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. 2024 Dec 24;10(1):e1226.
doi: 10.1097/PR9.0000000000001226. eCollection 2025 Feb.

The effects of psychosocial aftercare following pediatric chronic pain treatment withstand the coronavirus disease 2019 pandemic: long-term outcomes of a randomized controlled trial

Lisa-Marie Rau  1   2 , Meltem Dogan  1   2 , Gerrit Hirschfeld  3 , Markus Blankenburg  2   4 , Michael C Frühwald  5 , Rosemarie Ahnert  5 , Sarah Braun  4 , Ursula Marschall  6 , Boris Zernikow  1   2   7 , Julia Wager  1   2   7
Affiliations

The effects of psychosocial aftercare following pediatric chronic pain treatment withstand the coronavirus disease 2019 pandemic: long-term outcomes of a randomized controlled trial

Lisa-Marie Rau et al. Pain Rep. .

Abstract

Introduction: Intensive interdisciplinary pain treatment (IIPT) is the best therapy available for children and adolescents affected by severe chronic pain. Psychosocial aftercare (PAC) offered for 6 months after IIPT can improve treatment outcomes for up to 12 months.

Objectives: The current study is the first to explore whether PAC is superior to treatment as usual at a long-term follow-up of 18 to 33 months after discharge-including when facing the coronavirus disease 2019 (COVID-19) pandemic.

Methods: A multicenter randomized controlled trial investigated the impact of PAC with follow-up assessments in 2021 during the COVID-19 pandemic (N = 209). Multilevel models and regression analyses explored long-term treatment effects on pain characteristics and psychological outcomes, associations of pandemic-related burden with these outcomes, and whether pandemic-related burden moderates those effects.

Results: Patients who received PAC significantly improved treatment outcomes concerning pain characteristics and psychological well-being 18 to 33 months after IIPT discharge. A COVID-19 infection among family members or peers was associated with a lower probability of having chronic pain at long-term follow-up, whereas having missed or rescheduled health care appointments was associated with a higher probability. Positive evaluations of family time during the pandemic were associated with better psychological well-being. Regardless of pandemic-related burdens, PAC had similarly better outcomes than treatment as usual. Only for anxiety, greater burdens mitigated the advantages of PAC.

Conclusion: Despite adverse circumstances, PAC retained its superiority long-term. Integrating PAC into routine health care to support families after IIPT should be prioritized to yield enduring treatment effects, acting as a buffer against the impacts of unpredictable adverse events.

Keywords: COVID-19; Chronic pain; Longitudinal study; Pediatrics; Psychosocial aftercare; Randomized controlled trial.

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Conflict of interest statement

The authors have no conflicts of interest to declare. This study was funded by the Innovation Fund of the Federal Joint Committee (grant number: 01NVF17040). The funding source had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The authors report no conflicts of interest. Data and program codes are available upon request.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1.
Figure 1.
Flowchart of participation. LONG-TERM follow-up took place 18 to 33 months after discharge from IIPT. IIPT, intensive interdisciplinary pain treatment; PAC, psychosocial aftercare; TAU, treatment as usual.
Figure 2.
Figure 2.
Mean trajectories of psychological parameters stratified by treatment group (psychosocial aftercare [PAC] vs treatment as usual [TAU]). Assessments took place before IIPT (PRE), at IIPT discharge (POST), and 18 to 33 months after discharge (LONG-TERM). Error bars represent 95% confidence intervals. IIPT, intensive interdisciplinary pain treatment.
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