Effectiveness of interdisciplinary interventions in paediatric chronic pain management: a systematic review and subset meta-analysis

Abstract

Background: Paediatric chronic pain is a significant problem that can have devastating impacts on quality of life. Multimodal interdisciplinary interventions are the mainstay of paediatric treatment. The aim of this article is to provide a comprehensive review of the effectiveness of interdisciplinary interventions in the management of paediatric chronic pain. Methods: Studies were identified via a search of nine databases. The search strategy included concept blocks pertaining to type of pain, study population, and type of intervention. Eligible studies reported the effects of an intervention coordinated by two or more healthcare professionals of different disciplines, and recruited a sample aged 22 yr or below with chronic pain. Twenty-eight studies were included, and 21 provided data for inclusion in between-and withingroups meta-analyses. Results: Patients randomised to interdisciplinary interventions reported significantly lower pain intensity 0e1 month post-intervention compared with patients randomised to the control groups. Within-groups analysis of patients receiving interdisciplinary interventions showed significant improvements pre-to post-intervention in pain intensity, functional disability, anxiety, depression, catastrophising, school attendance, school functioning, and pain acceptance. Few differences were found between interventions delivered in inpatient vs outpatient settings. Significant heterogeneity due mainly to differing outcome variables and intervention content was found in most analyses. Conclusions: Overall, interdisciplinary interventions show promise in providing a range of clinical benefits for children with chronic pain. Methodologically robust randomised controlled trials using standardised outcome measures are needed, however, to guide clinical care.

Lifestyle and Chronic Pain across the Lifespan: An Inconvenient Truth?

“…Ultimately, this should decrease the psychological and socioeconomic burden of chronic pain. This view is supported by evidence indicating that multimodal interventions are more effective than single modal interventions in, among others, children having chronic pain, adults with chronic nonspecific neck pain, chronic tension‐type headache, low back pain, fibromyalgia, pain following cancer, and osteoarthritis …”

Mapping the evidence and gaps of interventions for pediatric chronic pain to inform policy, research, and practice: A systematic review and quality assessment of systematic reviews

“…Most reviews (n = 19; 40.4%) included variations of mixed chronic pain populations (e.g., abdominal pain, headaches or migraines, widespread pain/fibromyalgia, complex regional pain syndrome, neuropathic pain, sickle cell disease, cancer pain, back pain, and/or pelvic pain). 8,37,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] Reviews focused on single populations most frequently examined abdominal pain (n = 10; 21.3%), 10,35,39,40,57,[59][60][61]77,78 headaches or migraines (n = 5; 10.6%), [62][63][64][65][66] rheumatological conditions (e.g., juvenile idiopathic arthritis, lupus; n = 4; 8.5%), [67][68][69][70] cancer-related pain (n = 3; 6.4%), [71][72][73] or sickle cell disease (n = 2; 4.3%). 74,75 Single reviews focused on patellar tendon pain/Osgood-Schlatter's (n = 1; 2.1%), 76 cerebral palsy (n = 1; 2.1%), …”

“…41,75 Five reviews also included studies with adults (>18 years old). 48,50,70,74,75 Types of Settings Reviews included studies conducted in a variety of settings, including primarily tertiary care or hospital settings (inpatient, day treatment, outpatient clinics, and emergency departments), followed by primary care or community-based clinics and, rarely, schools. Three reviews (6.4%) focused exclusively on "e-health" or remotely delivered interventions.…”

Pharmacotherapy for treating chronic pain in children: A need for pragmatic idealism

“…However, a respectful body of evidence in support of this approach in children and adolescents is also lacking. A recently published systematic review and subset meta‐analysis that examined the effectiveness of inpatient and outpatient interdisciplinary interventions in the setting of pediatric chronic pain reported short‐term improvements in pain intensity and functional disability . However, heterogeneity with regard to the type of interventions administered, reported outcome variables, duration of treatment, and chronic pain conditions, along with small sample sizes meant that conclusions and recommendations regarding key components of interdisciplinary approaches could not be made.…”