Factors Contributing to Persistent Pain After Rehabilitation in Pediatric Patients
The rehabilitation program evaluated in this study included intensive daily physical, occupational, and psychological therapies.
Anxiety and reduced readiness to change are key factors related to nonresponsiveness to intensive pain rehabilitation in pediatric patients, according to a study published in the Journal of Pain.
In this study, investigators followed 280 children and adolescents who underwent and completed an interdisciplinary pain rehabilitation day program between 2009 and 2014. Participants entering this intensive program had not benefited from conventional outpatient physical and cognitive behavioral therapies.
The rehabilitation program evaluated in this study included intensive daily physical, occupational, and psychological therapies for 8 hours a day, 5 days a week, for 3 to 4 weeks.
Therapies were aimed at helping pediatric patients return to physical activities, improve independence, and strengthen physical fitness. Self-reported functional disability ratings were collected at admission, discharge, and at 1-, 4-, and 12-month follow-up points.
Of the 280 patients, 253 had ≥3 pain data points included in the trajectory analysis, 194 of whom also had ≥3 functional disability data points available. Of these 194 patients, 88% were responders. The investigators did not find any baseline variables as predictors of the disability trajectory group following a binomial logistic regression analysis.
Early treatment responders (35%), late treatment responders (38%), and treatment nonresponders (27%) emerged. Multinominal regression analyses indicated that higher pain scores, fewer social difficulties, greater anxiety levels, older age, and lower readiness to change all differentiated treatment responders from nonresponders. Despite these findings, the investigators found no significant predictors that distinguished late responders from early responders.
As much as 73% of pediatric patients report mild or no pain for at least 1 year following treatment. Overall, the known modifiable risk factors for pain were found to be higher anxiety symptoms and decreased willingness to change.
Since this study was primarily focused on white female patients with idiopathic small fiber sensory neuropathy conditions or neuropathic pain the findings cannot be generalized to other patient populations.
In order to increase readiness to change across this patient group, the investigators suggest incorporating a motivational enhancement component prior to treatment in order to “help patients get more out of intensive pain rehabilitation.”
Simons LE, Sieberg CB, Conroy C, et al. Children with chronic pain: Response trajectories following intensive pain rehabilitation treatment. J Pain [published online November 1, 2017]. doi:10.1016/j.jpain.2017.10.005