Insufficient Evidence to Determine Efficacy of Remotely Delivered Psychological Therapies in Children With Chronic Pain

child with headache
child with headache
Remote delivery of psychological therapies to children and adolescents may have limited efficacy on headache, but no effect on other chronic pain conditions.

Remote delivery of psychological therapies to children and adolescents may have limited efficacy on headache, but no effect on other chronic pain conditions, according to an updated review published in the Cochrane Database of Systematic Reviews.

For this review, authors searched for randomized controlled trials on psychological therapies delivered remotely (eg, via the Internet, computer-based programs, or smartphone apps) in MEDLINE, Embase, CENTRAL, and PsycINFO, as well as from reference sections, citations, and online trial registries. In all trials selected, patients were treated with a conventional, active treatment or added to a waiting list (control condition). All participants were children or adolescents (ie, ≤18 years; average age at treatment, 13.17 years) who had chronic pain, which included neuropathic pain, musculoskeletal pain, headache, and recurrent abdominal pain. Each study included at least 10 participants in each treatment group. Outcomes were examined immediately after and between 3 and 12 months after treatment. Group Reading Assessment and Diagnostic Evaluation (GRADE) was used to assess quality of evidence and risk for bias. Chronic pain conditions were categorized as headache or other.

Participants with headache reported reduced headache severity after remote interventions (risk ratio, 2.02; 95% CI, 1.35-3.01; P <.001) but not at follow-up (risk ratio, 1.76; 95% CI, 0.88-3.5]; P =.11). Participants with other chronic pain conditions, depression, anxiety, or issues with physical functioning did not benefit from remote intervention after treatment or at follow-up. Studies examining patients with mixed chronic pain conditions were too limited to draw conclusions (P =.10). Despite the inability to perform a meta-analysis on measures of treatment satisfaction due to heterogeneous measures, satisfaction with remote interventions was deemed generally positive.

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“We found one beneficial effect of therapies to reduce headache severity post‐treatment. For the remaining outcomes there was either no beneficial effect at post‐treatment or follow‐up, or lack of evidence to determine an effect. Overall, participant satisfaction with treatment was positive. We judged the quality of the evidence to be very low, meaning we are very uncertain about the estimate. Further studies are needed to increase our confidence in this potentially promising field,” noted the review authors.

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Fisher E, Law E, Dudeney J, Eccleston C, Palermo TM. Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents [published online April 2, 2019]. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD011118.pub3