Abstract
Chronic pain is common in individuals with joint hypermobility syndromes, but effective treatment options are poorly described. Intensive interdisciplinary pain management programs, incorporating medication management, pain psychology, biofeedback, physical and occupational therapy are effective for the treatment of multiple chronic pain conditions. We aimed to determine if such a program can improve pain and function in pediatric patients with chronic pain related to joint hypermobility. This retrospective cohort study included patients less than 18 years of age diagnosed with a joint hypermobility syndrome and chronic pain, who were treated in an intensive 6-week program at an interdisciplinary pain management center. Outcomes measured included Numeric Rating Scale (NRS) pain scores, Bath Adolescent Pain Questionnaire (BAPQ), Child Functional Disability Index (C-FDI) and Parent Functional Disability Index (P-FDI). Changes from admission to discharge were compared by Wilcoxon rank-sum test and assessed for clinical significance according to Cochrane Review criteria for treatment of chronic pain. Eleven female patients, mean age of 14.6, standard deviation (SD) 2.2 years (ranging 9-17), were included. From admission to discharge, average NRS scores significantly decreased for typical pain (p = 0.08) and greatest daily pain (p = 0.03). Patients showed significant improvement in the daily functioning as measured by the BAPQ (p = 0.04). The mean magnitude of change was 2.6 (SD 2.2), 2.5 (SD 3.0), and 4.5 (SD 6.6) for the decrease in typical pain, decrease in greatest pain, and improvement in daily functioning, respectively, representing clinically improvement for each of these outcome measures. Improvements on the C-FDI, P-FDI, and the emotion domain of the BAP-Q were nonsignificant (p’s >.05). Our findings suggest that an intensive interdisciplinary pain management program results in improvements in pain and functional scores that are both statistically and clinically significant. Chronic pain is common in individuals with joint hypermobility syndromes, but effective treatment options are poorly described. Intensive interdisciplinary pain management programs, incorporating medication management, pain psychology, biofeedback, physical and occupational therapy are effective for the treatment of multiple chronic pain conditions. We aimed to determine if such a program can improve pain and function in pediatric patients with chronic pain related to joint hypermobility. This retrospective cohort study included patients less than 18 years of age diagnosed with a joint hypermobility syndrome and chronic pain, who were treated in an intensive 6-week program at an interdisciplinary pain management center. Outcomes measured included Numeric Rating Scale (NRS) pain scores, Bath Adolescent Pain Questionnaire (BAPQ), Child Functional Disability Index (C-FDI) and Parent Functional Disability Index (P-FDI). Changes from admission to discharge were compared by Wilcoxon rank-sum test and assessed for clinical significance according to Cochrane Review criteria for treatment of chronic pain. Eleven female patients, mean age of 14.6, standard deviation (SD) 2.2 years (ranging 9-17), were included. From admission to discharge, average NRS scores significantly decreased for typical pain (p = 0.08) and greatest daily pain (p = 0.03). Patients showed significant improvement in the daily functioning as measured by the BAPQ (p = 0.04). The mean magnitude of change was 2.6 (SD 2.2), 2.5 (SD 3.0), and 4.5 (SD 6.6) for the decrease in typical pain, decrease in greatest pain, and improvement in daily functioning, respectively, representing clinically improvement for each of these outcome measures. Improvements on the C-FDI, P-FDI, and the emotion domain of the BAP-Q were nonsignificant (p’s >.05). Our findings suggest that an intensive interdisciplinary pain management program results in improvements in pain and functional scores that are both statistically and clinically significant.
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