Systematic review and meta-analysis of psychological therapies for children with chronic pain

Fisher, Emma; Heathcote, Lauren; Palermo, Tonya M.; de C Williams, Amanda C; Lau, Jennifer; Eccleston, Christopher

doi:10.1093/jpepsy/jsu008

Cited by 710Pediatric Pain Management TechniquesMusculoskeletal pain and rehabilitationPain Management and Treatment

Systematic review and meta-analysis of psychological therapies for children with chronic pain

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Fisher, Emma, Heathcote, Lauren, Palermo, Tonya M., de C Williams, Amanda C, Lau, Jennifer, Eccleston, Christopher·2014·Journal of Pediatric Psychology

DOI 10.1093/jpepsy/jsu008PMC PMC4148613

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Abstract

OBJECTIVES: This systematic review and meta-analysis examined the effects of psychological therapies for management of chronic pain in children. METHODS: Randomized controlled trials of psychological interventions treating children (<18 years) with chronic pain conditions including headache, abdominal, musculoskeletal, or neuropathic pain were searched for. Pain symptoms, disability, depression, anxiety, and sleep outcomes were extracted. Risk of bias was assessed and quality of the evidence was rated using GRADE. RESULTS: 35 included studies revealed that across all chronic pain conditions, psychological interventions reduced pain symptoms and disability posttreatment. Individual pain conditions were analyzed separately. Sleep outcomes were not reported in any trials. Optimal dose of treatment was explored. For headache pain, higher treatment dose led to greater reductions in pain. No effect of dosage was found for other chronic pain conditions. CONCLUSIONS: Evidence for psychological therapies treating chronic pain is promising. Recommendations for clinical practice and research are presented.

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There is substantial evidence that psychological interventions are effective at reducing pain severity, disability, and psychological distress (e.g., anxiety) in children with chronic pain.
“There is substantial evidence suggesting these interventions are effective at reducing pain severity, disability, and psychological distress (e.g., anxiety) in children with chronic pain [13,14,15].”
From Best-evidence for the rehabilitation of chronic pain part 1: Pediatric pain (2019) · cites this paper as [14]
The Summary of findings (p. 22) reports significant reductions in pain and disability, with benefits varying by pain condition. The Conclusion (p. 29) reports improved depressive symptoms for some conditions but says evidence is insufficient to conclude that therapies reduce anxiety; the claim overstates the evidence for psychological distress. (LLM, conf=0.90)
Experimental — accuracy not yet measured
Cognitive techniques such as cognitive restructuring, problem-solving, and positive self-talk have been shown effective for reducing negative thoughts associated with pain and related disability.
“Cognitive techniques such as cognitive restructuring, problem-solving, and positive self-talk, have been shown to be effective techniques for reducing negative thoughts associated with pain and related disability [10,13,14].”
From Best-evidence for the rehabilitation of chronic pain part 1: Pediatric pain (2019) · cites this paper as [14]
The Introduction (p. 3) describes CBT as challenging cognitions that exacerbate suffering, and the chronic-pain analysis (p. 15) finds a small post-treatment reduction in disability from psychological therapies. But the review does not establish that cognitive restructuring, problem-solving, or positive self-talk individually reduce pain-related negative thoughts or disability; its Interventions section (p. 7) lists problem-solving as a component, not a separately tested effective technique. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Conventional treatment has established positive effects.
“This is not necessarily an argument against conventional treatment, which has established positive effects (Bruce et al., 2017; Fisher et al., 2014)”
From Dispositional Mindfulness and Its Relationship With Distress and Functioning in Adolescents With Chronic Pain and Low-Level Pain. (2018) · cites this paper as Fisher et al., 2014
The Conclusion (p. 29) reports that psychological therapies reduce pain immediately after treatment in children and adolescents with chronic pain. That supports positive effects for this type of treatment, but the broader phrase “conventional treatment” is not established by this review; the Conclusion also says evidence for maintenance of effects is weak. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Psychological interventions effectively reduce pain in headache, abdominal pain, and musculoskeletal conditions, and functional disability in abdominal and musculoskeletal pain.
“Within pain conditions, psychological interventions have been found to effectively reduce pain in headache, abdominal pain, and musculoskeletal conditions, and functional disability in abdominal and musculoskeletal pain [14].”
From Best-evidence for the rehabilitation of chronic pain part 1: Pediatric pain (2019) · cites this paper as [14]

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2 of the 101 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

*Kashikar-Zuck, S., Ting, T. V., Arnold, L. M., Bean, J., Powers, S. W., Graham, B., . . . Lovell, D. J. (2012). Cognitive behavioral therapy for the treatment of juvenile fibromyalgia. Arthritis & Rheumatism, 64 (1), 297-305.
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Systematic Review and Meta-analysis: Psychological Therapies for
Pain, C. C. (2013)
Systematic review of randomised controlled trials of psychological therapy for chronic pain in children and adolescents, with a subset meta-analysis of pain relief
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Efficacy and safety of pharmacological, physical, and psychological interventions for the management of chronic pain in children: A WHO systematic review and meta-analysis
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The effectiveness of psychological interventions in the treatment of children and adolescents with chronic Pain: A systematic review
Sheykhangafshe, F. B., Farahani, H., Dehghani, M., & Fathi-Ashtiani, A. (2024) · Quarterly Journal of Child Mental Health · doi:10.61186/jcmh.11.1.6 · Cited by 5 · see citing works

Authors: Fisher, E., Heathcote, L., Palermo, T. M., de C Williams, A. C., Lau, J., & Eccleston, C.
Affiliations: King's College London (GB)
ORCID: Fisher, Emma
Heathcote, Lauren
Palermo, Tonya M.
Lau, Jennifer
Eccleston, Christopher
Venue: Journal of Pediatric Psychology
Publisher: Oxford University Press (OUP)
Published: 2014-03-06
Volume: 39
Issue: 8
Pages: 763-782
ISSN: 0146-8693 (ISSN-L)
1465-735X
DOI: 10.1093/jpepsy/jsu008
PMC: PMC4148613
OpenAlex: W2142456684
Cited by: 710
References: 101
Citations by year: 2026: 7 · 2025: 7 · 2024: 6 · 2023: 13 · 2022: 17 · 2021: 41 · 2020: 33 · 2019: 35 · 2018: 49 · 2017: 37 · 2016: 61 · 2015: 129 · 2014: 148 · 2013: 108 · 2012: 18
FWCI: 18.57
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Journal of Pediatric Psychology (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
The University of Bath Online Publications Store (The University of Bath) (submittedVersion)
Pure (University of Bath) (submittedVersion, other-oa)
UCL Discovery (University College London) (submittedVersion)
Research Portal (King's College London) (submittedVersion, other-oa)
Funders: Action Medical Research
National Institute for Health and Care Research (13/89/29)
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
Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords: chronic pain, children, psychological intervention, headache, abdominal pain, musculoskeletal pain, neuropathic pain, pain-related disability, depression, anxiety, sleep, treatment dosage, pediatric pain management
MeSH terms: Child, Humans, Psychotherapy, Treatment Outcome, Chronic Pain, Pain Management

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Systematic review and meta-analysis of psychological therapies for children with chronic pain

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