Randomized controlled trials of psychological therapies for management of chronic pain in children and adolescents: An updated meta-analytic review

Palermo, Tonya M.; Eccleston, Christopher; Lewandowski, Amy S.; Williams, Amanda C de C.; Morley, Stephen

doi:10.1016/j.pain.2009.10.004

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Volume 148, Issue 3 , Pages 387-397, March 2010

Randomized controlled trials of psychological therapies for management of chronic pain in children and adolescents: An updated meta-analytic review

Tonya M. Palermo
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR 97239, USA
- Corresponding author. Address: Department of Anesthesiology and Perioperative Medicine, Mail Code: UHN-2, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239-3098, USA. Tel.: +1 503 494 0848; fax: +1 503 494 3092.
Christopher Eccleston
- University of Bath, Bath, UK
Amy S. Lewandowski
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR 97239, USA
Amanda C de C. Williams
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
Stephen Morley
- Leeds Institute of Health Services, University of Leeds, Leeds, UK

Received 26 May 2009; received in revised form 1 September 2009; accepted 5 October 2009. published online 12 November 2009.

Abstract

The purpose of this meta-analytic review was to quantify the effects of psychological therapies for the management of chronic pain in youth. Specifically, in this review we updated previous systematic reviews of randomized controlled trials by including new trials, and by adding disability and emotional functioning to pain as treatment outcomes. Electronic searches of the Cochrane Register of Randomised Controlled Trials, MEDLINE, PsycLIT, EMBASE, and the Social Sciences Citation Index were conducted from inception through August 2008. Methodological quality of the studies was assessed, and data extracted on the three primary outcomes of interest. Twenty-five trials including 1247 young people met inclusion criteria and were included in the meta-analysis. Meta-analytic findings demonstrated a large positive effect of psychological intervention on pain reduction at immediate post-treatment and follow-up in youth with headache, abdominal pain, and fibromyalgia. Small and non-significant effects were found for improvements in disability and emotional functioning, although there were limited data on these outcomes available in the included studies. Omnibus cognitive–behavioral therapy, relaxation therapy, and biofeedback all produced significant and positive effects on pain reduction. Studies directly comparing the effects of self-administered versus therapist-administered interventions found similar effects on pain reduction. Psychological therapies result in improvement in pain relief across several different pain conditions in children. Future trials are needed that incorporate non-pain outcome domains, that focus significant therapeutic content on reductions in disability, and that include extended follow-up to better understand maintenance of treatment effects.

Keywords: Psychological therapies, Randomized controlled trials, Chronic pain, Pain, Children, Meta-analysis, Systematic review