title: Systematic Review on Intensive Interdisciplinary Pain Treatment of Children With Chronic Pain.
abstract: OBJECTIVE
  Pediatric debilitating chronic pain is a severe health problem, often requiring complex interventions such as intensive interdisciplinary pain treatment (IIPT). Research is lacking regarding the effectiveness of IIPT for children. The objective was to systematically review studies evaluating the effects of IIPT.
  
  
  METHODS
  Cochrane, Medline/Ovid, PsycInfo/OVID, PubMed, PubPsych, and Web of Science were searched. Studies were included if (1) treatment was coordinated by ≥3 health professionals, (2) treatment occurred within an inpatient/day hospital setting, (3) patients were <22 years, (4) patients experienced debilitating chronic pain, (5) the study was published in English, and (6) the study had ≥10 participants at posttreatment. The child's pain condition, characteristics of the IIPT, and 5 outcome domains (pain intensity, disability, school functioning, anxiety, depressive symptoms) were extracted at baseline, posttreatment, and follow-up.
  
  
  RESULTS
  One randomized controlled trial and 9 nonrandomized treatment studies were identified and a meta-analysis was conducted separately on pain intensity, disability, and depressive symptoms revealing positive treatment effects. At posttreatment, there were large improvements for disability, and small to moderate improvements for pain intensity and depressive symptoms. The positive effects were maintained at short-term follow-up. Findings demonstrated extreme heterogeneity.
  
  
  CONCLUSIONS
  Effects in nonrandomized treatment studies cannot be attributed to IIPT alone. Because of substantial heterogeneity in measures for school functioning and anxiety, meta-analyses could not be computed. There is preliminary evidence for positive treatment effects of IIPT, but the small number of studies and their methodological weaknesses suggest a need for more research on IIPTs for children.
authors.affiliation: German Paediatric Pain Centre, Children's Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health-School of Medicine, Witten/Herdecke University, Witten, Germany; t.hechler@deutsches-kinderschmerzzentrum.de.
authors.forename: Tanja
authors.initials: T
authors.lastname: Hechler
authors.affiliation: Behavior Medicine Pain Treatment Services, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden;
authors.forename: Marie
authors.initials: M
authors.lastname: Kanstrup
authors.affiliation: Division of Psychology, Institute on Development and Disability, Oregon Health and Science University, Portland, Oregon;
authors.forename: Amy Lewandowski
authors.initials: AL
authors.lastname: Holley
authors.affiliation: Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Simons
authors.affiliation: Behavior Medicine Pain Treatment Services, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden;
authors.forename: Rikard
authors.initials: R
authors.lastname: Wicksell
authors.affiliation: German Paediatric Pain Centre, Children's Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health-School of Medicine, Witten/Herdecke University, Witten, Germany; University of Applied Sciences, Osnabrueck, Osnabrueck, Germany.
authors.forename: Gerrit
authors.initials: G
authors.lastname: Hirschfeld
authors.affiliation: German Paediatric Pain Centre, Children's Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health-School of Medicine, Witten/Herdecke University, Witten, Germany;
authors.forename: Boris
authors.initials: B
authors.lastname: Zernikow
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D059350:Chronic Pain / Q000523:psychology / Q000628:therapy*; D003863:Depression / Q000453:epidemiology*; D019988:Children with Disabilities / Q000523:psychology*; D006801:Humans; D059408:Pain Management / Q000379:methods*; D010348:Patient Care Team