Psychological therapies may be effective in improving pain and disability in children and adolescents with chronic pain including headache and mixed chronic pain conditions, although some of these effects did not persist at follow-up, according to an updated Cochrane Review.
For this review, an update from the initial 2003 review and the subsequent versions updated in 2009, 2012, and 2014, investigators searched medical literature databases (CENTRAL, MEDLINE, MEDLINE in Process, Embase, and PsycINFO) for randomized controlled trials, meta-analyses, reviews, and trial registry databases published since the most recent update on the effects of psychological therapies (ie, behavioral and cognitive therapies) vs treatment-as-usual, active treatment, or waiting list on the pain and disability in children and adolescents with recurrent or chronic pain. The effects of such therapies on anxiety and depression symptoms were also examined. A total of 47 studies (n=2884) were included.
In pediatric patients with headache pain, psychological therapies were associated with a reduction in the frequency of pain after treatment (risk ratio, 2.35; 95% CI, 1.67-3.30; P <.01), but not at follow-up. Psychological therapies were not found to be associated with a reduction in pain-related disability after treatment (standardized men difference [SMD], -0.26; 95% CI, -0.56 to 0.03). In patients with mixed pain conditions, psychological therapies were associated with a posttreatment reduction in pain intensity (SMD, -0.43; 95% CI, -0.67 to -0.19; P <.01), which was not maintained at follow-up, with a reduction in disability posttreatment (SMD, -0.34; 95% CI, -0.54 to -0.15) and at follow-up (SMD, -0.27; 95% CI, -0.49 to -0.06), and with an improvement in anxiety symptoms after treatment (SMD, -0.16; 95% CI, -0.29 to -0.03), an effect which did not persist at follow-up.
The updated review was based primarily on patients in controlled conditions and may not capture real-world clinical care.
“Taken together, these findings suggested that behavioural and cognitive-behavioural treatment should be considered as part of standard care for children and adolescents with chronic pain conditions to improve pain and reduce disability,” concluded the review authors.
Fisher E, Law E, Dudeney J, et al. Psychological therapies for the management of chronic and recurrent pain in children and adolescents [published online September 29, 2018]. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD003968.pub5