Prise en charge multidisciplinaire des enfants souffrant de douleurs chroniques invalidantes dans un centre de rééducation fonctionnelle pédiatrique français : analyse rétrospective d’une série et perspectives

Abstract

Chronic pain in children and adolescents has a major impact on their life in terms of school, sleep as well as family and social life. Teenagers aged 13-15 and girls are at the highest risk. Zeltzer et al. established a bio-psychosocial model of chronic pain in 1998 to account for all its dimensions and advocated a multidisciplinary management plan. Programs based on their principles target specific symptoms such as anxiety and loss of function, while treating underlying factors and teaching coping skills to patients and their families. They aim for patients to regain autonomy rather than focusing on pain resolution. Such programs, with varied protocols, have existed outside of France for approximately 15 years. The efficacy of these multidisciplinary programs has been shown in studies in Germany, the United Kingdom, the United States, Canada, and Australia. To our knowledge, there are no French studies on this topic; therefore, our aim was to describe a French program. We hypothesized that the program would be effective in reducing chronic pain and its impact. The aim of this study was to describe the multidisciplinary management of chronic pain in a French pediatric functional rehabilitation center. It is a public health establishment located in the suburbs of Lille, offering care for children aged 0-18 with various conditions. It has 52 hospital beds, can accommodate up to 22 day-hospital visits per day and has comprehensive technical facilities. This prospective study consisted in a chart review of all consecutive patients who were hospitalized in the functional rehabilitation center for chronic pain with significant disability since 2010. We reviewed the treatment protocol for each patient as well as the treatment results for the composite primary endpoint, comprising pain characteristics and the impact of pain on function and schooling after discharge. Twenty-nine patients, aged 9.4-17.8 years, 62.1% of whom were girls, were hospitalized for chronic pain with a significant impact on their daily life between 2010 and August 2014. The most common diagnosis was complex regional pain syndrome type 1 (CRPS1) (37.9%). Pain had major consequences, with total disability in 69% of cases and 100% of children taking pain medications. In 65.5% of cases, patients were hospitalized in an inpatient setting, and 34.5% attended an outpatient program. Treatment lasted from 1 to 68 weeks (mean, 24.3; standard deviation [SD], 21.6). Patients received a combination of medical care, physical therapy (100%), occupational therapy (37.9%), psychological counseling (100%), pain medications (96.6%), and schooling (96.6%). Pain improved significantly in 89.7% of patients (95% confidence interval [95% CI] [0.73-0.98]) and pain medication consumption decreased significantly in 72.4% of children (95% CI [0.53-0.87]). Patients who had stopped walking could ambulate again in 91.7% of cases (95% CI [0.73-0.99]) and 86.4% of patients who had been missing school were back at school full time (95% CI [0.65-0.97]). There were no significant differences for these results between inpatient and outpatient management programs. Improvements were maintained at 3-6 months after discharge in 83.3% of cases. The multidisciplinary pain management program in this French pediatric functional rehabilitation center shows results comparable to the programs described in other countries. Chronic pain should be evaluated with standardized and validated tools, such as the measurement of the pain-related disability with the Functional Disability Index.