Specialized multimodal outpatient treatment for children with chronic pain: treatment pathways and long-term outcome.

OBJECTIVE: Despite the increased recognition of paediatric chronic pain, centres for providing appropriate treatment are scarce, and much remains unknown about optimal treatment approaches. The purpose of this study was to investigate effectiveness of multimodal outpatient treatment (MOT) through the examination of treatment pathways and long-term outcomes. METHODS: Within an observational longitudinal study, 275 children (4-18years) formed the study group and received MOT. Over a 12-month period, we followed the progress of the study group to identify how many children completed treatment, how many continued treatment and how many were stepped-up to more intensive treatment. To investigate significant and clinically relevant changes in primary and secondary outcomes the study group was assessed at three consecutive treatment sessions (initial session, 3-, 6-month visit) and 12months following the initial session. RESULTS: Analysis of treatment pathways showed that 1/3 of the children did not attend the prescribed second and third visit to the clinic. Cessation of treatment correlated with significant improvement. Only a small number of children were still in treatment at 12-month follow-up (12%) or needed more intensive treatment (11%). At 12-month follow-up, almost 70% of children in the study group were able to attend school regularly. Pain intensity, pain-related disability and inappropriate coping strategies were significantly reduced at 3-month visit and remained stable at the subsequent time points. CONCLUSIONS: MOT appears to be beneficial for children with chronic pain. A short intensive intervention (comprising of a total of 2.5-h) can lead to substantial improvements even for severely affected children.

Parental catastrophizing about their child's chronic pain: are mothers and fathers different?

Preliminary evidence suggests that parental catastrophizing about their child's pain may be important in understanding both parental responses to their child's pain and the child's pain experience. However, little is known about potential differences between mothers and fathers. There were three aims of the present study addressing this lack of knowledge: (i) to investigate the three-factor structure of the German version of the Parental Pain Catastrophizing Scale (PCS-P) (Goubert et al., 2006) in mothers and fathers of children with chronic pain, (ii) to explore differences between mothers and fathers in parental catastrophizing, (iii) to investigate the contribution of parental catastrophizing on the child's chronic pain problem and pain-related parent behavior. In a sample of 128 mothers and fathers of paediatric chronic pain patients, the invariance of the PCS-P was evaluated. Results replicated the previously established three-factor structure (i.e. rumination, magnification and helplessness) in both groups. Mothers reported higher levels of catastrophizing as compared to fathers. Specifically, mothers and fathers differed on levels of rumination; the two groups did not differ in magnification and helplessness. Maternal but not paternal catastrophizing contributed significantly in explaining the child's pain intensity whereas neither mothers' nor fathers' catastrophizing were significantly related to the child's disability. Both maternal and paternal catastrophizing contributed significantly to heightened parental solicitous responses. Fathers' but not mothers' catastrophizing also contributed to heightened distracting responses. The present findings attest to the importance of maternal and paternal catastrophizing for the child's pain characteristics and pain-related parent behavior, which are both relevant for treatment conceptualization.

The pain provocation technique for adolescents with chronic pain: preliminary evidence for its effectiveness.

OBJECTIVE: This study aims to investigate the effectiveness of the "pain provocation technique" (PPT)--a focused treatment strategy incorporating interoceptive exposure (i.e., imagining increases in pain intensity), bilateral stimulation (tactile stimulation), and implementation of pain-related coping to decrease pain intensity--for adolescents suffering from chronic pain. DESIGN: Prospective observational comparative study. METHODS: Adolescents utilizing PPT (19 boys and 21 girls) within multimodal inpatient treatment were compared with adolescents in standard multimodal inpatient treatment matched for age, gender, and diagnosis. Core outcome variables (pain intensity, disability, emotional distress) were assessed at admission and 3 months posttreatment. RESULTS: Adolescents in the PPT group demonstrated a sharper decrease in pain intensity and school aversion. Both groups demonstrated significant reductions in disability and emotional distress. CONCLUSIONS: Results are discussed in terms of the importance of focused treatment strategies such as interoceptive exposure for adolescents suffering from disabling chronic pain. Future studies are warranted to carefully investigate the effectiveness and possible process of change during the PPT such as sensory, cognitive, emotional, and memory aspects.