IMPORTANCE Severe chronic pediatric pain causes individual suffering and significantly affects social functioning and psychological well-being. For children with high pain severity, intensive interdisciplinary pain treatment (IIPT) is a well-established treatment. However, across specialized centers, it is not sufficient for all patients.OBJECTIVE To evaluate the effectiveness of a psychosocial aftercare (PAC) program for pediatric patients with severe chronic pain followed up for 6 months after discharge from IIPT. DESIGN, SETTING, AND PARTICIPANTSThis multicenter randomized clinical trial with 4 assessment points (pre-IIPT, immediately post-IIPT, 3 months, and 6 months) was conducted at 3 pediatric specialized tertiary care pain centers in Germany between September 11, 2018, and March 31, 2020. Included patients were aged 8 to 17 with a severe chronic pain condition who had been admitted for IIPT. Data were analyzed from June 8 to September 4, 2020. INTERVENTIONS Patients and their families were randomly assigned to 1 of 2 study groups at inpatient IIPT admission. Both groups received standardized 3-to 4-week IIPT. After IIPT discharge, the intervention group received PAC and the control group received usual care. PAC involved ongoing contact with a social worker for as long as the family requested the support, up to a maximum of 6 months. MAIN OUTCOMES AND MEASURES The primary outcome measure was pain at 6 months, measured using the Chronic Pain Grading (CPG), an instrument based on an algorithm indicating severity of the chronic pain disorder. Secondary outcomes included other pain-related and emotional parameters. RESULTS A total of 419 patients were randomized (mean [SD] age, 14.3 [2.1] years; 303 [72.3%] girls; 116 [27.7%] boys), with 218 assigned to usual care and 201 assigned to PAC. At baseline in both groups, the median (IQR) CPG was 3 (2-4). Superiority of PAC compared with usual care was demonstrated at 6 months (median [IQR] CPG: usual care, 2 [2-3]; PAC, 1 [1-2]; r = 0.30; 95% CI, 0.17-0.41). Additionally, PAC significantly improved emotional parameters (eg, significant time × group interaction: b = −8.84; P < .001). CONCLUSIONS AND RELEVANCEThis randomized clinical trial found that PAC improved painrelated and emotional parameters during the intervention 6 months after discharge from IIPT. Future research is needed to investigate the intervention's long-term effects. (continued) Key Points Question Does a psychosocial aftercare program (PAC) after in-hospital intensive interdisciplinary pain treatment (IIPT) for pediatric patients with chronic pain improve functional outcomes? Findings In this randomized clinical trial including 419 patients aged 8 to 17 years randomized and 222 patients analyzed at 6 months, PAC significantly improved all pain-related as well as emotional outcome parameters compared with treatment as usual. Meaning These findings suggest PAC should be considered in IIPT for pediatric chronic pain and its effectiveness tested in other pediatric psychosomatic conditions.

Background: For paediatric chronic pain patients, intensive interdisciplinary pain treatment (IIPT) is a well-established treatment. The treatment's shortterm effectiveness can be improved by an additive psychosocial aftercare (PAC). However, neither the program's long-term effectiveness nor the patients in particular need have been investigated yet. Methods: This study aimed at determining the long-term effects of PAC and detecting predictors of treatment outcome within a multicentre randomized controlled trial measured at five time points up to 12 months after discharge. At inpatient admission to IIPT, patients (N = 419, 14.3 years of age, 72.3% female) were randomly assigned to intervention or control group. After IIPT discharge, the intervention group received PAC, whereas the control group received treatment as usual (TAU). Patient-reported outcomes included pain and emotional characteristics. Clinicians assessed potential psychosocial risk factors and their prognosis of treatment outcome. Statistical analyses included mixed-models and univariable logistic regressions.Results: Data at the 12-month follow-up (n = 288) showed a significant benefit of PAC compared with TAU; the majority (59.0%) of patients in the PAC-group reported no chronic pain compared to 29.2% of TAU-patients (p < 0.001). Patients with a single parent specifically benefited from PAC compared to TAU. Clinicians were able to make a reliable prognosis of treatment outcome, but did not successfully predict which patients would benefit the most from PAC.Conclusions: Study results suggest that PAC is highly effective irrespective of patient characteristics, but particularly for patients with single parents. Its broad implementation could help to improve the long-term outcomes of youth with severely disabling chronic pain.Significance: A psychosocial aftercare following paediatric IIPT leads to significantly better pain and emotional outcomes compared to treatment as usual up to 12 months after discharge, especially for patients with single parents.

SummaryChronischer Schmerz bei Kindern und Jugendlichen ist ein unterschätztes Thema. Die Prävalenz ist in den letzten Jahrzehnten gestiegen. Von großer Bedeutung ist nicht nur die Stärke des Schmerzes, sondern die gefühlte Beeinträchtigung durch den Schmerz. Entscheidend für das Ausmaß des Leidens sind schmerzbezogene Überzeugungen, Resilienzfaktoren und das damit verbundene Verhalten und Einschränkungen. Diese betreffen häufig das Vermeiden von Sozialkontakten, aber auch das Auftreten weiterer Beschwerden wie Schlafstörungen, Appetitverlust, Konzentrationsschwierigkeiten, die weitreichende Folgen haben können für die weitere Entwicklung in allen Bereichen des Lebens. In der Therapie ist immer eine individuelle Betrachtung des jeweiligen Falles notwendig.Zur Behandlung bei Kindern und Jugendlichen hat sich die multimodale Schmerztherapie als wirksam erwiesen. Die Autorin stellt anhand dreier Fälle aus der Praxis die Komplexität des chronischen Schmerzes vor sowie das Vorgehen in der multimodalen Schmerztherapie.

Chronische Schmerzen bei Kindern und Jugendlichen sind oftmals multifaktoriell bedingt. Der Leidensdruck der Patient:innen ist extrem hoch und wird häufig durch zu viel Diagnostik beeinflusst. Ein Schmerztagebuch sowie spezifische Fragebogen zum Thema Schmerz und Depression können in der ambulanten Versorgung helfen, eine chronische Schmerzstörung zu erkennen. Die Therapie chronischer Schmerzen beruht auf einem multimodalen Konzept, das ein multiprofessionelles Team erfordert. Die ambulanten Versorgungsstrukturen für diese Patientenklientel sind teilweise immer noch unzureichend, weshalb die Behandlung fast ausschließlich stationär erfolgt. Eng damit verknüpft ist der Behandlungserfolg, da sonst die erlernten Strategien im Alltag nicht umgesetzt werden können.

A newly developed specialized psychosocial aftercare program (PAC) for pediatric patients with chronic pain following an intensive interdisciplinary pain treatment (IIPT) was found to be significantly more effective than IIPT alone. This qualitative study aimed to gain further insight into the mechanisms and prerequisites for the effectiveness of this specialized aftercare program. We conducted structured telephone interviews with patients, parents, and health care professionals conducting PAC. A total of 16 interviews were conducted—seven interviews with parents, six interviews with patients, and three interviews with health care professionals—and transcribed verbatim. Data were analyzed using reflexive thematic analysis. Four major themes consisting of 20 subcategories were identified, namely (1) frame conditions, (2) person factors, (3) stabilization and (4) catalyst. The foundations of treatment success are frame conditions, such as flexibility or constancy, and person factors, such as respect or expertise. Based on these foundations, stabilization is achieved through security, mediation, orientation and support. Altogether, these components of PAC reveal their potential as catalysts for further improvement even after discharge from IIPT. Overall, patients and their families emphasized widespread personal relevance and acceptance of the PAC program. The findings of this study may be employed in the development of other aftercare programs or interventions involving families in the context of psychotherapeutic and psychosocial health care.