The Influence of Anxiety Reduction on Clinical Response to Pediatric Chronic Pain Rehabilitation

Abstract

The findings of this study support existing research on anxiety and CP, specifically the relationship between anxiety and pain-related disability. This study also supports the benefit of intensive interdisciplinary rehabilitation for both reducing anxiety and increasing functional outcomes, suggesting a possible link in children's response to intervention. Study limitations and future directions for related research are discussed.

Specialized Rehabilitation Programs for Children and Adolescents with Severe Disabling Chronic Pain: Indications, Treatment and Outcomes

“…The systematic review showed large short-term reductions in pain intensity [36]. More recent studies confirm these short-term reductions in pain intensity [28,34,43]. Several studies also provide evidence for long-term reductions (12 to 24–42 months after treatment) of pain intensity [16,28,34,47,52,53].…”

“…Regarding pain management, various strategies are taught, such as relaxation techniques [32,33,34,41,49,50], attention defocusing techniques [33,41,49], imagery [32,41,43,49], active daily structures [28,32,33,34,35,41,48,49,50], stress management [32,33,45,49] and problem-solving activities [32,43,49]. Physical therapy [28,32,33,34,35,41,48,49,50], biofeedback [32,33,45,49] and therapy for psychological comorbidities [33,41] such as depression or anxiety are also included in rehabilitation.…”

“…Medical interventions include providing medical examinations [32,34,41,49] and tapering off or changing medications [28,33,41,49,50] if necessary and appropriate. Further treatment components incorporated by some of the programs address occupational therapy [28,32,33,34,35,41,49], recreational therapy [16,33,49], acupuncture/acupressure [34,49,50], diet [33,34], sleep hygiene [33,44,49], music therapy [28,41,43] and art therapy [16,28,41]. In some programs, the patients also attend some type of hospital school program [32,34,47].…”

“…In this review, we concentrated more on providing a comprehensive description of existing specialized rehabilitation programs and therefore further included referenced studies that were excluded from the systematic review, for example due to overlapping samples [25,37,38,39,40,41,42]. Additionally, we identified five more recent studies on this topic through a nonsystematic search in Medical Literature Analysis and Retrieval System Online (MEDLINE) and by conducting a manual search [16,28,34,43,44,45]. Overall, information about nine different rehabilitation programs from the USA, the UK, Australia and Germany was available.…”

Anxiety Adversely Impacts Response to Cognitive Behavioral Therapy in Children with Chronic Pain

“…The findings from this study also suggest further investigation focused on designing and testing tailored behavioral approaches to target both anxiety and pain symptoms in youth with chronic pain. At present, there is some evidence that improvements in pain can be made when anxiety is addressed at least in an intensive inpatient rehabilitation program that includes CBT (40) Thus, modifications of existing treatment protocols and future examination of the role of anxiety in relationship to pain-focused CBT treatment outcomes in a traditional outpatient setting is warranted.…”