Key message: Psychological therapies can be helpful in reducing pain in childen and adolescents with chronic and recurrent pain.
Living with chronic pain is a miserable business. It can be a major cause of disability and distress and affects not only the person themselves but those close to them. Any parent will tell you how upsetting it is to see their child in pain and I was surprised to learn how many children live with it, around 15% to 30%, with around 8% having severe and frequent pain. So what can be done to help them?
Well they may be offered some kind of psychological therapy and a review from the Cochrane Pain, Palliative Care and Supportive Care Group which looks at evidence on the effectiveness of this approach for such children has now been updated. Eight randomised controlled trials (RCTs) with 506 people have been added in this update, bringing the total to 37 RCTs with almost 2000 people aged under 18. Twenty-one studies involved children with headache/migraine. Interventions were largely behavioural treatments, typically based on relaxation, and cognitive behavioural therapy (CBT), such as coping skills training. All the newly added studies evaluated CBT, reflecting a shift in this field. Categories of treatment were not analysed separately. Treatment groups were compared with waiting list or standard care control groups. The reviewers were interested in the impact of treatment on pain, disability and mood, immediately after treatment and at three to twelve month follow-up, for children with headache or non-headache pain (excluding pain resulting from cancer or other malignant life-threatening disease).
What did they find?
- Pain improved in headache and non-headache groups immediately after treatment and in the headache group this was maintained at follow-up
- Those in the headache treatment group reported improved mood at follow-up in the two small studies contributing data to this analysis
- Disability improved in the non-headache group at the end of treatment
- There were no other significant treatment effects
How good is the evidence?
- Study quality was mixed and many were at unclear or high risk of bias in several categories of potential bias
- The reviewers note that study quality has improved and follow-up data more often reported in the newer studies. However, trials remain small and few explore non-headache pain conditions
This review found that for every three children with headaches undergoing psychological therapy one will find their pain improves more than 50%, which is encouraging. There is a need for more evidence on the usefulness of these treatments for other pain conditions and their impact on non-pain outcomes, relating to disability for example. Up- to-date systematic review evidence for the effectiveness of psychological therapies for adults with headache is lacking, but a Cochrane review on these treatments for adults with longstanding distressing pain (excluding headache) was also recently updated and is available from the link below.
Eccleston C, Palermo TM, Williams ACDC, Lewandowski A, Morley S, Fisher E, Law E. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD003968. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003968.pub3/abstract
Williams ACDC, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD007407. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007407.pub3/full