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. 2015 Jul;136(1):115-27.
doi: 10.1542/peds.2014-3319. Epub 2015 Jun 22.

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

Tanja Hechler  1 , Marie Kanstrup  2 , Amy Lewandowski Holley  3 , Laura E Simons  4 , Rikard Wicksell  2 , Gerrit Hirschfeld  5 , Boris Zernikow  6
Affiliations

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

Tanja Hechler et al. Pediatrics. 2015 Jul.

Abstract

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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Conflict of interest statement

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

Figures

FIGURE 1. PRISMA flow diagram.
FIGURE 1
PRISMA flow diagram.
FIGURE 2. Effect sizes (d) for changes in pain intensity from baseline to immediate posttreatment and to 3-month follow-up.
FIGURE 2
Effect sizes (d) for changes in pain intensity from baseline to immediate posttreatment and to 3-month follow-up.
FIGURE 3. Effect sizes (d) for changes in disability from baseline to posttreatment and to 3-month follow-up.
FIGURE 3
Effect sizes (d) for changes in disability from baseline to posttreatment and to 3-month follow-up.
FIGURE 4. Effect sizes (d) for changes in symptoms of depression from baseline to posttreatment and 3-month follow-up.
FIGURE 4
Effect sizes (d) for changes in symptoms of depression from baseline to posttreatment and 3-month follow-up.
See this image and copyright information in PMC

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