Cognitive behavioral group intervention for pain and well-being in children with juvenile idiopathic arthritis: a study of feasibility and preliminary efficacy

Abstract

BackgroundPain is still a part of everyday living for several children with juvenile idiopathic arthritis (JIA) despite improvement in treatment. Psychological interventions may contribute to diminish pain complaints and improve well-being in children with JIA. Only few studies have investigated the efficacy of psychological therapy in children with arthritis and with mixed results.The aim of the study was to evaluate the feasibility and preliminary efficacy of a cognitive behavioral therapy group intervention for children with JIA and their parents.MethodsNineteen children with JIA and their parents were allocated to six sessions’ group cognitive-behavioral therapy (n = 9) or a waitlist control condition (n = 10). Results were measured from self-reported scales and one-week pain diaries. Clinical data was collected by a rheumatologist.ResultsThe participation rate was low; 33 % of the invited families participated. However, the participants rated the intervention’s credibility and satisfaction with the intervention as high. The dropout rate was low and attendance rate high. Increased quality of life and improvements in adaptive pain cognitions was reported in the intervention condition compared to the waitlist condition, whereas no differences were found for pain and functional disability. The disease activity increased in the treatment condition but not in the control condition.ConclusionsThe feasibility of this study seemed high with regards to the acceptability of the families participating in the intervention. However, the feasibility in general was challenged by implementation problems with a low participation rate. A reduction in pain after the intervention was not found even though pain management was the main target in the intervention. Preliminary analysis showed that although the severity of the disease status increased, an increase in quality of life, reduction in pain catastrophizing, and an improvement in adaptive pain cognitions (the beliefs in controlling pain and self-efficacy) were seen in the intervention condition. The study highlights the importance of considering the disease status when evaluating the efficacy of a psychological intervention in children with arthritis. Conclusions on the strength of the efficacy require further research in a large, randomized controlled trial.

A systematic review of psychosocial therapies for children with rheumatic diseases

“…Between group comparisons of post-intervention pain scores revealed a statistically significant difference ( p  = 0.03), favoring the psychosocial intervention (internet-based education, relaxation and distraction) in one study [20], revealed no significant difference in one study [19] and were not reported in one study [18]. The latter study included an active control group (massage).…”

“…In these studies, between-group post-treatment disability scores did not significantly differ from each other. Pre-post significance levels were only provided in 1 of 2 studies, and this was not significant [19]. Stinson et al reported a non-significant post-score difference (adjusted for pre-treatment baseline).…”

Non-pharmacological options for managing chronic musculoskeletal pain in children with pediatric rheumatic disease: a systematic review

“…In contrast, participating in a peer-support program did not result in a significant decrease in pain (measured using the recalled pain inventory) compared to control patients [ 33 ]. Two studies measured the effect of cognitive behavioral therapy (CBT), in patients with JIA and patients with SLE and found no difference in either pain or quality of life compared to the respective control groups; both of these studies assessed pain using a VAS, and one additionally used the McGill Pain Questionnaire [ 34 , 43 ]. With respect to studies that reported functional disability (assessed using Child Health Assessment Questionnaire, the Functional Disability Inventory, or the Juvenile Arthritis Functional Assessment Report), functioning was improved with biofeedback, but not with CBT or telephone consultation with a nurse [ 36 , 40 ].…”

Mental health care for youth with rheumatologic diseases – bridging the gap

“…Fortunately, early recognition and treatment of mental health disorders improves outcomes. In small, randomized controlled trials cognitive behavioral therapy was found to lower levels of functional disability and reported depressive symptoms in adolescents with fibromyalgia [ 50 ] and improve quality of life and adaptive pain cognitions in children with JIA [ 51 ]. Recent systematic reviews of psychological interventions for pediatric chronic illness describe programs implemented within various settings (i.e.…”

“…In fact, the majority of patients surveyed in an ongoing mood screening project for youth with SLE believe that emotional health should be addressed by their rheumatologist [Rubinstein, unpublished data]. Additionally, a preliminary study of cognitive-behavioral therapy to improve pain and well-being in children with JIA indicated that this intervention within the pediatric rheumatology setting was acceptable to patients and families [ 51 ].…”