Systematic Review on Intensive Interdisciplinary Pain Treatment of Children With Chronic Pain

Hechler, Tanja; Kanstrup, Marie; Holley, Amy Lewandowski; Simons, Laura E.; Wicksell, Rikard K.; Hirschfeld, Gerrit; Zernikow, Boris

doi:10.1542/peds.2014-3319

Cited by 192 publications

(220 citation statements)

References 45 publications

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“…Au vu de l'impression globale du clinicien, il existait un handicap important pour la majorité des patients hospitalisés au CRF, ce qui est retrouvé dans les études réalisées à l'étranger [19,22,23]. Les données démographiques de notre étude semblent en accord avec la littérature étrangère portant sur la douleur chronique de l'enfant, avec une majorité de filles, et un âge moyen à 12,9 ans [2,3,16,17,19,21,22,24,26,27]. Les pathologies rencontrées chez les enfants hospitalisés dans les programmes étrangers sont classifiées de manière variée.…”

Section: Discussionunclassified

“…Le retentissement sur le sommeil n'a pas été significativement amélioré et nous n'avons pas observé de différence significative entre les résultats en hospitalisation de jour et de semaine, contrairement à l'hypothèse que nous avions émise. En effet, les études comparant les 2 modalités de prise en charge ont montré une plus grande efficacité des programmes intensifs réalisés en hospitalisation de semaine ou complète [16,19,22]. L'absence de différence dans notre étude peut être expliquée par un manque de puissance, l'effectif du groupe hospitalisation de jour étant faible (un tiers de l'effectif total).…”

Section: Discussionunclassified

“…Ce programme multidisciplinaire de prise en charge de la douleur suivait les mêmes principes qu'à l'étranger, reposant sur le modèle bio-psychosocial. Il semble que les programmes en hospitalisation de jour aient des modalités variables [16,17,22,26], tandis que ceux en hospitalisation complète semblent plus standardisés. Ce sont en revanche des programmes généralement plus intensifs qu'au CRF, avec une durée quotidienne de soins plus importante et une durée totale généralement prédéterminée de 3 à 4 semaines [19][20][21][22][23].…”

Section: Discussionunclassified

“…Le but est, selon les auteurs, de permettre à l'enfant de retrouver son indépendance dans le fonctionnement de la vie quotidienne et de se concentrer sur le gain de fonction plutôt que sur la disparition totale de la douleur. Une prise en charge psychologique s'intègre à la réadaptation physique afin d'améliorer les techniques de coping de l'enfant et de la famille, et de modifier les interactions intervenant dans le maintien de la douleur [16]. Les publications sur ces programmes de prise en charge multidisciplinaire étaient rares il y a une quinzaine d'années [7].…”

Section: Introductionunclassified

“…Ces programmes ont des modalités variées en ce qui concerne le mode d'hospitalisation, sa durée et le mode de prise en charge psychologique. Leurs résultats démontrent une efficacité sur la réduction de l'incapacité fonctionnelle, de l'absentéisme scolaire et de la douleur [16][17][18]20,21,25], le bénéfice étant plus important en hospitalisation complète qu'en hospitalisation de jour [20,22]. À notre connaissance, aucun article sur ce sujet n'a été publié en France.…”

Section: Introductionunclassified

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Prise en charge multidisciplinaire des enfants souffrant de douleurs chroniques invalidantes dans un centre de rééducation fonctionnelle pédiatrique français : analyse rétrospective d’une série et perspectives

Roessler

Debeaurepaire²,

Deprez

et al. 2016

Archives de Pédiatrie

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Section: Discussionunclassified

Section: Introductionunclassified

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Prise en charge multidisciplinaire des enfants souffrant de douleurs chroniques invalidantes dans un centre de rééducation fonctionnelle pédiatrique français : analyse rétrospective d’une série et perspectives

Roessler

Debeaurepaire²,

Deprez

et al. 2016

Archives de Pédiatrie

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

et al. 2021

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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.

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Psychological therapies for the management of chronic and recurrent pain in children and adolescents

Fisher¹,

Law²,

Dudeney³

et al. 2018

Cochrane Database of Systematic Reviews

174

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Background This is an update of the original Cochrane review first published in Issue 1, 2003, and previously updated in 2009, 2012 and 2014. Chronic pain, defined as pain that recurs or persists for more than three months, is common in childhood. Chronic pain can affect nearly every aspect of daily life and is associated with disability, anxiety, and depressive symptoms. Objectives The aim of this review was to update the published evidence on the efficacy of psychological treatments for chronic and recurrent pain in children and adolescents. The primary objective of this updated review was to determine any effect of psychological therapy on the clinical outcomes of pain intensity and disability for chronic and recurrent pain in children and adolescents compared with active treatment, waiting-list, or treatment-as-usual care. The secondary objective was to examine the impact of psychological therapies on children’s depressive symptoms and anxiety symptoms, and determine adverse events. Search methods Searches were undertaken of CENTRAL, MEDLINE, MEDLINE in Process, Embase, and PsycINFO databases. We searched for further RCTs in the references of all identified studies, meta-analyses, and reviews, and trial registry databases. The most recent search was conducted in May 2018. Selection criteria RCTs with at least 10 participants in each arm post-treatment comparing psychological therapies with active treatment, treatment-as-usual, or waiting-list control for children or adolescents with recurrent or chronic pain were eligible for inclusion. We excluded trials conducted remotely via the Internet. Data collection and analysis We analysed included studies and we assessed quality of outcomes. We combined all treatments into one class named ‘psychological treatments’. We separated the trials by the number of participants that were included in each arm; trials with > 20 participants per arm versus trials with < 20 participants per arm. We split pain conditions into headache and mixed chronic pain conditions. We assessed the impact of both conditions on four outcomes: pain, disability, depression, and anxiety. We extracted data at two time points; post-treatment (immediately or the earliest data available following end of treatment) and at follow-up (between three and 12 months post-treatment). Main results We identified 10 new studies (an additional 869 participants) in the updated search. The review thus included a total of 47 studies, with 2884 children and adolescents completing treatment (mean age 12.65 years, SD 2.21 years). Twenty-three studies addressed treatments for headache (including migraine); 10 for abdominal pain; two studies treated participants with either a primary diagnosis of abdominal pain or irritable bowel syndrome, two studies treated adolescents with fibromyalgia, two studies included adolescents with temporomandibular disorders, three were for the treatment of pain associated with sickle cell disease, and two studies treated adolescents with inflammatory bowel disease. Finally, three...

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Systematic Review on Intensive Interdisciplinary Pain Treatment of Children With Chronic Pain

Cited by 192 publications

References 45 publications

Prise en charge multidisciplinaire des enfants souffrant de douleurs chroniques invalidantes dans un centre de rééducation fonctionnelle pédiatrique français : analyse rétrospective d’une série et perspectives

Prise en charge multidisciplinaire des enfants souffrant de douleurs chroniques invalidantes dans un centre de rééducation fonctionnelle pédiatrique français : analyse rétrospective d’une série et perspectives

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

Psychological therapies for the management of chronic and recurrent pain in children and adolescents

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