Abstract
Severe chronic pediatric pain causes individual suffering and significantly affects social functioning and psychological well-being. For children with high pain severity, intensive interdisciplinary pain treatment (IIPT) is a well-established treatment. However, across specialized centers, it is not sufficient for all patients. To evaluate the effectiveness of a psychosocial aftercare (PAC) program for pediatric patients with severe chronic pain followed up for 6 months after discharge from IIPT. This multicenter randomized clinical trial with 4 assessment points (pre-IIPT, immediately post-IIPT, 3 months, and 6 months) was conducted at 3 pediatric specialized tertiary care pain centers in Germany between September 11, 2018, and March 31, 2020. Included patients were aged 8 to 17 with a severe chronic pain condition who had been admitted for IIPT. Data were analyzed from June 8 to September 4, 2020. Patients and their families were randomly assigned to 1 of 2 study groups at inpatient IIPT admission. Both groups received standardized 3- to 4-week IIPT. After IIPT discharge, the intervention group received PAC and the control group received usual care. PAC involved ongoing contact with a social worker for as long as the family requested the support, up to a maximum of 6 months. The primary outcome measure was pain at 6 months, measured using the Chronic Pain Grading (CPG), an instrument based on an algorithm indicating severity of the chronic pain disorder. Secondary outcomes included other pain-related and emotional parameters. A total of 419 patients were randomized (mean [SD] age, 14.3 [2.1] years; 303 [72.3%] girls; 116 [27.7%] boys), with 218 assigned to usual care and 201 assigned to PAC. At baseline in both groups, the median (IQR) CPG was 3 (2-4). Superiority of PAC compared with usual care was demonstrated at 6 months (median [IQR] CPG: usual care, 2 [2-3]; PAC, 1 [1-2]; r = 0.30; 95% CI, 0.17-0.41). Additionally, PAC significantly improved emotional parameters (eg, significant time × group interaction: b = -8.84; P < .001). This randomized clinical trial found that PAC improved pain-related and emotional parameters during the intervention 6 months after discharge from IIPT. Future research is needed to investigate the intervention's long-term effects. German Clinical Trials Register ID: DRKS00015230.
Highlights
Intensive interdisciplinary pain treatment (IIPT) is a well-established treatment for severe pediatric chronic pain.[1]
Superiority of psychosocial aftercare (PAC) compared with usual care was demonstrated at 6 months
PAC significantly improved emotional parameters. This randomized clinical trial found that PAC improved painrelated and emotional parameters during the intervention 6 months after discharge from IIPT
Summary
Intensive interdisciplinary pain treatment (IIPT) is a well-established treatment for severe pediatric chronic pain.[1]. Interventions supporting transition from clinician-led treatment to self-determined use of learned strategies have been assessed in other chronic health conditions. Meta-analyses provide evidence that clinician-led multicomponent interventions (eg, parent education or behavioral training) can empower pediatric patients with chronic health conditions, such as asthma or diabetes, to self-reliantly follow their treatment plan, leading to improvements in disease management and disease severity.[6] In light of this evidence, an adjunctive family-centered treatment module for severe chronic pain was developed: personalized psychosocial aftercare (PAC), which aims to provide support for pediatric patients and their families in adherence to discharge recommendations and facilitate maintenance of IIPT treatment outcomes
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