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

• Published in: European journal of pain 2011-10, Vol.15 (9), p.976-984
• Main Authors: Hechler, Tanja, Martin, Annick, Blankenburg, Markus, Schroeder, Sandra, Kosfelder, Joachim, Hölscher, Lisa, Denecke, Heide, Zernikow, Boris
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Adolescent; Adolescents; Analgesics - therapeutic use; Anesthesia & Perioperative Care; Child; Child, Preschool; Children; Chronic pain; Chronic Pain - drug therapy; Chronic Pain - psychology; Chronic Pain - therapy; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Multimodal treatment; Outpatient treatment; Pain Measurement; Pain Medicine; Psychotherapy; Treatment Outcome; Treatment pathway
• ISSN: 1090-3801; 1532-2149
• DOI: 10.1016/j.ejpain.2011.03.001

Abstract 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 (4–18 years) 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 12 months 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.