Acceptance and Commitment Training for Adolescents and Young Adults With Neurofibromatosis Type 1, Plexiform Neurofibromas, and Chronic Pain
| Status: | Recruiting |
|---|---|
| Conditions: | Cancer, Other Indications |
| Therapuetic Areas: | Oncology, Other |
| Healthy: | No |
| Age Range: | 16 - 59 |
| Updated: | 3/24/2019 |
| Start Date: | June 1, 2015 |
| End Date: | December 31, 2019 |
| Contact: | Staci M Peron, Ph.D. |
| Email: | martins@mail.nih.gov |
| Phone: | (240) 760-6025 |
Acceptance and Commitment Training for Adolescents and Young Adults With Neurofibromatosis Type 1, Plexiform Neurofibromas, and Chronic Pain: A Phase III Clinical Trial
Background:
- People with neurofibromatosis type I (NF1) and plexiform neurofibroma (PN) tumors often
have chronic pain that his hard to control. People usually take medicines for the pain, but
they may not work well and might cause side effects. A new strategy called Acceptance and
Commitment Training (ACT) may help these people cope with chronic pain. ACT focuses on things
like values and living in the moment.
Objective:
- To see if Acceptance and Commitment Training improves pain coping in people with NF1 pain.
Eligibility:
- People age 16 34 who have NF1, 1 or more PN tumors, and pain that interferes with their
daily functioning.
Design:
- Participants will be screened with a physical exam, medical history, and questions about
their pain.
- Participants will fill out questionnaires about their pain and feelings. Their heart
rate will be measured via ECG.
- Participants will be divided into 2 groups randomly. One will wait 8 weeks.
- The other will start training right away.
- Participants will have 2 two-hour sessions with an ACT trainer. They will learn
techniques for setting goals based on personal values and other ways to cope with pain.
They will get a workbook and a CD to take home for practice.
- Participants will do practice exercises at home between sessions. They will get weekly
emails with a practice exercise. They will join video chat sessions via home computer
with their trainer.
- All participants will return to NIH after 8 weeks for questionnaires and an ECG. The
wait group will then start training. They will return 8 weeks later for questionnaires
and an ECG.
- Six months later, they will complete questionnaires from home by computer.
- People with neurofibromatosis type I (NF1) and plexiform neurofibroma (PN) tumors often
have chronic pain that his hard to control. People usually take medicines for the pain, but
they may not work well and might cause side effects. A new strategy called Acceptance and
Commitment Training (ACT) may help these people cope with chronic pain. ACT focuses on things
like values and living in the moment.
Objective:
- To see if Acceptance and Commitment Training improves pain coping in people with NF1 pain.
Eligibility:
- People age 16 34 who have NF1, 1 or more PN tumors, and pain that interferes with their
daily functioning.
Design:
- Participants will be screened with a physical exam, medical history, and questions about
their pain.
- Participants will fill out questionnaires about their pain and feelings. Their heart
rate will be measured via ECG.
- Participants will be divided into 2 groups randomly. One will wait 8 weeks.
- The other will start training right away.
- Participants will have 2 two-hour sessions with an ACT trainer. They will learn
techniques for setting goals based on personal values and other ways to cope with pain.
They will get a workbook and a CD to take home for practice.
- Participants will do practice exercises at home between sessions. They will get weekly
emails with a practice exercise. They will join video chat sessions via home computer
with their trainer.
- All participants will return to NIH after 8 weeks for questionnaires and an ECG. The
wait group will then start training. They will return 8 weeks later for questionnaires
and an ECG.
- Six months later, they will complete questionnaires from home by computer.
BACKGROUND:
- Neurofibromatosis type 1 (NF1) is a genetic disorder that affects approximately 1 in
3,500 individuals.
- A number of common clinical manifestations, including plexiform neurofibromas, can cause
frequent and significant pain and impact quality of life.
- Often, NF1-related pain is not well-controlled with medication and many of the
medications cause significant side effects.
- To our knowledge, only one prior study (by our group) has examined the effectiveness of
a psychological intervention for chronic pain in adolescents and young adults (AYA) with
NF1.
- Acceptance and Commitment Therapy (ACT), a newer generation of cognitive-behavioral
therapy, focuses on encouraging individuals to engage in more adaptive ways of coping
with pain.
- The goal of ACT is not to eliminate the person s pain, but to optimize the person s
functioning despite their pain
OBJECTIVES:
-To compare pain interference mean score changes from baseline to 8 weeks between the ACT
intervention group and the waitlist (WL) group.
ELIGIBILITY:
- Patients 16 - 59 years of age with a confirmed diagnosis of NF1 and greater than or
equal to 1 plexiform neurofibroma (PN).
- The patient must obtain a mean score of 2.0 or higher or a score of 3 on three or more
items on the Pain Interference Index, and report having pain that interferes with
functioning for at least three months.
- The patient must have regular access to a computer or tablet with internet access.
DESIGN:
- This is a psychological intervention study to determine the potential benefit of ACT on
pain interference, with patients randomized to the ACT intervention or a wait-list
control group.
- Patients will come to the NIH for a 2-day visit (Time 1). After baseline assessments
(questionnaires and ECG) are completed, participants in the ACT group will take part in
two 2-hour ACT training sessions. At home, this group will receive weekly emails through
week 8, and will participate in further ACT training/educational sessions via video chat
at weeks 2, 4, and 6.
- All patients will return to the NIH at week 8 (Time 2) to complete follow-up
questionnaires and ECG. At this time, the WL group will cross over and receive the ACT
intervention (in-person sessions, weekly emails, and video chat sessions). All patients
will complete questionnaires again from home six months following the completion of the
intervention.
- To detect a change of .68 standard deviation on the primary outcome measure between the
two groups at .80 power, 41 patients per group are needed.
- Neurofibromatosis type 1 (NF1) is a genetic disorder that affects approximately 1 in
3,500 individuals.
- A number of common clinical manifestations, including plexiform neurofibromas, can cause
frequent and significant pain and impact quality of life.
- Often, NF1-related pain is not well-controlled with medication and many of the
medications cause significant side effects.
- To our knowledge, only one prior study (by our group) has examined the effectiveness of
a psychological intervention for chronic pain in adolescents and young adults (AYA) with
NF1.
- Acceptance and Commitment Therapy (ACT), a newer generation of cognitive-behavioral
therapy, focuses on encouraging individuals to engage in more adaptive ways of coping
with pain.
- The goal of ACT is not to eliminate the person s pain, but to optimize the person s
functioning despite their pain
OBJECTIVES:
-To compare pain interference mean score changes from baseline to 8 weeks between the ACT
intervention group and the waitlist (WL) group.
ELIGIBILITY:
- Patients 16 - 59 years of age with a confirmed diagnosis of NF1 and greater than or
equal to 1 plexiform neurofibroma (PN).
- The patient must obtain a mean score of 2.0 or higher or a score of 3 on three or more
items on the Pain Interference Index, and report having pain that interferes with
functioning for at least three months.
- The patient must have regular access to a computer or tablet with internet access.
DESIGN:
- This is a psychological intervention study to determine the potential benefit of ACT on
pain interference, with patients randomized to the ACT intervention or a wait-list
control group.
- Patients will come to the NIH for a 2-day visit (Time 1). After baseline assessments
(questionnaires and ECG) are completed, participants in the ACT group will take part in
two 2-hour ACT training sessions. At home, this group will receive weekly emails through
week 8, and will participate in further ACT training/educational sessions via video chat
at weeks 2, 4, and 6.
- All patients will return to the NIH at week 8 (Time 2) to complete follow-up
questionnaires and ECG. At this time, the WL group will cross over and receive the ACT
intervention (in-person sessions, weekly emails, and video chat sessions). All patients
will complete questionnaires again from home six months following the completion of the
intervention.
- To detect a change of .68 standard deviation on the primary outcome measure between the
two groups at .80 power, 41 patients per group are needed.
- INCLUSION CRITERIA FOR PARTICIPANT
1. Patients must be between 16 and 59 years of age at the time of the baseline
assessment. Because the research on the effectiveness of ACT with younger
children is still emerging, children 15 and younger will be excluded from the
present study.
2. Diagnosis of NF1 through germline mutation OR clinical diagnosis; for the
clinical diagnosis of NF1 all study subjects must have two or more diagnostic
criteria for NF1 listed below (NIH Consensus Conference):
- Six or more cafe-au-lait spots (greater than or equal to 0.5 cm in
prepubertal subjects or greater than or equal to 1.5 cm in postpubertal
subjects)
- Greater than or equal to 2 neurofibromas or 1 plexiform neurofibroma
- Freckling in the axilla or groin
- Optic glioma
- Two or more Lisch nodules
- A distinctive bony lesion (dysplasia of the sphenoid bone or dysplasia or
thinning of long bone cortex)
- A first-degree relative with NF1
3. Participants must have documentation of a PN, based on either clinical exam or
imaging.
4. Patient must self-report having chronic pain for at least the past 3 months that
has interfered with their daily functioning, as assessed by the Pain Interference
Index (must get a mean score of 2.0 or higher, or score a 3 on three or more
individual items).
5. Patients must have regular access to a computer or tablet with internet access.
6. Ability of subject or Legally Authorized Representative (LAR) to understand and
the willingness to sign a written informed consent document.
7. No anticipated major changes in their pain treatment regimen (i.e., new class of
pain medication starting or change in the class of pain medication) or enrollment
on a new treatment study presumed to impact pain in the near future.
8. Subjects must be able to read and comprehend the English language, since the
highly trained ACT therapists are not fluent enough to conduct the trainings in
Spanish or other languages.
EXCLUSION CRITERIA FOR PARTICIPANT
1. In the opinion of the PI or an AI, the subject has significant cognitive or emotional
difficulties that would prevent them from being able to understand and/or participate
fully in the intervention or the measures.
2. Subjects who are participating in any other treatment studies, either medical or
behavioral, specifically for pain management.
3. Subjects who began a medical intervention for treatment of their disease that has a
possible impact on pain (including MEK trials) will not be eligible until after one
year on the medical treatment; at that time, eligibility will be discussed with the PI
of the medical study to assess the stability of the patient s pain and whether further
pain-related changes due to the medical treatment are likely.
4. Inability to travel to the NIH, for example, due to physical limitations, for the
in-person evaluation(s).
No groups in regards to gender, race, or ethnicity are being excluded from participation in
the trial.
We found this trial at
1
site
9000 Rockville Pike
Bethesda, Maryland 20892
Bethesda, Maryland 20892
Phone: 888-624-1937
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