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Does intensive interdisciplinary pain treatment improve pediatric headache-related disability?
Julie Shulman1,2,3, Caitlin Conroy3,4,5, Anna Cybulski1,3
1Department of Physical and Occupational Therapy, Boston Children's Hospital, Boston, MA, USA.
Insights
Intensive interdisciplinary pain treatment significantly reduces disability in children with chronic headaches. This approach improves pain, physical capacity, and school participation, highlighting its effectiveness for pediatric headache management.
Area of Science:
- Pediatric Pain Management
- Rehabilitation Medicine
- Disability Assessment
Background:
- Chronic headaches significantly impact children's functioning and quality of life.
- The International Classification of Functioning, Disability and Health (ICF) model provides a framework for understanding disability in pediatric populations.
- Effective treatment strategies are needed to address the multifaceted nature of disability associated with chronic headaches in children.
Purpose of the Study:
- To evaluate the efficacy of an intensive interdisciplinary pain treatment program for improving disability in children experiencing chronic headaches.
- To utilize the ICF model as a conceptual framework for assessing disability in this pediatric cohort.
- To identify specific outcome measures that effectively capture improvements in functioning.
Main Methods:
- A cohort of 50 children (ages 10-19) with chronic headaches participated in an intensive interdisciplinary pain treatment program (8 hours/day, 5 days/week, for 2-7 weeks).
- Disability assessments, including the Headache Impact Test-6 and the modified Bruce protocol, were administered at admission, discharge, and 6-8 week follow-up.
- Retrospective analysis employed Wilcoxon signed rank tests and Friedman's analyses of variance to compare longitudinal changes in disability scores.
Main Results:
- Significant reductions in headache-related disability were observed, with scores on the Headache Impact Test-6 decreasing from severe to some impact post-treatment (p < 0.001).
- Physical capacity, measured by the modified Bruce protocol, showed significant improvement, with median time increasing from 13.1 to 14.4 minutes (p < 0.001), gains maintained at follow-up.
- Improvements in pain and disability were positively correlated with enhanced school participation.
Conclusions:
- Intensive interdisciplinary pain treatment is an effective intervention for reducing disability and improving pain in children with chronic headaches.
- The ICF model is valuable for assessing disability, revealing significant functional limitations even when physical capacity measures appear normal.
- The Headache Impact Test-6 and modified Bruce protocol are recommended tools for understanding and monitoring disability in pediatric chronic headache patients.
Purpose:
To examine the effectiveness of intensive interdisciplinary pain treatment for improving disability in children with chronic headache using the International Classification of Functioning, Disability and Health model as a conceptual framework for disability assessment.
Materials And Methods:
Children with chronic headache (n = 50; ages 10-19 years; 62% female) attended an intensive interdisciplinary pain treatment program 8 h/day, 5 times/week for 2-7 weeks. Disability measures were administered at admission, discharge, and 6-8 week follow-up. Disability outcomes were analyzed retrospectively. Wilcoxon signed rank tests and Friedman's analyses of variance were used to compare scores across two and three longitudinal time points, respectively.
Results:
After rehabilitation, disability reduced on the Headache Impact Test-6 from severe impact at admission to some impact at follow-up (p < 0.001). Median time on the modified Bruce protocol increased from 13.1 min (interquartile range = 12.6-14.1) to 14.4 min (interquartile range = 12.9-16.3), p < 0.001, with gains maintained at follow-up. Improvements in pain and disability were associated with improvements in school participation.
Conclusions:
Findings of this study support the effectiveness of intensive interdisciplinary pain treatment for improving disability in children with chronic headache.Implication for rehabilitationIntensive interdisciplinary pain treatment is effective for improving pain and disability in children with chronic headaches.Application of the ICF model to disability assessment suggests that children with chronic headaches may experience significant disability, even when standardized assessments of physical capacity are normal.The modified Bruce protocol, Pediatric Evaluation of Disability Inventory - Computerized Adaptive Tests, and Headache Impact Test-6 appear particularly valuable in understanding the nature of disability in children with chronic headaches.
