITH PATIENTS TO CHECK OUT THE 1894 01:06:22,480 --> 01:06:23,480 PRODUCT YOURSELF, MAKE SURE YOU 1895 01:06:23,480 --> 01:06:29,520 KNOW WHAT IT DOES, AND ASK 1896 01:06:29,520 --> 01:06:30,360 COLLEAGUES ABOUT WHAT THEY'VE 1897 01:06:30,360 --> 01:06:33,200 USED IN POPULATIONS AS WELL WHEN 1898 01:06:33,200 --> 01:06:34,160 YOU CAN'T FIND PUBLISHED 1899 01:06:34,160 --> 01:06:36,960 EVIDENCE. 1900 01:06:36,960 --> 01:06:40,400 >>SO WE HAD A PERSON WHO WROTE 1901 01:06:40,400 --> 01:06:43,000 IN, IT'S A THREE-PART QUESTION, 1902 01:06:43,000 --> 01:06:45,400 SO LET'S SEE WHAT WE CAN DO HERE 1903 01:06:45,400 --> 01:06:48,040 FOR THEM. 1904 01:06:48,040 --> 01:06:50,240 FIRST THE COMMENT WAS 1905 01:06:50,240 --> 01:06:52,480 "INCREDIBLE PRESENTATION," SO 1906 01:06:52,480 --> 01:06:53,440 THANKING YOU FOR THAT. 1907 01:06:53,440 --> 01:06:54,880 THEN THEY'RE ASKING, CAN YOU 1908 01:06:54,880 --> 01:06:56,880 ADDRESS CHRONIC, QUOTE-UNQUOTE, 1909 01:06:56,880 --> 01:06:58,320 GROWING PAIN AMONG ADOLESCENTS? 1910 01:06:58,320 --> 01:07:00,640 AND THEN HOW IS CHRONIC PAIN 1911 01:07:00,640 --> 01:07:02,360 DETERMINED AND ADDRESSED IN 1912 01:07:02,360 --> 01:07:04,120 YOUNGER CHILDREN WHO MAY NOT BE 1913 01:07:04,120 --> 01:07:06,720 ABLE TO SORT OF ADEQUATELY 1914 01:07:06,720 --> 01:07:07,920 DESCRIBE THEIR PAIN EXPERIENCE 1915 01:07:07,920 --> 01:07:10,480 OR EXPRESS THE SEVERITY OF THE 1916 01:07:10,480 --> 01:07:11,960 PAIN THAT THEY'RE EXPERIENCING? 1917 01:07:11,960 --> 01:07:13,600 SO DO YOU WANT TO START WITH 1918 01:07:13,600 --> 01:07:17,000 THOSE AND THEN WE CAN CATCH THIS 1919 01:07:17,000 --> 01:07:17,720 THIRD ONE. 1920 01:07:17,720 --> 01:07:19,440 >>YEAH, AND I THINK, YOU KNOW, 1921 01:07:19,440 --> 01:07:21,640 GROWING PAINS IS AN INTERESTING 1922 01:07:21,640 --> 01:07:22,840 QUESTION BECAUSE CLEARLY THERE'S 1923 01:07:22,840 --> 01:07:30,000 A PHENOMENON OF, YOU KNOW, 1924 01:07:30,000 --> 01:07:31,760 GROWTH SPURTS FOR CHILDREN 1925 01:07:31,760 --> 01:07:33,200 DESCRIBE JOINT OR BONE-RELATED 1926 01:07:33,200 --> 01:07:33,640 PAIN. 1927 01:07:33,640 --> 01:07:34,800 I THINK THE PROBLEM I HAVE WITH 1928 01:07:34,800 --> 01:07:36,320 THAT TERM IS IT'S BEEN 1929 01:07:36,320 --> 01:07:39,520 GENERALIZED ACROSS CHILDHOOD 1930 01:07:39,520 --> 01:07:40,800 WITH -- AS MENTIONED WITH THIS 1931 01:07:40,800 --> 01:07:43,600 MYTH THAT CHILDREN GROW OUT OF 1932 01:07:43,600 --> 01:07:44,720 PAIN, SO I'VE BEEN REALLY 1933 01:07:44,720 --> 01:07:45,760 WORRIED ABOUT THAT TERM BECAUSE 1934 01:07:45,760 --> 01:07:48,160 IT IMPLIES THAT IT'S TRANSITORY, 1935 01:07:48,160 --> 01:07:50,880 AND IT MAY BE GENERALIZED TO 1936 01:07:50,880 --> 01:07:52,320 PAIN COMPLAINTS THAT REALLY ARE 1937 01:07:52,320 --> 01:07:53,120 NOT. 1938 01:07:53,120 --> 01:07:54,880 SO I THINK -- I'VE ALWAYS JUST 1939 01:07:54,880 --> 01:07:55,840 BEEN CAUTIOUS OF THAT. 1940 01:07:55,840 --> 01:07:57,480 I THINK IT WOULD BE BETTER IF 1941 01:07:57,480 --> 01:08:02,880 THERE WAS ANOTHER TERM USED TO 1942 01:08:02,880 --> 01:08:04,920 DESCRIBE SOME OF THESE OTHER 1943 01:08:04,920 --> 01:08:05,600 MUSCULOSKELETAL COMPLAINTS THAT 1944 01:08:05,600 --> 01:08:09,760 ARE COMMON IN CHILDHOOD. 1945 01:08:09,760 --> 01:08:11,080 IN TERMS OF YOUNG CHILDREN, IT'S 1946 01:08:11,080 --> 01:08:11,720 A GOOD QUESTION. 1947 01:08:11,720 --> 01:08:13,480 WE DO HAVE VALID AND RELIABLE 1948 01:08:13,480 --> 01:08:15,640 PAIN ASSESSMENT TOOLS ACROSS A 1949 01:08:15,640 --> 01:08:18,360 PRETTY BROAD PEDIATRIC AGE 1950 01:08:18,360 --> 01:08:19,120 RANGE. 1951 01:08:19,120 --> 01:08:21,520 THE AVERAGE AGE OF A CHILD WITH 1952 01:08:21,520 --> 01:08:23,600 CHRONIC PAIN IS A LITTLE BIT 1953 01:08:23,600 --> 01:08:25,200 OLDER, SO A LOT OF THE TOOLS 1954 01:08:25,200 --> 01:08:27,480 HAVE FOCUSED MORE -- THAT ARE 1955 01:08:27,480 --> 01:08:29,040 FOR YOUNG CHILDREN -- ON ACUTE 1956 01:08:29,040 --> 01:08:32,320 PAIN EXPERIENCES, BUT THERE 1957 01:08:32,320 --> 01:08:35,480 CERTAINLY ARE RELIABLE AND VALID 1958 01:08:35,480 --> 01:08:37,200 TOOLS THAT CAN BE USED ACROSS 1959 01:08:37,200 --> 01:08:38,520 THE WHOLE AGE RANGE. 1960 01:08:38,520 --> 01:08:40,680 >>SO THEN THIS PERSON GOES TO A 1961 01:08:40,680 --> 01:08:42,200 THIRD PART WHICH I THINK IS 1962 01:08:42,200 --> 01:08:44,040 INTERESTING, BECAUSE IT TALKS 1963 01:08:44,040 --> 01:08:44,920 ABOUT -- YOU TALK ABOUT TRYING 1964 01:08:44,920 --> 01:08:47,200 TO SHY AWAY FROM THINGS THAT 1965 01:08:47,200 --> 01:08:48,800 SOUND TRANSITORY, BUT THE PERSON 1966 01:08:48,800 --> 01:08:50,240 SAYS THEY'RE CURIOUS ABOUT WHAT 1967 01:08:50,240 --> 01:08:52,480 THEY'RE CALLING, QUOTE-UNQUOTE, 1968 01:08:52,480 --> 01:08:53,720 GHOST CHRONIC PAIN AMONG 1969 01:08:53,720 --> 01:08:55,360 STUDENTS WHO MAY NOT WANT TO 1970 01:08:55,360 --> 01:08:56,080 ATTEND SCHOOL FOR VARIOUS 1971 01:08:56,080 --> 01:08:57,320 REASONS. 1972 01:08:57,320 --> 01:09:00,880 WHICH I THINK IS AN INTERESTING 1973 01:09:00,880 --> 01:09:03,840 QUESTION, SO ANY THOUGHTS ON 1974 01:09:03,840 --> 01:09:07,360 THAT AS A -- 1975 01:09:07,360 --> 01:09:11,480 >>I'VE NOT HEARD THE TERM GHOST 1976 01:09:11,480 --> 01:09:12,480 CHRONIC PAIN BEFORE BUT I 1977 01:09:12,480 --> 01:09:13,200 UNDERSTAND THE QUESTION IS 1978 01:09:13,200 --> 01:09:15,600 REALLY ABOUT HOW T DO YOU 1979 01:09:15,600 --> 01:09:16,920 UNDERSTAND WHEN THERE ARE 1980 01:09:16,920 --> 01:09:18,120 REASONS PERHAPS THAT ARE 1981 01:09:18,120 --> 01:09:20,520 REINFORCING TO AVOID CERTAIN 1982 01:09:20,520 --> 01:09:22,120 ACTIVITIES AND INDEED FOR SOME 1983 01:09:22,120 --> 01:09:24,960 KIDS, SCHOOL IS NOT AN ACTIVITY 1984 01:09:24,960 --> 01:09:28,880 THAT BRINGS A LOT OF -- A LOT 1985 01:09:28,880 --> 01:09:30,440 OF, YOU KNOW, POSITIVES FOR 1986 01:09:30,440 --> 01:09:31,160 THEM. 1987 01:09:31,160 --> 01:09:34,880 I WILL SAY COVID WAS INTERESTING 1988 01:09:34,880 --> 01:09:36,760 BECAUSE WITH KIDS NOT BEING IN 1989 01:09:36,760 --> 01:09:40,080 SCHOOL OR HAVING HOME-BASED 1990 01:09:40,080 --> 01:09:41,640 LEARNING, WE LEARNED THAT FOR 1991 01:09:41,640 --> 01:09:42,680 SOME KIDS WITH CHRONIC PAIN, 1992 01:09:42,680 --> 01:09:44,680 THAT WAS INCREDIBLY POSITIVE 1993 01:09:44,680 --> 01:09:46,400 EXPERIENCE TO NOT BE EXPECTED TO 1994 01:09:46,400 --> 01:09:47,480 BE AT SCHOOL. 1995 01:09:47,480 --> 01:09:50,240 AND IT WAS FOR MANY REASONS, NOT 1996 01:09:50,240 --> 01:09:53,120 JUST THAT THAT DIDN'T WANT TO BE 1997 01:09:53,120 --> 01:09:54,800 IN THE CLASSROOM, BUT THEY ALSO 1998 01:09:54,800 --> 01:09:55,920 DIDN'T EXPERIENCE BULLYING, FOR 1999 01:09:55,920 --> 01:09:56,960 EXAMPLE, THAT THEY MIGHT HAVE 2000 01:09:56,960 --> 01:09:57,880 EXPERIENCED IN PERSON. 2001 01:09:57,880 --> 01:09:59,480 SO THERE'S SOME LEARNINGS, I 2002 01:09:59,480 --> 01:10:00,760 THINK, TO BE HAD ABOUT WHAT 2003 01:10:00,760 --> 01:10:02,440 REALLY IS HAPPENING IN AN 2004 01:10:02,440 --> 01:10:05,480 ENVIRONMENT THAT MAYBE IS NOT 2005 01:10:05,480 --> 01:10:11,240 POSITIVE FOR ALL CHILDREN IN OUR 2006 01:10:11,240 --> 01:10:13,440 WORK ON INCREASING SCHOOL 2007 01:10:13,440 --> 01:10:14,320 ATTENDANCE WHEN THAT'S A GOAL 2008 01:10:14,320 --> 01:10:16,280 FOR FAMILIES, WE'RE USUALLY 2009 01:10:16,280 --> 01:10:17,680 TRYING TO UNDERSTAND WHAT ARE 2010 01:10:17,680 --> 01:10:19,120 THOSE FACTORS THAT ARE LIMITING 2011 01:10:19,120 --> 01:10:21,880 A CHILD'S PARTICIPATION IN 2012 01:10:21,880 --> 01:10:23,160 SCHOOL AND INDIVIDUALIZING SOME 2013 01:10:23,160 --> 01:10:24,120 OF OUR RECOMMENDATIONS AROUND 2014 01:10:24,120 --> 01:10:25,120 THAT. 2015 01:10:25,120 --> 01:10:29,840 SO I THINK IT'S AN IMPORTANT 2016 01:10:29,840 --> 01:10:32,640 TOPIC. 2017 01:10:32,640 --> 01:10:33,640 BECAUSE OF THE LATER IMPACT THAT 2018 01:10:33,640 --> 01:10:35,480 I SHOWED YOU ON FUTURE 2019 01:10:35,480 --> 01:10:37,120 EDUCATIONAL ATTAINMENT, I THINK 2020 01:10:37,120 --> 01:10:38,520 IT'S ONE WE REALLY NEED TO MAKE 2021 01:10:38,520 --> 01:10:44,440 SURE WE UNDERSTAND. 2022 01:10:44,440 --> 01:10:46,280 >>THEN WE MOVE TO A QUESTION 2023 01:10:46,280 --> 01:10:48,760 THAT CAME IN ABOUT WHAT ARE YOUR 2024 01:10:48,760 --> 01:10:49,360 RECOMMENDATIONS FOR PARENTS 2025 01:10:49,360 --> 01:10:50,960 DEALING WITH AN ADOLESCENT WHO'S 2026 01:10:50,960 --> 01:10:51,960 EXPERIENCING CHRONIC PAIN AND IS 2027 01:10:51,960 --> 01:10:54,880 NOT GETTING THEIR CHILD'S NEEDS 2028 01:10:54,880 --> 01:10:56,320 MET BY HEALTHCARE PROVIDERS? 2029 01:10:56,320 --> 01:10:58,480 FOR EXAMPLE, THEY'RE CONCERNED 2030 01:10:58,480 --> 01:11:00,520 THAT MAYBE THE PROVIDER IS NOT 2031 01:11:00,520 --> 01:11:01,400 EXPLORING WHAT WAS REALLY 2032 01:11:01,400 --> 01:11:03,600 CAUSING THE PAIN, OR NOT 2033 01:11:03,600 --> 01:11:04,880 RECOMMENDING TESTING TO GET TO 2034 01:11:04,880 --> 01:11:07,920 THE BOTTOM OF THE PAIN. 2035 01:11:07,920 --> 01:11:12,600 SO THOUGHTS THERE FOR THE 2036 01:11:12,600 --> 01:11:13,400 FRUSTRATED PARENT? 2037 01:11:13,400 --> 01:11:17,200 >>I THINK THAT'S A VERY COMMON 2038 01:11:17,200 --> 01:11:19,160 EXPERIENCE OF PARENTS BECAUSE 2039 01:11:19,160 --> 01:11:20,840 THERE ARE FEW PROVIDERS TO START 2040 01:11:20,840 --> 01:11:23,880 WITH, SO NOT ONLY IS THE 2041 01:11:23,880 --> 01:11:27,560 EXPERIENCE OF NOT GETTING THE 2042 01:11:27,560 --> 01:11:28,880 RECOMMENDATION, ALSO THE WAIT TO 2043 01:11:28,880 --> 01:11:30,880 GET THE LIMITED RECOMMENDATION, 2044 01:11:30,880 --> 01:11:32,040 SO I THINK THE COMBINATION OF 2045 01:11:32,040 --> 01:11:33,760 FACTORS IS INCREDIBLY 2046 01:11:33,760 --> 01:11:36,960 FRUSTRATING FOR MANY FAMILIES. 2047 01:11:36,960 --> 01:11:38,160 UNFORTUNATELY, THERE ARE OFTEN 2048 01:11:38,160 --> 01:11:40,080 NOT SPECIFIC DIAGNOSTIC TESTS 2049 01:11:40,080 --> 01:11:42,160 THAT HELP US UNDERSTAND WHY PAIN 2050 01:11:42,160 --> 01:11:43,840 IS OCCURRING WHEN IT CHRONIC, 2051 01:11:43,840 --> 01:11:45,840 AND SO THAT CAN ALSO BE A SOURCE 2052 01:11:45,840 --> 01:11:47,520 OF FRUSTRATION BECAUSE THERE'S 2053 01:11:47,520 --> 01:11:51,040 NOT A SIMPLE WAY OF DETERMINING 2054 01:11:51,040 --> 01:11:52,640 A DIAGNOSIS OR THE SPECIFIC 2055 01:11:52,640 --> 01:11:53,760 ETIOLOGY OF THE PAIN. 2056 01:11:53,760 --> 01:11:58,080 YOU KNOW, WE REALLY ENCOURAGE 2057 01:11:58,080 --> 01:12:00,480 PARENTS TO MAKE GOOD USE OF 2058 01:12:00,480 --> 01:12:02,520 THEIR PRIMARY CARE PHYSICIAN WHO 2059 01:12:02,520 --> 01:12:06,320 KNOWS THEIR CHILD BETTER THAN A 2060 01:12:06,320 --> 01:12:07,880 PROVIDER WHO THEY MAYBE HAVE 2061 01:12:07,880 --> 01:12:09,600 ONLY SEEN ONCE OR TWICE AND TO 2062 01:12:09,600 --> 01:12:10,720 REALLY BE ABLE TO FOLLOW UP WITH 2063 01:12:10,720 --> 01:12:12,360 A PERSON WHO KNOWS YOUR FAMILY 2064 01:12:12,360 --> 01:12:17,160 WELL AND WHO CAN MAKE CONTINUED 2065 01:12:17,160 --> 01:12:17,920 RECOMMENDATIONS. 2066 01:12:17,920 --> 01:12:19,000 AND KNOWING THAT ALL CHRONIC 2067 01:12:19,000 --> 01:12:20,080 PAIN DOESN'T NEED TO BE TREATED 2068 01:12:20,080 --> 01:12:21,520 BY A SPECIALIST, THERE ARE MANY 2069 01:12:21,520 --> 01:12:24,040 EFFECTIVE STRATEGIES THAT 2070 01:12:24,040 --> 01:12:25,240 PRIMARY CARE PROVIDERS ARE VERY 2071 01:12:25,240 --> 01:12:28,240 SKILLED AT BEING ABLE TO ALSO 2072 01:12:28,240 --> 01:12:30,120 DELIVER. 2073 01:12:30,120 --> 01:12:32,200 >>I THINK WE'RE GOING TO NOW 2074 01:12:32,200 --> 01:12:36,760 TAKE OUR LAST QUESTION HERE, AND 2075 01:12:36,760 --> 01:12:41,320 THIS IS -- THIS IS SHARED IN THE 2076 01:12:41,320 --> 01:12:43,120 CHAT, IN CASE YOU WANT TO TAKE A 2077 01:12:43,120 --> 01:12:44,960 LOOK WHILE I'M SUMMARIZING AND 2078 01:12:44,960 --> 01:12:46,560 PARAPHRASING A LITTLE BIT. 2079 01:12:46,560 --> 01:12:48,160 SO WE'RE HEARING FROM A PROVIDER 2080 01:12:48,160 --> 01:12:49,800 WHO SAYS THAT THEY'VE WORKED IN 2081 01:12:49,800 --> 01:12:51,440 PEDIATRIC SURGERY AND THEY'VE 2082 01:12:51,440 --> 01:12:54,560 SEEN CARE FOR A TEEN POST SPINAL 2083 01:12:54,560 --> 01:12:59,680 FUSION AND THE PAIN MANAGEMENT 2084 01:12:59,680 --> 01:13:01,640 REGIMEN SEEMED TO BE, TO HER OR 2085 01:13:01,640 --> 01:13:05,120 THIS INDIVIDUAL, INEFFECTIVE. 2086 01:13:05,120 --> 01:13:13,760 SO THEY'RE COMMENTING THAT IT'S 2087 01:13:13,760 --> 01:13:15,160 CRITICAL TO PROPERLY TREAT ACUTE 2088 01:13:15,160 --> 01:13:16,480 PAIN TO MINIMIZE ITS TRANSITION 2089 01:13:16,480 --> 01:13:18,440 TO CHRONIC PAIN AND 2090 01:13:18,440 --> 01:13:19,320 COMPLEMENTARY AND MULTIMODAL 2091 01:13:19,320 --> 01:13:20,760 APPROACHES COULD HAVE GREATLY 2092 01:13:20,760 --> 01:13:21,600 IMPROVED THIS PATIENT'S 2093 01:13:21,600 --> 01:13:22,160 EXPERIENCE. 2094 01:13:22,160 --> 01:13:24,200 SO I THINK REALLY THEIR QUESTION 2095 01:13:24,200 --> 01:13:28,880 TO YOU IS HOW CAN THEY AS A 2096 01:13:28,880 --> 01:13:31,520 PROVIDER PROMOTE CHANGES IN PAIN 2097 01:13:31,520 --> 01:13:33,280 MANAGEMENT WITHIN A HEALTHCARE 2098 01:13:33,280 --> 01:13:34,560 SYSTEM THAT YOU MIGHT SHARE WITH 2099 01:13:34,560 --> 01:13:34,840 PROVIDERS? 2100 01:13:34,840 --> 01:13:35,760 >>IT'S A GREAT POINT. 2101 01:13:35,760 --> 01:13:37,560 WE TALK A LOT ABOUT THESE 2102 01:13:37,560 --> 01:13:38,680 INDIVIDUAL LEVEL INTERVENTIONS, 2103 01:13:38,680 --> 01:13:41,000 BUT INDEED, WE NEED TO DO MORE 2104 01:13:41,000 --> 01:13:42,520 AT THE SYSTEMS LEVEL IF WE'RE 2105 01:13:42,520 --> 01:13:44,920 REALLY GOING TO EFFECT CHANGE 2106 01:13:44,920 --> 01:13:46,560 MORE BROADLY SO I APPRECIATE 2107 01:13:46,560 --> 01:13:48,080 YOUR QUESTION BECAUSE WE HAVEN'T 2108 01:13:48,080 --> 01:13:49,640 EVALUATED VERY MANY SYSTEMS 2109 01:13:49,640 --> 01:13:51,360 LEVEL INTERVENTIONS IN PEDIATRIC 2110 01:13:51,360 --> 01:13:55,160 PAIN MANAGEMENT. 2111 01:13:55,160 --> 01:13:56,680 THERE IS A GREAT ORGANIZATION 2112 01:13:56,680 --> 01:13:57,800 CALLED CHILD KIND THAT CAN WORK 2113 01:13:57,800 --> 01:13:59,640 WITH HOSPITALS AROUND 2114 01:13:59,640 --> 01:14:02,040 PARTNERSHIPS AROUND PROMOTING -- 2115 01:14:02,040 --> 01:14:03,640 I WON'T SAY A PAIN-FREE 2116 01:14:03,640 --> 01:14:06,640 ENVIRONMENT BUT A COMFORT 2117 01:14:06,640 --> 01:14:08,040 ENVIRONMENT IN CHILDREN'S 2118 01:14:08,040 --> 01:14:08,400 HOSPITALS. 2119 01:14:08,400 --> 01:14:09,440 I THINK THAT'S ONE ORGANIZATION 2120 01:14:09,440 --> 01:14:12,160 TO THINK ABOUT, AND IF YOU CAN 2121 01:14:12,160 --> 01:14:13,880 GET YOUR HOSPITAL INVOLVED IN 2122 01:14:13,880 --> 01:14:15,760 WANTING TO BE PART OF THAT, YOU 2123 01:14:15,760 --> 01:14:18,360 GET KIND OF A CHILD KIND STAMP 2124 01:14:18,360 --> 01:14:19,920 OF APPROVAL AS A HOSPITAL THAT 2125 01:14:19,920 --> 01:14:21,400 CARES ABOUT PAIN MANAGEMENT IN 2126 01:14:21,400 --> 01:14:22,320 CHILDREN. 2127 01:14:22,320 --> 01:14:25,160 BUT THAT'S ONE TYPE OF, I THINK, 2128 01:14:25,160 --> 01:14:27,160 THING TO EXPLORE THAT COULD BE 2129 01:14:27,160 --> 01:14:30,200 HELPFUL AT A SYSTEMS LEVEL. 2130 01:14:30,200 --> 01:14:33,720 >>WELL, THANK YOU SO MUCH. 2131 01:14:33,720 --> 01:14:35,960 AND THE ORGANIZATION THAT YOU 2132 01:14:35,960 --> 01:14:37,360 MENTIONED WAS CHILD KIND, YOU 2133 01:14:37,360 --> 01:14:37,880 SAID? 2134 01:14:37,880 --> 01:14:38,520 >>YES. 2135 01:14:38,520 --> 01:14:39,120 >>YES. 2136 01:14:39,120 --> 01:14:39,520 GREAT. 2137 01:14:39,520 --> 01:14:41,360 THANK YOU. 2138 01:14:41,360 --> 01:14:42,440 WELL, DR. PALERMO, THANK YOU SO 2139 01:14:42,440 --> 01:14:42,680 MUCH. 2140 01:14:42,680 --> 01:14:43,880 I THINK THAT BRINGS US TO THE 2141 01:14:43,880 --> 01:14:45,480 END OF OUR QUESTION AND ANSWER 2142 01:14:45,480 --> 01:14:46,920 PERIOD WITH YOU, AND BRINGS US 2143 01:14:46,920 --> 01:14:48,920 TO THE END OF OUR LECTURE TODAY. 2144 01:14:48,920 --> 01:14:51,800 SO AGAIN, I WANT TO THANK 2145 01:14:51,800 --> 01:14:54,880 DR. PALERMO, I WANT TO THANK DRT 2146 01:14:54,880 --> 01:14:58,040 TO THANK THE NCCIH TEAM WHO 2147 01:14:58,040 --> 01:15:00,200 HELPED THIS LECTURE COME TO 2148 01:15:00,200 --> 01:15:00,680 FRUITION. 2149 01:15:00,680 --> 01:15:02,000 BUT ALSO WE REALLY JUST WANT TO 2150 01:15:02,000 --> 01:15:04,600 THANK YOU, OUR VIEWERS, FOR 2151 01:15:04,600 --> 01:15:05,680 JOINING US TODAY, FOR ASKING 2152 01:15:05,680 --> 01:15:06,800 YOUR THOUGHTFUL QUESTIONS. 2153 01:15:06,800 --> 01:15:09,080 AGAIN, THIS IS BEING RECORDED, 2154 01:15:09,080 --> 01:15:12,440 AND WILL BE AVAILABLE ON THE NIH 2155 01:15:12,440 --> 01:15:14,200 VIDEOCAST WEBSITE IN THE PAST 2156 01:15:14,200 --> 01:15:15,280 EVENTS SECTION FOR FUTURE 2157 01:15:15,280 --> 01:15:17,240 VIEWING, SO IF YOU'D LIKE TO 2158 01:15:17,240 --> 01:15:18,320 WATCH AGAIN, TUNE IN AGAIN. 2159 01:15:18,320 --> 01:15:22,720 AND ALSO AS YOU KNOW, 2160 01:15:22,720 --> 01:15:23,920 DR. PALERMO GRACIOUSLY SHARED 2161 01:15:23,920 --> 01:15:24,760 HER CONTACT INFORMATION WITH YOU 2162 01:15:24,760 --> 01:15:25,760 IF YOU'D LIKE TO FOLLOW UP WITH 2163 01:15:25,760 --> 01:15:27,400 ANY QUESTIONS THAT YOU HAVE. 2164 01:15:27,400 --> 01:15:28,840 SO WITH THAT, I WANT TO BRING 2165 01:15:28,840 --> 01:15:30,880 OUR TIME TOGETHER TODAY TO A 2166 01:15:30,880 --> 01:15:32,840 CONCLUSION, AND I WISH YOU ALL A 2167 01:15:32,840 --> 01:15:33,640 WONDERFUL AFTERNOON. 2168 01:15:33,640 --> 01:15:34,000 SO TAKE CARE, EVERYONE. 2169 01:15:34,000 --> 01:15:41,920 BYE-BYE.