Abstract
BackgroundTo assess the quality of evidence for the effects of psychosocial therapies on pain and function in children with rheumatic diseases.MethodsWe conducted a literature search of MEDLINE and PsycINFO for randomized clinical trials of psychosocial interventions for pain and disability in children with rheumatic diseases from January 1969 to September 2015. Studies with a sample size less than 10 subjects were excluded. Study quality was assessed using the Jadad score.ResultsFive articles met inclusion criteria, for a total of 229 patients, aged 5 to 18 years. Two studies included children with fibromyalgia. Three studies included children with juvenile arthritis. Neither study in fibromyalgia reported the statistical significance of immediate between-group pre-post changes in functioning or pain. One study examining the effects of an internet-based psychosocial intervention in children with juvenile arthritis reported significant differences in post-intervention pain scores (p = 0.03). However, 2 studies did not show improvements in pain scores among children with juvenile arthritis treated with psychosocial interventions vs. a wait-list control or vs. an active control (massage). No studies reported significant between-group differences for functional outcomes in children with juvenile arthritis.ConclusionsThe available data were limited by the scarcity of randomized trials. Definite conclusions about the immediate effect of psychosocial interventions on pain and function in children with fibromyalgia could not be made because between-group comparisons of post-treatment change scores were not reported. For children with juvenile inflammatory arthritis, results of between-group comparisons for pain differed across studies, and analyses examining disability revealed no significant differences between groups.
Highlights
To assess the quality of evidence for the effects of psychosocial therapies on pain and function in children with rheumatic diseases
We divided these into trials of juvenile fibromyalgia and trials of juvenile arthritis because the pathophysiology of these conditions differs, with fibromyalgia being a noninflammatory condition and juvenile arthritis being a systemic inflammatory condition
Post-score difference adjusted for pre-score: p-value NS
Summary
To assess the quality of evidence for the effects of psychosocial therapies on pain and function in children with rheumatic diseases. Children with rheumatic conditions often experience pain and disability [1, 2], leading to significant impairment in quality of life [3]. Pain and disability are frequently associated with mood disorders. Stress and mood problems may be associated with pain and disability [5, 6]. Given the association between pain, disability and Psychosocial therapies may be defined as any therapies that influence the psychosocial processes which underpin or maintain pain, disability or other symptoms [7]. Mind-body comprises the most commonly used complementary and alternative therapies, such as acupuncture, Cohen et al Pediatric Rheumatology (2017) 15:6 biofeedback, hypnosis, progressive muscle relaxation, guided imagery, mindfulness, meditation, yoga, tai chi and qi gong [9] Mindbody therapies are defined by the National Center for Complementary and Integrative Health as “a large and diverse group of techniques that are administered or taught to others by a trained practitioner or teacher [8].” Mind-body comprises the most commonly used complementary and alternative therapies, such as acupuncture, Cohen et al Pediatric Rheumatology (2017) 15:6 biofeedback, hypnosis, progressive muscle relaxation, guided imagery, mindfulness, meditation, yoga, tai chi and qi gong [9]
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