In kids with chronic pain, function improves faster than pain with psychological treatment

By Anne Harding

NEW YORK (Reuters Health) - Improvement in functional ability precedes improvement in pain in pediatric chronic pain patients undergoing psychological treatment, new findings show.

"Our research shows that our treatments improve function first and pain may be a slower marker to move," Dr. Anne Lynch-Jordan of Cincinnati Children's Hospital Medical Center, the first author of the new study, told Reuters Health. "Prior to this study this was anecdotally told to patients, but there wasn't data to actually back this up."

Chronic pain patients frequently expect their pain to improve before they can return to normal functioning, Dr. Lynch-Jordan and her team note in their report, published online June 23rd in Pain.

"In practice, outpatient treatments for chronic pain emphasize a rehabilitative approach including decreasing pain-related disability, and it has been a common dictum amongst clinicians that 'improvement is first measured by increased functioning,'" they add.

To investigate their hypothesis that functional disability would improve more rapidly over time during psychological treatment than pain intensity, the researchers looked at 94 patients with chronic pain who ranged in age from 8 to 18. Patients received cognitive behavioral therapy (CBT) for pain management, averaging 5.6 sessions each, and completed the Functional Disability Inventory (FDI) and a Numeric Rating Scale of average pain intensity at each session. They also received standard medical care for their pain as prescribed, such as medication for headache and dietary changes for abdominal pain.

Study participants included 45 patients with headache, 19 with abdominal pain, 11 with joint pain, and 19 with other pain problems. On average, patients had moderate amounts of pain, although a subset of 16 patients reported very high pain levels. Average score on the FDI was 15.9, indicating moderate disability, while 14 patients had severe levels of functional disability. Types of disability included difficulty attending school due to pain, having to miss sports or gym class, trouble sleeping, and difficulty playing with friends.

Over time, there was a significant improvement in average FDI score. While average pain scores also improved, decreasing from 4.6 at pretreatment to 3.4 at the end of treatment, there was not a statistically significant longitudinal decline over the course of treatment.

Patients' pain intensity would likely have shown improvement if they had been followed for a more extended amount of time, Dr. Lynch-Jordan noted. "We're not seeing pain improvements because it's a slower marker to change and we don't have the follow-up period, because this is a real-world study, not a clinical trial."

She and her colleagues are now investigating whether subgroups of patients - for example, those with the most severe pain - show a different pattern of improvement in functional disability and pain intensity.

While CBT is an accepted treatment for chronic pain in pediatric patients that has been scientifically proven to work, Dr. Lynch-Jordan said in an interview, it is not widely available. "If a child with chronic pain is seen in a major medical center that has a pediatric chronic pain clinic, this is almost universally offered and embedded into that clinic, however this is a very specific area," she added. "If people don't live near a major city that has a major pediatric institution, they are going to have trouble finding this."

Insurance coverage can also be a barrier to psychological treatment for chronic pain in children, Dr. Lynch-Jordan said. Studies are now underway, she added, to investigate whether Web -based delivery of psychological treatment for chronic pain can be an effective alternative to in-person care.

SOURCE: http://bit.ly/1nkbGeR

Pain 2014.

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