Inpatient-based intensive interdisciplinary pain treatment for highly impaired children with severe chronic pain: Randomized controlled trial of efficacy and economic effects

Abstract

Pediatric chronic pain, which can result in deleterious effects for the child, bears the risk of aggravation into adulthood. Intensive interdisciplinary pain treatment (IIPT) might be an effective treatment, given the advantage of consulting with multiple professionals on a daily basis. Evidence for the effectiveness of IIPT is scarce. We investigated the efficacy of an IIPT within a randomized controlled trial by comparing an intervention group (IG) (n=52) to a waiting-list control group (WCG) (n=52). We made assessments before treatment (PRE), immediately after treatment (POST), as well as at short-term (POST6MONTHS) and long-term (POST12MONTHS) follow-up. We determined a combined endpoint, improvement (pain intensity, disability, school absence), and investigated 3 additional outcome domains (anxiety, depression, catastrophizing). We also investigated changes in economic parameters (health care use, parental work absenteeism, subjective financial burden) and their relationship to the child's improvement. Results at POST showed that significantly more children in the IG than in the WCG were assigned to improvement (55% compared to 14%; Fisher P<.001; 95% confidence interval for incidence difference: 0.21% to 0.60%). Although immediate effects were achieved for disability, school absence, depression, and catastrophizing, pain intensity and anxiety did not change until short-term follow-up. More than 60% of the children in both groups were improved long-term. The parents reported significant reductions in all economic parameters. The results from the present study support the efficacy of the IIPT. Future research is warranted to investigate differences in treatment response and to understand the changes in economic parameters in nonimproved children.

A Review of Intravenous Lidocaine Infusion Therapy for Paediatric Acute and Chronic Pain Management

“…The impact of chronic pain on the family matches the adverse impact experienced by families caring for children at home with severe cerebral palsy or birth defects [242][243][244]. Direct and indirect costs such as loss of earnings, adaptations to housing, over-thecounter medications and care assistance managing a child with chronic pain are considerable [245][246][247][248].…”

“…The multi-disciplinary team management approach, based on pharmacology, physiotherapy and psychology (the 3P approach), is now well established to be the standard of care for children with chronic pain. This method involves looking beyond a child's pathology in isolation and engages multiple specialists to optimize the child/youth's psychological and emotional wellbeing, physical function and pharmacological therapy [247,[249][250][251]. This process requires adoption of a self-management approach and reduced reliance on medical investigation and intervention.…”

“…This process requires adoption of a self-management approach and reduced reliance on medical investigation and intervention. Children and youth with significant pain-related disability have been shown to derive significant improvements in functional ability after participating in an intensive pain rehabilitation program employing daily physical, occupational and psychological therapies [247,248,252,253].…”

Lėtinis vaikų skausmas biopsichosocialiniu požiūriu: samprata, įvertinimo ir gydymo strategija

“…Pagrindinis tikslas yra ne išgydyti lėtinį skausmą (jo kartais visiškai išgydyti nepavyksta), bet sumažinti ir valdyti skausmą bei jo sukeliamus simptomus: mažinti negalią, gerinti ligonio psichologinę būklę ir visų sričių funkcijų atkūrimą, tarp jų darbo ar mokyklos lankymą [50,51], taip pat užkirsti kelią nereikalingų ar net sukeliančių žalą medikamentų vartojimui, invazinių diagnostinių procedūrų taikymui [52] ir sumažinti individualias bei visuomenines ekonomines išlaidas [51]. Svarbu, jog gydymas būtų pradedamas kuo anksčiau, nes, remiantis tyrimų duomenimis, kuo ilgiau patiriamas lėtinis skausmas, tuo daugiau vaikas patiria nusivylimo dėl nesėkmingo gydymo, skausmingų ir mažai efektyvių procedūrų, tuo daugiau pasitaiko komorbidinių sutrikimų (emocijų, elgesio), tuo pagalba yra sudėtin-gesnė ir mažiau efektyvi [42].…”

“…Siekiama mažinti su skausmu susijusią negalią, gerinti vaiko psichologinę būseną ir socialinį įsitraukimą [50,51], užkirsti kelią nereikalingų ar net sukeliančių žalą medikamentų vartojimui, invazinių gydomųjų ir diagnostinių procedūrų taikymui [52] bei sumažinti individualias ir visuomenines ekonomines išlaidas [51].…”