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Psychological therapies for the management of chronic and recurrent pain in children and adolescents

Eccleston C, Palermo TM, Williams AC de C, Lewandowski Holley A, Morley S, Fisher E, Law E
Published Online: 
5 May 2014

Psychological therapies (e.g. relaxation, hypnosis, coping skills training, biofeedback, and cognitive behavioural therapy) may help people manage pain and its disabling consequences. Therapies can be delivered face-to-face by a therapist, via the Internet, by telephone call, or by computer programme. This review focuses on treatments that are delivered face-to-face by a therapist. For children and adolescents there is evidence that both relaxation and cognitive behavioural therapy (treatment that helps people test and revise their thoughts and actions) are effective in reducing the intensity of pain in chronic headache, recurrent abdominal pain, fibromyalgia, and sickle cell disease immediately after treatment.

Psychological therapies also have a lasting effect in reducing pain and disability for chronic headache. Fifty-six per cent of children who were treated with psychological therapies reported less pain compared with 22% of children who did not receive a psychological therapy. Anxiety was also reduced for children with headaches immediately following treatment. Psychological therapies also reduce pain and disability for children with mixed pain conditions (excluding headache) immediately following treatment. However, we did not find that any treatment effects were maintained at follow-up (between 3-12 months after the end of treatment) for children with mixed pain conditions. Psychological therapies did not produce changes in depression in children with either headache or non-headache conditions, and anxiety did not change in children with non-headache conditions receiving psychological therapies.

More studies are needed to understand whether psychological therapies can improve depression and anxiety and have more lasting effects on pain and disability in other groups of young people who have chronic pain.