Interventional Procedures for Chronic Pain in Children and Adolescents: A Review of the Current Evidence

Shah, Ravi D.; Cappiello, Dario; Suresh, Santhanam

doi:10.1111/papr.12285

Cited by 20 publications

(11 citation statements)

References 142 publications

(156 reference statements)

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“…Additional research and more specific data establishing the clinical benefits of specific interventional procedures for specific pain conditions would be beneficial and can further identify various procedures for specific clinical conditions, 172 particularly for certain populations, such as children. 173 Many interventional pain procedures are available on an outpatient basis, which is vital to ensuring cost-effective access to care. Some minor interventional procedures can be performed in the primary care setting, while other more advanced procedures require specialty training.…”

Section: Interventional Proceduresmentioning

confidence: 99%

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Darnall¹,

Krishnamurthy²,

Tsuei³

et al. 2020

JMIR Form Res

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Background Patients with chronic pain often have limited access to comprehensive care that includes behavioral pain management strategies. Virtual reality (VR) is an immersive technology and emerging digital behavioral pain therapy with analgesic efficacy for acute pain. We found no scientific literature on skills-based VR behavioral programs for chronic pain populations. Objective The primary aim of this study is to evaluate the feasibility of a self-administered VR program that included content and skills informed by evidence-based behavioral treatment for chronic pain. The secondary aim is to determine the preliminary efficacy of the VR program in terms of average pain intensity and pain-related interference with activity, stress, mood, and sleep, and its impact on pain-related cognition and self-efficacy. The tertiary aim was to conduct a randomized controlled trial (RCT) and compare the VR treatment with an audio-only treatment. This comparison isolated the immersive effects of the VR program, thereby informing potential mechanisms of effect. Methods We conducted an RCT involving a web-based convenience sample of adults (N=97) aged 18-75 years with self-reported chronic nonmalignant low back pain or fibromyalgia, with an average pain intensity >4 over the past month and chronic pain duration >6 months. Enrolled participants were randomly assigned to 1 of 2 unblinded treatments: (1) VR: a 21-day, skills-based VR program for chronic pain; and (2) audio: an audio-only version of the 21-day VR program. The analytic data set included participants who completed at least 1 of 8 surveys administered during the intervention period: VR (n=39) and audio (n=35). Results The VR and audio groups launched a total of 1067 and 1048 sessions, respectively. The majority of VR participants (n=19/25, 76%) reported no nausea or motion sickness. High satisfaction ratings were reported for VR (n=24/29, 83%) and audio (n=26/33, 72%). For VR efficacy, symptom improvement over time was found for each pain variable (all P<.001), with results strengthening after 2 weeks. Importantly, significant time×group effects were found in favor of the VR group for average pain intensity (P=.04), pain-related inference with activity (P=.005), sleep (P<.001), mood (P<.001), and stress (P=.003). For pain catastrophizing and pain self-efficacy, we found a significant declining trend for both treatment groups. Conclusions High engagement and satisfaction combined with low levels of adverse effects support the feasibility and acceptability of at-home skills-based VR for chronic pain. A significant reduction in pain outcomes over the course of the 21-day treatment both within the VR group and compared with an audio-only version suggests that VR has the potential to provide enhanced treatment and greater improvement across a range of pain outcomes. These findings provide a foundation for future research on VR behavioral interventions for chronic pain.

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Section: Interventional Proceduresmentioning

confidence: 99%

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Darnall¹,

Krishnamurthy²,

Tsuei³

et al. 2020

JMIR Form Res

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“…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%), …”

Section: Types Of Populationsmentioning

confidence: 99%

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

Birnie

Ouellette

Amaral

et al. 2020

Canadian Journal of Pain

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Background: Reviews in pediatric chronic pain often focus on only one intervention or population, making it difficult for policymakers and decision makers to quickly synthesize knowledge to inform larger-scale policy and funding priorities. Aims: The aims of this study were to (1) create an evidence and gap map of interventions for pediatric chronic pain and (2) identify gaps between existing evidence and recently identified patient-oriented research priorities. Methods: We performed a systematic review of English-language peer-reviewed systematic reviews or clinical practice guidelines of pediatric chronic pain intervention published in the past 20 years. Database searches of Medline, Embase, PsycINFO, Web of Science, CINAHL, and SCOPUS were conducted inclusive to June 3, 2019. Review quality was assessed using the AMSTAR-2. Results: Of 4168 unique abstracts, 50 systematic reviews (including 2 clinical practice guidelines) crossing diverse pediatric chronic pain populations and intervention settings were included. One third were rated high quality, with half rated low to critically low quality. The largest proportion of reviews addressed psychological and pharmacological interventions, followed by interdisciplinary, other (e.g., dietary), and physical interventions. Most common outcomes included pain, physical, emotional, and role functioning and quality of life. Treatment satisfaction and adverse events were less common, with minimal report of sleep or economic factors. Most patient-oriented research priorities had not been investigated. Conclusions: Sufficient quality evidence is available to guide evidence-informed policies in pediatric chronic pain, most notably regarding psychological and pharmacological interventions. Numerous evidence gaps in patient-oriented research priorities and treatment outcomes should guide prioritization of research funds, as well as study aims and design. RÉSUMÉ Contexte: Les études sur la douleur chronique chez les enfants se concentrent souvent sur une seule intervention ou sur une seule population, de sorte qu'il est difficile pour les responsables politiques et les décideurs de synthétiser rapidement les connaissances afin d'éclairer les priorités de financement et les politiques à plus grande échelle. Objectifs: Les objectifs de cette étude étaient (1) de créer une carte présentant les lacunes dans les données probantes en ce qui concerne les interventions pour la douleur chronique chez les enfants et (2) de répertorier les lacunes dans les données probantes existantes par rapport aux priorités de recherche axées sur le patient récemment déterminées. Méthodes: Nous avons effectué une revue systématique des revues systématiques évaluées par des pairs ou des guides de pratique clinique portant sur les interventions en matière de douleur chronique pédiatrique publiés en langue anglaise au cours des 20 dernières années. Des recherches ont été menées dans les bases de données Medline, Embase, PsycINFO, Web of Science, CINAHL et SCOPUS jusqu'au 3 juin 2019 inclusivement. La qualit...

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“…The majority of literature consists of case reports or retrospective studies focused on the description of different techniques. 10 Even in treating complex regional pain syndrome (CRPS), one of the most common clinical conditions where the interventional procedures have been used, their effectiveness has been difficult to establish. [11][12][13] The limited evidence of the efficacy of the interventional procedures could be explained by the quality of the publications, by the use of them as part of a multidisciplinary approach or by the lack of a standard definition of success.…”

Section: Introductionmentioning

confidence: 99%

“…Nonetheless, there is no consistent information regarding their effectiveness in children with chronic non‐cancer pain. The majority of literature consists of case reports or retrospective studies focused on the description of different techniques . Even in treating complex regional pain syndrome (CRPS), one of the most common clinical conditions where the interventional procedures have been used, their effectiveness has been difficult to establish …”

Section: Introductionmentioning

confidence: 99%

Interventional procedures in children and adolescents with chronic non‐cancer pain as part of a multidisciplinary pain treatment program

Vega

Rivera

Echevarría

et al. 2018

Pediatric Anesthesia

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Summary Background Interventional procedures are part of multidisciplinary pain treatment programs to treat chronic non‐cancer pain conditions in children and adolescents. However, the real benefit of these interventions remains unclear. Aims The aim of this study was to analyze the potential benefits of the interventional procedures in children and adolescents with chronic non‐cancer pain in the setting of a multidisciplinary pain treatment program. Methods We retrospectively reviewed the charts of 98 children and adolescents receiving 314 diagnostic or therapeutic interventional procedures. We applied the following definitions of efficacy Short‐term positive therapeutic effect: block that produced a minimum of 50% reduction in pain intensity for at least 4 weeks. Long‐term positive therapeutic effect: a patient with a minimum of 50% reduction in pain intensity for at least 6 months Full recovery: a patient free of pain, not taking analgesics with normal physical and role functioning 6 months after the last procedure. Results Seventy‐six of 112 diagnostic blocks (68%) were associated with a 50% reduction in pain intensity for at least 4 weeks after the procedure. One hundred and sixty‐six of 202 therapeutics blocks (82%) were associated with a short‐term benefit. Seventy‐two of 98 patients (73%) referred a 50% reduction in their pain intensity (17%) or had full recovery 6 months after the procedures (56%) and a MPTP. Psychiatric comorbidity and more advanced age were factors associated with failure to respond to interventional procedures. Conclusion The use of interventional procedures may represent a valid therapeutic option, associated with positive clinical outcomes within a multidisciplinary program.

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Interventional Procedures for Chronic Pain in Children and Adolescents: A Review of the Current Evidence

Cited by 20 publications

References 142 publications

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

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

Interventional procedures in children and adolescents with chronic non‐cancer pain as part of a multidisciplinary pain treatment program

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