The effectiveness of non-pharmacological pain management in relieving chronic pain for children and adolescents.
BACKGROUND
There is accumulating evidence that recurring pain symptoms in children are becoming a serious health concern. Children and adolescents who suffer from ongoing pain have negative outcomes not only to their physical health, but also to their emotional and spiritual health. Furthermore, recurrent pain in children may also cause a number of other negative consequences to the child, the family and society. Thus, a non-pharmacological approach to reduce the pain is vital to help children having better quality of life.


OBJECTIVE
The objective of this review is to determine the best available evidence on the effectiveness of non-pharmacological pain management in relieving chronic pain for children and adolescents.


METHODS
The search strategy aimed to find published studies, between 1956 and 2008 and limited to the English or Chinese languages. Reference lists of studies that met the inclusion criteria were searched for additional studies.
This review included any systematic reviews, randomized controlled trials and quasi-experimental design that explored the effectiveness of non-pharmacological intervention for chronic pain in children and adolescents.


METHODS
Children and adolescents with cancer pain, Juvenile chronic arthritis, sickle cell disease, burn pain, chronic or recurrent abdominal pain, headache and aged 18 years old or less and suffering with pain for at least one month.
The review considered studies that examined non-pharmacological interventions in relieving chronic pain for children and adolescents that included heat wrap therapy, massage, chiropractic spinal manipulative therapy, cognitive-behavioral therapy (distraction & guided imagery), meditation, progressive muscle relaxation, self-hypnosis, biofeedback, music therapy, and dance training.


METHODS
The primary outcome measures included: (1) Behavioral variables, such as pain behavior, cognitive coping and appraisal, psychiatric reaction (anxiety and depression), and social activities, (2) Quality of life scores and (3) Pain scores.
The review focuses on studies that operated either at a hospital or in a community setting.


METHODS
Meta-analysis was used to pool the data from studies to determine the effectiveness of the intervention. The Comprehensive Meta Analysis V2 was used to manage the data.


RESULTS
The search process identified 43,100 studies that addressed the objectives of the review protocol. Fifty-four articles were selected for critical appraisal. Finally, 31 trials were considered to be eligible for the present review and 5 articles were excluded. Data was pooled together from eight articles using meta-analysis to examine the effectiveness of relaxation training of the pre-test and post-test of headache intensity. The findings show that the effective size was 0.323 with significant difference. Two of the articles evaluate the effectiveness of relaxation training for releasing the recurrent headaches for adolescents and the post-test data were collected over the following six months. The findings show that there is a statistically significance difference. Another two articles examined the effectiveness of a relaxation training program in reducing the sum of medication used of adolescents with recurrent headaches. The findings show that there is no statistical significance. Furthermore, the findings show that biofeedback treatment could improve the outcome of children and adolescents' headache, especially at 6 and 12 months after the treatment. In terms of psychosocial treatment, five articles examined the effectiveness of behavioral treatment, relaxation training program, cognitive behavior therapy, and acupuncture/ hypnosis intervention to reduce anxiety of children and adolescent with chronic pain. The various outcomes measures among the five studies.


CONCLUSIONS
This review has provided an evidence-based guide to future priorities for clinical practice. Relaxation programs could reduce recurrent headache and pain intensity in children and adolescents in the short term as well as lasting for three and six months. Furthermore, biofeedback treatment could reduce recurrent headache of pain intensity in children and adolescents in the short term and last for as long as six months.
1. School of Nursing, National Yang-Ming University, 2. Department of Nursing, Veteran General Hospital, Taipei, Taiwan R. O. C.
Pei-Fan
PF
Mu
Yu-Chih
YC
Chen
Shu-Chen
SC
Cheng