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

Eccleston C, Palermo TM, Williams AC de C, Lewandowski A, Morley S

Published Online:

April 15, 2009

Psychological therapies (relaxation, hypnosis, coping skills training, biofeedback, cognitive behavioural therapy) are treatments which may help people manage pain and its disabling consequences. For children and youths there is good evidence that both relaxation and cognitive behavioural therapy (treatment which helps people test and revise their thoughts and actions) are effective in reducing the severity and frequency of chronic headache, recurrent abdominal pain, and fibromyalgia. These treatments appear to have a lasting effect. Not enough studies, however, measure the effects of these treatments on reducing disability and helping young people to be more independently active, and not enough measure the effects on mood.

Abstract (click to read)

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.

Objectives:

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

Search strategy:

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.

Selection criteria:

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.

Data collection and analysis:

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.

Main 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.

Authors' 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.

This record should be cited as:

Eccleston C, Palermo TM, Williams AC de C , Lewandowski A, Morley S. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD003968. DOI: 10.1002/14651858.CD003968.pub2

Assessed as up to date:

January 27, 2009

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Primary Review Group:

Pain, Palliative and Supportive Care Group

Health topics:

Anaesthesia & pain control > Chronic non-cancer pain management > Management in children

Anaesthesia & pain control > Chronic non-cancer pain management > Prevention

Anaesthesia & pain control > Chronic non-cancer pain management > Psychological therapies

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

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

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