Psychological therapies for the management of chronic and recurrent pain in children and adolescents
Abstract
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.
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Mostly small to moderate effect sizes on disability, mood, catastrophizing, and pain have been reported for CBT; long-term effects are unclear; and the diversity of CBT interventions has made it hard to identify treatment mechanisms.
“Mostly small to moderate effect sizes on disability, mood, catastrophizing and pain have been reported, longterm effects are unclear, and the diversity of CBT interventions has made it hard to identify treatment mechanisms (Eccleston et al., 2009;Morley et al., 2013;Williams et al., 2012).”
From Internet-delivered acceptance and commitment therapy as microlearning for chronic pain: A randomized controlled trial with 1-year follow-up (2021) · cites this paper as Eccleston et al., 2009
The majority of studies in the review were brief treatments for children with headaches.
“However, this review showed that the majority of studies were of brief treatments for children with headaches, and despite good evidence for pain relief, there was much less evidence for reduced disability after treatment.”
From Acceptance and values-based treatment of adolescents with chronic pain: Outcomes and their relationship to acceptance (2013) · cites this paper as Eccleston, Palermo, Williams, Lewandowski, & Morley, 2009
Psychological treatments that focus on skilful coping responses and cognitive-behavioral techniques are well supported by research.
“In contrast, psychological treatments that focus on skilful coping responses and cognitive-behavioral techniques are well supported by research.”
From Acceptance and values-based treatment of adolescents with chronic pain: Outcomes and their relationship to acceptance (2013) · cites this paper as Eccleston, Palermo, Williams, Lewandowski, & Morley, 2009
Despite good evidence for pain relief, there was much less evidence for reduced disability after treatment.
“However, this review showed that the majority of studies were of brief treatments for children with headaches, and despite good evidence for pain relief, there was much less evidence for reduced disability after treatment.”
From Acceptance and values-based treatment of adolescents with chronic pain: Outcomes and their relationship to acceptance (2013) · cites this paper as Eccleston, Palermo, Williams, Lewandowski, & Morley, 2009
A recent meta-analysis of 25 well-conducted trials showed evidence of benefit for headache, abdominal pain, and fibromyalgia.
“A recent meta-analysis included 25 wellconducted trials and showed evidence of benefit for headache, abdominal pain, and fibromyalgia (Eccleston, Palermo, Williams, Lewandowski, & Morley, 2009).”
From Acceptance and values-based treatment of adolescents with chronic pain: Outcomes and their relationship to acceptance (2013) · cites this paper as Eccleston, Palermo, Williams, Lewandowski, & Morley, 2009
There has been little innovation in the psychological models and techniques used in pain treatments, with most trials using relaxation, biofeedback, or established cognitive-behavioral techniques.
“Also, there has been little innovation in the psychological models and techniques used in pain treatments, with most trials using relaxation, biofeedback, or established cognitive-behavioral techniques.”
From Acceptance and values-based treatment of adolescents with chronic pain: Outcomes and their relationship to acceptance (2013) · cites this paper as Eccleston et al., 2009
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- Authors
- Eccleston, C., Palermo, T. M., Williams, A. C. D. C., Lewandowski, A., & Morley, S.
- Affiliations
- University of Bath (GB)
- Oregon Health & Science University (US)
- University College London (GB)
- Boston Children's Hospital (US)
- University of Leeds (GB)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- John Wiley & Sons, Ltd
- Published
- 2009-04-15
- Issue
- 2
- Pages
- CD003968-CD003968
- ISSN
- 1361-6137 (ISSN-L)
- OpenAlex
- W4244899728
- Cited by
- 78
- References
- 12
- Citations by year
- 2025: 1 · 2023: 3 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 6 · 2017: 6 · 2016: 3 · 2015: 3 · 2014: 6 · 2013: 6 · 2012: 15
- Type
- reference entry
- Language
- en
- Open access
- closed
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Medicine › Psychiatry and Mental health › Migraine and Headache Studies
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- psychotherapy, chronic pain, recurrent pain, children, adolescents, headache, migraine, abdominal pain, fibromyalgia, sickle cell disease, pain-related disability, mood, treatment effectiveness, placebo comparison, waitlist control, relapse, adverse effects, cost-effectiveness, cost-benefit analysis, cost-effectiveness ratio, benefit-cost ratio
- MeSH terms
- Adolescent, Child, Chronic Disease, Fibromyalgia, Headache, Hemoglobin SC Disease, Humans, Pain, Psychotherapy, Recurrence, Abdominal Pain, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Mood Disorders, Pain Management
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