Psychological therapies for the management of chronic and recurrent pain in children and adolescents.
BACKGROUND
Headache, recurrent abdominal pain, and musculoskeletal pain affect many children, who report severe pain, distressed mood, and disability. Psychological therapies are emerging as effective interventions to treat children with chronic or recurrent pain. This is a substantially updated and expanded version of the Cochrane review published in 2003.


OBJECTIVE
To assess the effectiveness of psychological therapies for reducing pain, disability, and improving mood in children and adolescents with recurrent, episodic, or persistent pain.


METHODS
Searches were undertaken of MEDLINE, PsycLIT, EMBASE and CONSORT. RCTs were sought in references of all identified studies, meta-analyses and reviews. Date of most recent search: August 2008.


METHODS
Randomised Controlled Trials (RCTs) with at least ten participants in each arm post-treatment comparing psychological therapies with placebo, waiting list or standard medical care for children or adolescents with episodic, recurrent or persistent pain, were eligible for inclusion.


METHODS
All included studies were analysed and the quality of the studies recorded. All treatments were combined into one class: psychological treatments; headache and non-headache outcomes were separately analysed on three outcomes: pain, disability, and mood.


RESULTS
Thirty-four RCT studies were recovered; 29 met the inclusion criteria. The total number of participants completing treatments was 1432. Twenty studies addressed treatments for headache (including migraine); six for abdominal pain; one for both headache and abdominal pain, one study was for fibromyalgia, and one was for pain associated with sickle cell disease. The analysis of headache treatment versus control differences immediately post-treatment for pain gave an odds ratio (OR) of 5.51 (95% CI 3.28 to 9.24; z = 6.46, P < 0.05); NNT = 2.57 (CI 2.2 to 3.13). At follow-up, the OR was 9.91 (95% CI 3.73 to 26.33); z = 9.91, P < 0.05); NNT = 1.99 (CI 1.63 to 2.72). Analysis of non-headache treatment versus control differences immediately post-treatment for pain found a large effect size of -0.94 (95% CI -1.43 to -0.44) Z = 3.71, P < 0.05. At follow-up, a large effect size was found of -1.08 (95%CI -1.84 to -0.33); Z = 2.82, P < 0.05). There were no other significant effects.


CONCLUSIONS
Psychological treatments are effective in pain control for children with headache and benefits appear to be maintained. Psychological treatments may also improve pain control for children with musculoskeletal and recurrent abdominal pain. There is little evidence available to estimate effects on disability or mood.
Eccleston
Christopher
C
Cochrane Pain, Palliative and Supportive Care Review Group, Centre for Pain Research, University of Bath, Claverton Down, Bath, UK, BA2 7AY. c.eccleston@bath.ac.uk
Palermo
Tonya M
TM
Williams
Amanda C de C
AC
Lewandowski
Amy
A
Morley
Stephen
S
D015746:Abdominal Pain / Q000628:therapy; D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D005356:Fibromyalgia / Q000628:therapy; D006261:Headache / Q000628:therapy; D006450:Hemoglobin SC Disease / Q000150:complications; D006801:Humans; D019964:Mood Disorders / Q000628:therapy; D010146:Pain / Q000523:psychology; D059408:Pain Management; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence