Functional Disability in Adolescents with Chronic Pain: Comparing an Interdisciplinary Exposure Program to Usual Care.

Carolien Dekker,Jeanine Verbunt,Caroline Bastiaenen,Mariëlle Goossens,Silvia Remerie,Bjorn Winkens

doi:10.3390/children7120288

Carolien Dekker, Jeanine Verbunt + Show 4 more

Open Access

https://doi.org/10.3390/children7120288

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Journal: Children	Publication Date: Dec 11, 2020
Citations: 8	License type: CC BY 4.0

Affiliation: Maastricht University, Adelante

Abstract

(1) Background: Chronic musculoskeletal pain (CMP) in adolescents can negatively affect physical, psychological, and social functioning, resulting in functional disability. This randomized controlled trial (RCT) aimed to evaluate the effectiveness of an outpatient rehabilitation program based on graded exposure in vivo (EP) compared with care as usual (CAU: interdisciplinary outpatient rehabilitation care). Both EP and CAU aim to improve functional ability in adolescents with CMP. (2) Methods: Pragmatic multicenter RCT with 12-month follow-up. Adolescents (12–21 years) with CMP were invited to participate. Primary outcome: functional disability; secondary outcomes: perceived harmfulness; pain catastrophizing; pain intensity. Data analysis: intention-to-treat linear mixed model. (3) Results: Sixty adolescents (mean 16 years) were randomized; data for 53 were analyzed. Adolescents in EP showed relevant and significant decreases in functional disability (estimated mean difference at least −8.81, p ≤ 0.01) compared with CAU at all times. Significant differences in favor of EP were found for perceived harmfulness at all times (p ≤ 0.002), for pain catastrophizing at 2 months (p = 0.039) and for pain intensity at 4 and 10 months (p ≤ 0.028). (4) Conclusion: EP leads to a significant and clinically relevant decrease in functional disability compared with usual care.

Highlights

Chronic pain in children and adolescents is a major health concern [1,2]
Psychologically-based treatments, including cognitive behavioral therapy, for adolescent chronic pain appear to be effective in reducing pain, and the quality of studies has improved over the years [5,6]
Most studies focus on adolescents with headache and use pain reduction as the primary outcome of interest

Summary

Introduction

Chronic pain in children and adolescents is a major health concern [1,2]. Since pain during adolescence increases the risk of pain in adulthood [3,4], such complaints need to be treated as early as possible to prevent later suffering. Evidence about treatment effects of interdisciplinary treatments for adolescent chronic pain is relatively scarce. Psychologically-based treatments, including cognitive behavioral therapy, for adolescent chronic pain appear to be effective in reducing pain, and the quality of studies has improved over the years [5,6]. Most studies focus on adolescents with headache and use pain reduction as the primary outcome of interest. Evidence of treatment effectiveness on disability and emotional distress in adolescents with CMP is rare [5,6,7]

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