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Author Spotlight: Methodologies and Advancements of Chronic Pain Management Research
Published on: January 5, 2024
Systematic Review on Intensive Interdisciplinary Pain Treatment of Children With Chronic Pain
Tanja Hechler1, Marie Kanstrup2, Amy Lewandowski Holley3
1German Paediatric Pain Centre, Children's Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health-School of Medicine, Witten/Herdecke University, Witten, Germany; t.hechler@deutsches-kinderschmerzzentrum.de.
Insights
Intensive interdisciplinary pain treatment (IIPT) shows preliminary positive effects for pediatric chronic pain, improving disability and pain intensity. However, more rigorous research is needed due to study limitations.
Area of Science:
- Pediatric Pain Management
- Clinical Psychology
- Rehabilitation Medicine
Background:
- Pediatric debilitating chronic pain is a significant health issue.
- Intensive interdisciplinary pain treatment (IIPT) is a complex intervention for children.
- Limited research exists on the effectiveness of IIPT for pediatric populations.
Purpose of the Study:
- To systematically review studies evaluating the effects of IIPT in children.
- To synthesize evidence on IIPT's impact on pain intensity, disability, school functioning, anxiety, and depressive symptoms.
Main Methods:
- Searched multiple databases (Cochrane, Medline, PsycInfo, PubMed, PubPsych, Web of Science).
- Included studies with coordinated care by ≥3 professionals, inpatient/day hospital settings, patients <22 years, debilitating chronic pain, English publication, and ≥10 participants.
- Extracted data on pain condition, IIPT characteristics, and 5 outcome domains at baseline, posttreatment, and follow-up.
Main Results:
- A meta-analysis of 1 randomized controlled trial and 9 nonrandomized studies revealed positive treatment effects.
- Significant improvements were observed in disability, pain intensity, and depressive symptoms at posttreatment and short-term follow-up.
- Extreme heterogeneity was noted, precluding meta-analyses for school functioning and anxiety.
Conclusions:
- Preliminary evidence suggests positive treatment effects of IIPT for pediatric chronic pain.
- Methodological weaknesses and heterogeneity in existing studies necessitate further research.
- Effects in nonrandomized studies may not be solely attributable to IIPT.
Background And Objective:
Pediatric debilitating chronic pain is a severe health problem, often requiring complex interventions such as intensive interdisciplinary pain treatment (IIPT). Research is lacking regarding the effectiveness of IIPT for children. The objective was to systematically review studies evaluating the effects of IIPT.
Methods:
Cochrane, Medline/Ovid, PsycInfo/OVID, PubMed, PubPsych, and Web of Science were searched. Studies were included if (1) treatment was coordinated by ≥3 health professionals, (2) treatment occurred within an inpatient/day hospital setting, (3) patients were <22 years, (4) patients experienced debilitating chronic pain, (5) the study was published in English, and (6) the study had ≥10 participants at posttreatment. The child's pain condition, characteristics of the IIPT, and 5 outcome domains (pain intensity, disability, school functioning, anxiety, depressive symptoms) were extracted at baseline, posttreatment, and follow-up.
Results:
One randomized controlled trial and 9 nonrandomized treatment studies were identified and a meta-analysis was conducted separately on pain intensity, disability, and depressive symptoms revealing positive treatment effects. At posttreatment, there were large improvements for disability, and small to moderate improvements for pain intensity and depressive symptoms. The positive effects were maintained at short-term follow-up. Findings demonstrated extreme heterogeneity.
Conclusions:
Effects in nonrandomized treatment studies cannot be attributed to IIPT alone. Because of substantial heterogeneity in measures for school functioning and anxiety, meta-analyses could not be computed. There is preliminary evidence for positive treatment effects of IIPT, but the small number of studies and their methodological weaknesses suggest a need for more research on IIPTs for children.
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