Chronic pain treatment in children and adolescents: less is good, more is sometimes better

BMC Pediatrics

Boris Zernikow¹  Julia Wager¹  Tanja Hechler¹ 

[1] German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, Datteln, Department of Children’s Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Dr.-Friedrich-Steiner Str. 5, 45711 Datteln, Germany

关键词: Paediatric chronic pain;    Intensive inpatient treatment;    Outpatient treatment;    Interdisciplinary;   

Others  :  1121193
DOI  :  10.1186/1471-2431-14-262

 received in 2014-04-30, accepted in 2014-10-03,  发布年份 2014

【 摘 要 】

Background

In children with chronic pain, interdisciplinary outpatient and intensive inpatient treatment has been shown to improve pain intensity and disability. However, there are few systematic comparisons of outcomes of the two treatments. The present naturalistic study aimed to compare the clinical presentation and achieved changes at return in three outcome domains (pain intensity, disability, school absence) between a) outpatients vs. inpatients and b) patients who declined intensive inpatient treatment and completed outpatient treatment instead (decliners) vs. those who completed inpatient treatment (completers).

Methods

The study compared treatment outcomes between n = 992 outpatients vs. n = 320 inpatients (Analysis A) who were treated at a tertiary treatment centre and returned for a return visit within a one-year interval. In Analysis B, treatment outcomes were compared between n = 67 decliners vs. n = 309 completers of inpatient treatment. The three outcome domains were compared by calculating standardized change scores and clinically significant changes.

Results

In analysis A, outpatients and inpatients reported comparably low levels of pain intensity (NRS 0–10; mean = 4, SD = 2.7) and disability (Paediatric Pain Disability Index (PPDI: 12–60; mean = 24; SD = 10) at the return visit. Compared to outpatients, more inpatients achieved clinically significant changes in pain intensity (52% vs. 45%) and disability (46% vs. 31%). There were also significantly greater changes in disability in the inpatient group (change score _outpatients = 1.0; change score _inpatients = 1.4; F_(1,1138) = 12.6, p = .011). School absence was substantially reduced, with approximately 80% in each group attending school regularly. Analysis B showed that even though inpatient decliners achieved improvements in the outcome domains, they reported greater disability at the return visit (PPDI mean _decliners = 27, SD = 9.9; PPDI mean _completers = 24, SD = 10) because they had achieved fewer changes in disability (change score _decliners = 0.9; change score _completers = 1.4; F_(1.334) = 5.7, p = .017). In addition, less decliners than completers achieved clinically significant changes in disability (25% vs. 47%).

Conclusions

Inpatient and outpatient treatments are able to elicit substantial changes in pain intensity, disability and school absence. The results highlight the necessity of intensive inpatient pain treatment for highly affected children, as children who declined inpatient treatment and were treated as outpatients did less well.

【 授权许可】

   
2014 Hechler et al.; licensee BioMed Central Ltd.

【 图 表 】

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