Systematic review and meta-analysis of psychological therapies for children with chronic pain.
Fisher E., Heathcote L., Palermo TM., de C Williams AC., Lau J., Eccleston C.
OBJECTIVES: This systematic review and meta-analysis examined the effects of psychological therapies for management of chronic pain in children. METHODS: Randomized controlled trials of psychological interventions treating children (<18 years) with chronic pain conditions including headache, abdominal, musculoskeletal, or neuropathic pain were searched for. Pain symptoms, disability, depression, anxiety, and sleep outcomes were extracted. Risk of bias was assessed and quality of the evidence was rated using GRADE. RESULTS: 35 included studies revealed that across all chronic pain conditions, psychological interventions reduced pain symptoms and disability posttreatment. Individual pain conditions were analyzed separately. Sleep outcomes were not reported in any trials. Optimal dose of treatment was explored. For headache pain, higher treatment dose led to greater reductions in pain. No effect of dosage was found for other chronic pain conditions. CONCLUSIONS: Evidence for psychological therapies treating chronic pain is promising. Recommendations for clinical practice and research are presented.