Factors Associated With Dropout Versus Completion of a Manualized Treatment for Pediatric Chronic Pain

To identify characteristics of pediatric patients who completed participation in a manualized psychosocial treatment (CHIRP: Children’s Health & Illness Recovery Program) for adolescents with chronic pain compared with those who discontinued treatment early. Preintervention demographic characteristics and ratings of pain, fatigue, functional disability, coping style, health beliefs and behaviors, sleep, and parent/teen dynamics were compared between adolescents who either completed (42 total; 39 females, 3 males) or prematurely discontinued (25 total; 19 females, 6 males) a 12-session manualized treatment. Participants who dropped out of treatment were more likely to be male and have a history of repeating a grade in school. Parents of adolescents who dropped out of treatment were more likely to minimize the impact of symptoms on adolescent functioning and reported their teen was less likely to employ active problem-solving coping, have more comorbid medically unexplained conditions, more mood problems, and more sleep difficulties. Adolescents who dropped out of treatment reported being more sensitive or reactive to stress and were more likely to use medications to help them sleep. Certain demographic and individual patient characteristics and family dynamics appear to impact treatment attrition to a manualized cognitive–behavioral and family systems intervention for adolescents with chronic pain. These findings suggest the need for developing strategies for strengthening patient and family commitment to a psychosocial approach to chronic pain coping and recovery.