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Efficacy of adding interoceptive exposure to intensive interdisciplinary treatment for adolescents with chronic pain: a randomized controlled trial
Abstract
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, and school absence), and emotional characteristics (anxiety and catastrophizing) when implemented as an adjunctive treatment in the context of intensive interdisciplinary pain treatment for pediatric chronic pain patients. N = 126 adolescents, aged 11 to 17 years, who were receiving standard intensive interdisciplinary pain treatment 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 3 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 (eg, total score [range 0-60; IE/RT]: admission M = 23.5/24.9; discharge M = 16.0/19.7; P < 0.001, (Equation is included in full-text article.)= 0.27) and mainly large reductions in pain characteristics. There were no greater decreases in the IE group (P > 0.1). The exploratory analyses revealed that the patients with high fear of pain before treatment (P < 0.05, (Equation is included in full-text article.)> 0.03) and the patients with abdominal pain (P < 0.04, (Equation is included in full-text article.)> 0.25) 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 the pediatric chronic pain patients, but the patients with high fear of pain before treatment and with abdominal pain strongly benefit from this intervention.
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“In a study on adolescents with chronic pain, those with high baseline fear showed larger pain reductions under interoceptive exposure compared to control conditions (Flack et al., 2018).”
From Listen to your inner body: embodied emotions in predictive neuroscience and traditional East Asian medicine (2026) · cites this paper as Flack et al., 2018
In the citing paper
“A recent introceptive exposure treatment for youth with chronic pain observed a medium effect size (cohen's d = 0.73) improvement in pain-related fear, suggesting a sample size of 31 per group to achieve 80% power, suitably within range of these estimates [66].”
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References 51 · Cited by 28
Metadata
- Authors
- Flack, F., Stahlschmidt, L., Dobe, M., Hirschfeld, G., Strasser, A., Michalak, J., Wager, J., & Zernikow, B.
- Affiliations
- Witten/Herdecke University (DE)
- Hochschule Osnabrück (DE)
- Corresponding author
- Flack, Florentina
- Venue
- Pain
- Published
- 2018-06-21
- Volume
- 159
- Issue
- 11
- Pages
- 2223-2233
- ISSN
- 0304-3959 (ISSN-L)
- 1872-6623
- OpenAlex
- W2809759783
- Cited by
- 28
- References
- 51
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 7 · 2021: 4 · 2020: 4 · 2019: 7 · 2018: 1
- FWCI
- 4.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- fear of pain, pediatric chronic pain, adolescents, relaxation training, pain catastrophizing, anxiety, abdominal pain, pain intensity, school absenteeism, treatment moderators
- MeSH terms
- Adolescent, Analysis of Variance, Child, Female, Follow-Up Studies, Humans, Implosive Therapy, Male, Pain Measurement, Stress, Psychological, Treatment Outcome, Catastrophization, Chronic Pain, Interoception
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