Specialized Rehabilitation Programs For Children And Adolescents With Severe Disabling Chronic Pain: Indications, Treatment And Outcomes
Chronic Pain; Effectiveness; Indication; Pediatric; Rehabilitation Programs; Specialized Pain Treatment
Children and adolescents with highly disabling chronic pain of high intensity and frequency are admitted to specialized pain rehabilitation programs. Some barriers to obtaining this specialized care include a lack of availability of treatment centers, a perceived social stigma and individual barriers such as socioeconomic status. Specialized rehabilitation programs for severe disabling chronic pain worldwide have similarities regarding admission criteria, structure and therapeutic orientation. They differ, however, regarding their exclusion criteria and program descriptions. The short- and long-term effectiveness of some rehabilitation programs is well documented. All countries should promote the establishment of future pediatric pain centers to improve the health care of children and adolescents suffering from severe chronic pain. Standardized reporting guidelines should be developed to describe treatments and outcomes to enable comparability across treatment centers.
Stahlschmidt L; Zernikow B; Wager J
Children (basel)
2016
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
10.3390/children3040033
Clinical And Economic Long-term Treatment Outcome Of Children And Adolescents With Disabling Chronic Pain
Financial Burden; Health Care Utilization; Intensive Interdisciplinary Pain Treatment; Long-term Outcome; Pediatric Chronic Pain
Objective.: Disabling pediatric chronic pain is accompanied by a significant burden to those affected and by high societal costs. Furthermore, it bears the risk of aggravation into adulthood. Studies have shown intensive interdisciplinary pain treatment to result in short-term positive effects on pain-related and psychological outcomes. In this study, we aimed to prove the stability of the long-term effects of intensive interdisciplinary pain treatment four years after treatment. Methods.: This longitudinal observational study followed adolescents who had received intensive interdisciplinary pain treatment over four years. We defined a combined end point, overall improvement (pain intensity, pain-related disability, and school/work absence), and investigated three additional psychological outcome domains (anxiety, depression, pain catastrophizing). We also examined changes to economic parameters (health care utilization, subjective financial burden) and their relationship to patient improvement. Results.: Similar patterns were observed for pain-related and psychological outcome domains, with data showing statistically and clinically significant reductions from admission to four-year follow-up. These positive effects were stable from one- to four-year follow-up. Approximately 60% of the adolescents showed an overall long-term improvement. Older age was found to be a risk factor for treatment failure. Economic parameters decreased statistically significantly, particularly for those with an overall improvement of the chronic pain disorder. Conclusions.: The results of this study support the long-term effectiveness of intensive interdisciplinary pain treatment and indicate that it can interrupt pain chronification. Future research is warranted to investigate why some of the adolescents did not show improvement and to allow for a more individualized treatment.
Zernikow B; Ruhe AK; Stahlschmidt L; Schmidt P; Staratzke T; Frosch M; Wager J
Pain Medicine
2017
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
10.1093/pm/pnx067
Efficacy of adding interoceptive exposure to intensive interdisciplinary treatment for adolescents with chronic pain: A randomized controlled trial
Fear of pain plays an important role in the maintenance of chronic pain. It may be reduced through exposure therapy. This 2-arm parallel samples, randomized controlled trial aimed to investigate whether interoceptive exposure (IE) therapy enhances reductions in fear of pain (primary outcome), pain (pain intensity, pain-related disability, school absence) and emotional characteristics (anxiety, catastrophizing) when implemented as an adjunctive treatment in the context of intensive interdisciplinary pain treatment (IIPT) for pediatric chronic pain patients. N=126 adolescents, aged 11-17 years, who were receiving standard IIPT were randomly assigned to either receive additional IE (n=64) or additional relaxation therapy (RT) (n=62). All patients were assessed at admission, discharge and three months after discharge. The data of N=104 patients were analyzed. Significant large reductions were found in the total score and subscale scores of the Fear of Pain Questionnaire for Children in both study groups (e.g., total score (range 0-60; IE/RT): admission M=23.5/24.9; discharge M=16.0/19.7; p<.001, engp=.27) and mainly large reductions in pain characteristics. There were no greater decreases in the IE-group (p>.1). The exploratory analyses revealed that the patients with high fear of pain before treatment (p<.05, engp>.03) and the patients with abdominal pain (p<.04, engp>.25) showed greater decreases in their fear of pain (total and subscale score) in the IE-group than in the RT-group. In conclusion, the results suggest that IE is not particularly effective for all pediatric chronic pain patients, but patients with high fear of pain before treatment and with abdominal pain strongly benefit from this intervention. TRIAL REGISTRATION: This randomized controlled clinical trial was registered in the "German Clinical Trials Register" (trial number: DRKS00010030; name: Randomisiert kontrollierte Studie zur Wirksamkeit der Schmerzprovokation bei Jugendlichen mit chronischen Schmerzstorungen).
Flack F; Stahlschmidt L; Dobe M; Hirschfeld G; Kesper A; Michalak J; Wager J; Zernikow B
Pain
2018
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/j.pain.0000000000001321" target="_blank" rel="noreferrer noopener">10.1097/j.pain.0000000000001321</a>