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Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents
Open accessAbstract
Background This is the first update of a review published in 2015, Issue 1. Chronic pain is common during childhood and adolescence and is associated with negative outcomes, such as increased severity of pain, reduced function, and low mood. Psychological therapies, traditionally delivered face‐to‐face with a therapist, are efficacious at reducing pain intensity and disability. To address barriers to treatment access, such as distance and cost of treatment, technology is being used to deliver these psychological therapies remotely. Therapies delivered remotely, such as via the Internet, computer‐based programmes, and smartphone applications, can be used to deliver treatment to children and adolescents with chronic pain. Objectives To determine the efficacy of psychological therapies delivered remotely compared to waiting list, treatment as usual, or active control treatments, for the management of chronic pain in children and adolescents. Search methods We searched four databases (CENTRAL, MEDLINE, Embase, and PsycINFO) from inception to May 2018 for randomised controlled trials (RCTs) of remotely‐delivered psychological interventions for children and adolescents with chronic pain. We searched for chronic pain conditions including, but not exclusive to, headache, recurrent abdominal pain, musculoskeletal pain, and neuropathic pain. We also searched online trial registries, reference sections, and citations of included studies for potential trials. Selection criteria We included RCTs that investigated the efficacy of a psychological therapy delivered remotely via technology in comparison to an active, treatment as usual, or waiting‐list control. We considered blended treatments, which used a combination of technology and up to 30% face‐to‐face interaction. Interventions had to be delivered primarily via technology to be included, and we excluded interventions delivered via telephone. We included studies that delivered interventions to children and adolescents (up to 18 years of age) with a chronic pain condition or where chronic pain was a primary symptom of their condition (e.g. juvenile arthritis). We included studies that reported 10 or more participants in each comparator arm, at each extraction point. Data collection and analysis We combined all psychological therapies in the analyses. We split pain conditions into headache and mixed (non‐headache) pain and analysed them separately. We extracted pain severity/intensity, disability, depression, anxiety, and adverse events as primary outcomes, and satisfaction with treatment as a secondary outcome. We considered outcomes at two time points: first immediately following the end of treatment (known as 'post‐treatment'), and second, any follow‐up time point post‐treatment between three and 12 months (known as 'follow‐up'). We assessed risk of bias and all outcomes for quality using the GRADE assessment. Main results We found 10 studies with 697 participants (an additional 4 studies with 326 participants since the previous review) that delivered treatment remotely; four studies investigated children with headache conditions, one study was with children with juvenile idiopathic arthritis, one included children with sickle cell disease, one included children with irritable bowel syndrome, and three studies included children with different chronic pain conditions (i.e. headache, recurrent abdominal pain, musculoskeletal pain). The average age of children receiving treatment was 13.17 years. We judged selection, detection, and reporting biases to be mostly low risk. However, we judged performance and attrition biases to be mostly unclear. Out of the 16 planned analyses, we were able to conduct 13 meta‐analyses. We downgraded outcomes for imprecision, indirectness of evidence, inconsistency of results, or because the analysis only included one study. Headache conditions For headache pain conditions, we found headache severity was reduced post‐treatment (risk ratio (RR) 2.02, 95% confidence interval (CI) 1.35 to 3.01); P < 0.001, number needed to treat to benefit (NNTB) = 5.36, 7 studies, 379 participants; very low‐quality evidence). No effect was found at follow‐up (very low‐quality evidence). There were no effects of psychological therapies delivered remotely for disability post‐treatment (standardised mean difference (SMD) ‐0.16, 95% CI ‐0.46 to 0.13; P = 0.28, 5 studies, 440 participants) or follow‐up (both very low‐quality evidence). Similarly, no effect was found for the outcomes of depression (SMD ‐0.04, 95% CI ‐0.15 to 0.23, P = 0.69, 4 studies, 422 participants) or anxiety (SMD ‐0.08, 95% CI ‐0.28 to 0.12; P = 0.45, 3 studies, 380 participants) at post‐treatment, or follow‐up (both very low‐quality evidence). Mixed chronic pain conditions We did not find any beneficial effects of psychological therapies for reducing pain intensity post‐treatment for mixed chronic pain conditions (SMD ‐0.90, 95% CI ‐1.95 to 0.16; P = 0.10, 5 studies, 501 participants) or at
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“There are Cochrane reviews of psychological treatments for both adults and children delivered remotely by a therapist using electronic communication technology (Eccleston 2014; Fisher 2019). Again, the findings are broadly similar.”
From Psychological therapies for the management of chronic pain (excluding headache) in adults (2020) · cites this paper as Fisher 2019
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“Prior to the pandemic, remotely delivered pain treatment centered on digital tools[13] with essentially no evidence for video delivery of multidisciplinary pain treatment.”
From A randomized controlled trial of graded exposure treatment (GET living) for adolescents with chronic pain (2024) · cites this paper as [13]
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Williams, A. C. D. C., Fisher, E., Hearn, L., & Eccleston, C. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007407.pub4 · Cited by 605
Self-citationEccleston, C., Blyth, F. M., Dear, B. F., Fisher, E. A., Keefe, F. J., Lynch, M. E., Palermo, T. M., Reid, M. C., & Williams, A. C. D. C. (2020) · Pain · doi:10.1097/j.pain.0000000000001885 · Cited by 480
Self-citationPhilippe, T. J., Sikder, N., Jackson, A., Koblanski, M. E., Liow, E., Pilarinos, A., & Vasarhelyi, K. (2022) · JMIR Mental Health · doi:10.2196/35159 · Cited by 436
Delivering transformative action in paediatric pain: a Lancet Child & Adolescent Health Commission
Eccleston, C., Fisher, E., Howard, R. F., Slater, R., Forgeron, P. A., Palermo, T. M., Birnie, K. A., Anderson, B. J., Chambers, C. T., Crombez, G., et al. (2020) · The Lancet Child & Adolescent Health · doi:10.1016/s2352-4642(20)30277-7 · Cited by 338
Self-citationBadawy, S. M., & Radovic, A. (2020) · JMIR Pediatrics and Parenting · doi:10.2196/20049 · Cited by 242
Metadata
- Authors
- Fisher, E., Law, E., Dudeney, J., Eccleston, C., & Palermo, T. M.
- Affiliations
- Churchill Hospital (GB)
- University of Washington (US)
- Seattle Children's Research Institute (US)
- University of Bath (GB)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2019-04-02
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- OpenAlex
- W4250086404
- Cited by
- 164
- References
- 76
- Citations by year
- 2026: 11 · 2025: 24 · 2024: 17 · 2023: 27 · 2022: 17 · 2021: 35 · 2020: 20 · 2019: 9
- FWCI
- 4.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- Pure (University of Bath) (publishedVersion, other-oa)
- Funders
- National Institute for Health and Care Research (13/89/29)
- National Institutes of Health
- Evidence Synthesis Programme
- National Institute of Neurological Disorders and Stroke (K23NS089966)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K24HD060068)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- chronic pain, recurrent pain, children and adolescents, online intervention, mobile application, headache, recurrent abdominal pain, musculoskeletal pain, neuropathic pain, juvenile idiopathic arthritis, pain intensity, disability, depression, anxiety, treatment satisfaction, medication adherence, barriers to treatment access
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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