Cochrane reviews psychological therapies in paediatric chronic and recurrent pain

  • Fisher E & al.
  • Cochrane Database Syst Rev
  • 29 Sep 2018

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Psychological therapies reduced pain frequency immediately after treatment in children and adolescents with chronic headache and pain intensity and anxiety in those with other chronic pain conditions.
  • The effects were not maintained at follow-up, except disability for children with mixed chronic pain conditions.

Why this matters

  • 2014 review found that psychological therapies were effective in reducing pain frequency/intensity for children with headache and mixed chronic pain conditions immediately after treatment.

Study design

  • Meta-analysis of 47 studies including 2884 children and adolescents with chronic and recurrent pain, identified after a search on CENTRAL, MEDLINE, MEDLINE in Process, EMBASE and PsycINFO databases until 2018.
  • Funding: National Institutes of Health, USA; National Institute of Neurological Disorders and Stroke, USA.

Key results

  • In children with headache pain:
    • Psychological therapies showed a significant reduction in the pain frequency post-treatment (risk ratio [RR], 2.35; P<.01 but these effects were not maintained at follow-up p=".06).</li">
    • Psychological therapies showed no beneficial effect on reducing disability in young people post-treatment (standardised mean difference [SMD], -0.26; P=.08), a beneficial effect in studies at follow-up (SMD, -0.37; P<.01>
    • No beneficial effect of psychological interventions was seen in depression or anxiety symptoms.
  • In children with mixed pain conditions:
    • Psychological therapies showed a significant reduction in the pain intensity (SMD, -0.43; P<.01 but these effects were not maintained at follow-up p=".45).</li">
    • Psychological therapies significantly reduced disability post-treatment (SMD, -0.34; P<.01 and at follow-up p=".01).</li">
    • No benefit was seen in depression symptoms.
    • Anxiety significantly decreased with psychological therapies post-treatment (SMD, -0.16; P=.02), but not at follow-up (SMD, 0.01; P=.92)                         `.

Limitations

  • Low-quality evidence.

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