Effectiveness of a Psychosocial Aftercare Program for Youth Aged 8 to 17 Years With Severe Chronic Pain

Abstract

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.

A randomized controlled trial on long‐term effectiveness of a psychosocial aftercare program following paediatric chronic pain treatment: Who benefits the most?

“…At PRE‐IIPT, no significant differences were found between both study groups regarding demographic characteristics (i.e., age, sex), pain‐related parameters (i.e., pain intensity, pain‐related disability), or psychological characteristics (i.e., anxiety, depression). For details on the demographic and pain‐related characteristics of the total study sample at PRE‐IIPT, please see Dogan et al (2021) Table 1 provides an overview of the demographic and clinical characteristics of the study sample providing data at 12‐months. No systematic attrition was detected as patients who completed the assessment at 12‐months ( n = 288) did not differ in PRE‐IIPT characteristics from patients who dropped out ( n = 131) (all p > 0.090).…”

“…Note that for this study, the sample of patients providing data up to 6 months overlaps with-but is not identical to-the study sample analysed in Dogan et al (2021). This is due to the fact that, for the current study, only patients providing data at 12-months were included as study sample.…”

“…The only exclusion criterion was withdrawal of study participation. For details on the characteristics of the total RCT sample, see Dogan et al (2021). The sample size was determined a priori based on expected differences between groups with regard to the originally planned primary outcome (see 2.7).…”

“…Home visits were conducted for 27.0% of patients. For details on the intervention, please see Dogan et al (2021)(https://bit. ly/3O9ja3H).…”

“…Intensive interdisciplinary pain treatment (IIPT) is a well‐established treatment for children and adolescents with severe chronic pain conditions (Claus et al, 2022; Hechler et al, 2015). However, a significant number of patients do not have a positive treatment response (Dogan et al, 2021; Eccleston et al, 2003; Zernikow et al, 2018). A recent study demonstrated that the short‐term effectiveness of IIPT can be further improved by a personalized psychosocial aftercare program (PAC) initiated at discharge from IIPT and provided for up to 6 months by a team of trained social workers, psychologists and physicians (Dogan et al, 2021).…”