Inpatient-based intensive interdisciplinary pain treatment for highly impaired children with severe chronic pain: Randomized controlled trial of efficacy and economic effects
Inpatient-based intensive interdisciplinary pain treatment for highly impaired children with severe chronic pain: Randomized controlled trial of efficacy and economic effects
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DOI：
10.1016/j.pain.2013.09.015
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发表时间：
2014-01-01
期刊：
影响因子：
7.4
通讯作者：
Zernikow, Boris
中科院分区：
文献类型：
--
作者：
Hechler, Tanja;Ruhe, Ann-Kristin;Zernikow, Boris
儿童慢性疼痛，可导致儿童的有害影响，承担恶化到成年的风险。强化跨学科疼痛治疗（IIPT）可能是一种有效的治疗方法，因为它具有每天咨询多名专业人士的优势。ipt有效性的证据很少。我们在一项随机对照试验中通过比较干预组（IG） （n = 52）和等候名单对照组（WCG） （n = 52）来研究ipt的疗效。在治疗前（PRE）、治疗后（POST）、短期（6个月后）和长期（12个月后）随访时进行评估。我们确定了一个联合终点，改善（疼痛强度、残疾、缺课），并调查了3个额外的结果域（焦虑、抑郁、灾难化）。我们还调查了经济参数（医疗保健使用、父母缺勤、主观经济负担）的变化及其与儿童进步的关系。POST结果显示，IG组比WCG组有更多的儿童得到改善（55%对14%；Fisher P < 0.001；发生率差异的95%置信区间：0.21%对0.60%）。虽然对残疾、缺课、抑郁和灾难化有直接影响，但疼痛强度和焦虑直到短期随访才发生变化。两组中均有超过60%的儿童长期得到改善。父母们报告说，所有经济指标都显著下降。本研究的结果支持ipt的有效性。未来的研究有必要调查治疗反应的差异，并了解未改善儿童经济参数的变化。(C) 2013年国际疼痛研究协会。Elsevier B.V.版权所有。
Pediatric chronic pain, which can result in deleterious effects for the child, bears the risk of aggravation into adulthood. Intensive interdisciplinary pain treatment (IIPT) might be an effective treatment, given the advantage of consulting with multiple professionals on a daily basis. Evidence for the effectiveness of IIPT is scarce. We investigated the efficacy of an IIPT within a randomized controlled trial by comparing an intervention group (IG) (n = 52) to a waiting-list control group (WCG) (n = 52). We made assessments before treatment (PRE), immediately after treatment (POST), as well as at short-term (POST6MONTHS) and long-term (POST12MONTHS) follow-up. We determined a combined endpoint, improvement (pain intensity, disability, school absence), and investigated 3 additional outcome domains (anxiety, depression, catastrophizing). We also investigated changes in economic parameters (health care use, parental work absenteeism, subjective financial burden) and their relationship to the child's improvement. Results at POST showed that significantly more children in the IG than in the WCG were assigned to improvement (55% compared to 14%; Fisher P < .001; 95% confidence interval for incidence difference: 0.21% to 0.60%). Although immediate effects were achieved for disability, school absence, depression, and catastrophizing, pain intensity and anxiety did not change until short-term follow-up. More than 60% of the children in both groups were improved long-term. The parents reported significant reductions in all economic parameters. The results from the present study support the efficacy of the IIPT. Future research is warranted to investigate differences in treatment response and to understand the changes in economic parameters in nonimproved children. (C) 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.