# Get moving, GET living: Graded exposure treatment for adolescents with chronic musculoskeletal pain.

> **NIH NIH R21** · STANFORD UNIVERSITY · 2020 · $138,160

## Abstract

With up to a third of adolescents reporting recurrent or chronic musculoskeletal pain, it is a critical national
health problem. The experience of chronic pain in adolescence negatively impacts overall health during this
important life period, and increases the risk of pain and mental health problems in adulthood. Pain-related fear
is repeatedly identified as an important factor that increases the likelihood of poor outcomes among
adolescents with pain, and yet pain-related fear is rarely targeted in typical pain management (TPM).
Perhaps unsurprisingly, TPM yields no change in pain-related fear, and modest improvements in functional
disability. To overcome limitations of TPM for pain-related fear, graded in-vivo exposure treatment (GET)
was developed. While TPM focuses on pain control via pain management psychology and impairment-based
physical therapy, GET is jointly delivered by a pain psychologist and physical therapist targeting functional
improvement, through exposing patients to activities previously avoided due to fear of pain. GET is successful
in adults with chronic musculoskeletal pain! and our pilot data of GET for adolescents with chronic pain (GET
Living) is robust, with significant declines in patient fear, activity avoidance, and disability. Uniquely, GET
Living also targets parent distress and behavior, and our pilot data demonstrate decreases in parent fear,
avoidance, and protective behavior. GET Living also distinguishes itself with an innovative assessment
approach to patient progress and clinical endpoints. In addition to standard assessment tools, GET Living
utilizes electronic daily diary technology to identify exactly when improvements in outcomes are occurring/not
occurring, and objective biomechanical assessment using motion analysis and physical activity monitoring via
Actigraphy. Building from this work, the proposed research concerns an exploratory randomized controlled trial
(RCT) of GET Living aimed at measuring changes in fear and function for adolescents with chronic
musculoskeletal pain when compared to TPM. This study will provide necessary findings to support or refute a
large multi-site RCT. Aim 1 compares changes in pain-related fear (primary outcome), disability, and parent
behavior (secondary outcomes) between GET Living and TPM. Aim 2 characterizes feasibility and
acceptability of GET Living to inform implementation of a large multi-site RCT. Treatment of adolescent chronic
musculoskeletal pain is suboptimal. Significant breakthroughs require directly targeting mechanisms underlying
pain-related dysfunction, such as pain-related fear. Implementing innovative interdisciplinary outpatient
treatment that addresses pain-related fear and dysfunction, coupled with proof-of-concept electronic daily
diaries and biomechanical assessment to determine clinical endpoints and treatment response, will lead to
advancements in our understanding and treatment of adolescent chronic pain. These findings will directly
inform...

## Key facts

- **NIH application ID:** 9980786
- **Project number:** 5R21AR072921-03
- **Recipient organization:** STANFORD UNIVERSITY
- **Principal Investigator:** LAURA E SIMONS
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $138,160
- **Award type:** 5
- **Project period:** 2018-09-01 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9980786

## Citation

> US National Institutes of Health, RePORTER application 9980786, Get moving, GET living: Graded exposure treatment for adolescents with chronic musculoskeletal pain. (5R21AR072921-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9980786. Licensed CC0.

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