Inpatient-based intensive interdisciplinary pain treatment for highly impaired children with severe chronic pain: randomized controlled trial of efficacy and economic effects.
Pediatric chronic pain, which can result in deleterious effects for the child, bears the risk of aggravation into adulthood. Intensive interdisciplinary pain treatment (IIPT) might be an effective treatment, given the advantage of consulting with multiple professionals on a daily basis. Evidence for the effectiveness of IIPT is scarce. We investigated the efficacy of an IIPT within a randomized controlled trial by comparing an intervention group (IG) (n=52) to a waiting-list control group (WCG) (n=52). We made assessments before treatment (PRE), immediately after treatment (POST), as well as at short-term (POST6MONTHS) and long-term (POST12MONTHS) follow-up. We determined a combined endpoint, improvement (pain intensity, disability, school absence), and investigated 3 additional outcome domains (anxiety, depression, catastrophizing). We also investigated changes in economic parameters (health care use, parental work absenteeism, subjective financial burden) and their relationship to the child's improvement. Results at POST showed that significantly more children in the IG than in the WCG were assigned to improvement (55% compared to 14%; Fisher P<.001; 95% confidence interval for incidence difference: 0.21% to 0.60%). Although immediate effects were achieved for disability, school absence, depression, and catastrophizing, pain intensity and anxiety did not change until short-term follow-up. More than 60% of the children in both groups were improved long-term. The parents reported significant reductions in all economic parameters. The results from the present study support the efficacy of the IIPT. Future research is warranted to investigate differences in treatment response and to understand the changes in economic parameters in nonimproved children.
German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany Institute of Medical Biometrics and Epidemiology, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany.
Tanja
T
Hechler
Ann-Kristin
AK
Ruhe
Pia
P
Schmidt
Jessica
J
Hirsch
Julia
J
Wager
Michael
M
Dobe
Frank
F
Krummenauer
Boris
B
Zernikow
D000293:Adolescent; D001007:Anxiety / Q000523:psychology; D058443:Catastrophization / Q000523:psychology; D002648:Child; D059350:Chronic Pain / Q000191:economics / Q000523:psychology / Q000628:therapy; D003863:Depression / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D008297:Male; D059408:Pain Management / Q000191:economics* / Q000379:methods*; D010147:Pain Measurement; D016896:Treatment Outcome
Financial burden; Health care utilization; Intensive interdisciplinary pain treatment; Parental work absenteeism; Pediatric chronic pain; Randomized controlled trial