Exploring the Mechanisms Underlying the Effectiveness of Psychosocial Aftercare in Pediatric Chronic Pain Treatment: A Qualitative Approach.

Meltem Dogan,Boris Zernikow,Susanne Lopez Lumbi,Ursula Marschall,Sarah Braun,Michael C. Frühwald,Rosemarie Ahnert,Julia Wager,Almut Hartenstein-Pinter,Markus Blankenburg

doi:10.3390/children9030407

Abstract

A newly developed specialized psychosocial aftercare program (PAC) for pediatric patients with chronic pain following an intensive interdisciplinary pain treatment (IIPT) was found to be significantly more effective than IIPT alone. This qualitative study aimed to gain further insight into the mechanisms and prerequisites for the effectiveness of this specialized aftercare program. We conducted structured telephone interviews with patients, parents, and health care professionals conducting PAC. A total of 16 interviews were conducted—seven interviews with parents, six interviews with patients, and three interviews with health care professionals—and transcribed verbatim. Data were analyzed using reflexive thematic analysis. Four major themes consisting of 20 subcategories were identified, namely (1) frame conditions, (2) person factors, (3) stabilization and (4) catalyst. The foundations of treatment success are frame conditions, such as flexibility or constancy, and person factors, such as respect or expertise. Based on these foundations, stabilization is achieved through security, mediation, orientation and support. Altogether, these components of PAC reveal their potential as catalysts for further improvement even after discharge from IIPT. Overall, patients and their families emphasized widespread personal relevance and acceptance of the PAC program. The findings of this study may be employed in the development of other aftercare programs or interventions involving families in the context of psychotherapeutic and psychosocial health care.

Highlights

Intensive interdisciplinary pain treatment (IIPT), a therapeutic approach based on a biopsychosocial understanding of pain, is the treatment of choice for severe pediatric chronic primary pain conditions [1,2]
This qualitative interview study was part of a larger multicenter randomized control trial (RCT) carried out in three large pediatric pain centers in Germany (German Paediatric Pain Centre in Datteln, Baden-Wuerttemberg Pediatric Pain Centre in Stuttgart, and Bavarian Pediatric Pain Centre in Augsburg), which investigated the effectiveness of a new personalized psychosocial aftercare program (PAC) for pediatric chronic pain patients [12]
Frame conditions and person factors constitute the base of PAC

Summary

Introduction

Intensive interdisciplinary pain treatment (IIPT), a therapeutic approach based on a biopsychosocial understanding of pain, is the treatment of choice for severe pediatric chronic primary pain conditions [1,2]. IIPT is delivered within a period of 3 to 4 weeks in an inpatient or day hospital setting. It involves collaboration between members of a multi-professional team, such as pediatricians, psychotherapists, nurses, and physiotherapists [1,3,4]. Two of the primary goals of IIPT are to provide patients and their families with strategies for pain management, as well as to address psychosocial problems, such as those related to school or family functioning [5]. While IIPT shows high long-term effectiveness for about 60% of patients, it is still not sufficient for some [6,7]. Clinical observations indicate a potential source of risk for treatment failure: The pain management techniques acquired—and the behavior change processes initiated—during

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Discussion

Conclusion