The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding), and by imprecise results (wide cofidence intervals).
A Cochrane review (abstract , review [Abstract]) included 47 studies with a total of 2 884 children and adolescents (<18 years). 23 studies examined treatments for headache (including migraine), 10 for abdominal pain, 2 for fibromyalgia, 2 for temporomandibular disorders, 2 for recurrent abdominal pain or irritable bowel syndrome, 3 for pain associated with sickle cell disease, 2 for inflammatory bowel disease, and 3 for mixed pain conditions.
Psychological therapies reduced headache pain frequency post-treatment but the effects were not maintained at follow-up (table T1).
Outcome | Relative effect (95% CI) | Probable outcome with control | Probable outcome with intervention | NNT | Participants (studies) |
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50% reduction in headache frequency post-treatment | RR 2.35 (1.67 to 3.30) | 10 per 1000 | 24 per 1000 | 2.86 | 644 (15 studies) |
50% reduction in headache frequency (at up to 12 months follow-up) | RR 2.73 (0.98 to 7.63)* | 10 per 1000 | 27 per 1000 | 3.16 | 223 (5 studies) |
*statistical heterogeneity, I2 =77% | |||||||||||||||||||||||||||
Psychological therapies also had a small beneficial effect at reducing disability in headache conditions at follow-up (table T2) but not post treatment. No beneficial effects were found on depression or anxiety symptoms.
Psychological therapies compared with any control for children and adolescents with frequent headache
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*statistical heterogeneity, I2 =55%, ** I2 =72% | |||||||||||||||||||||||||||
Psychological therapies reduced pain intensity post-treatment, but not at follow-up for children and adolescents with mixed pain conditions (table T3). Psychological therapies also had a beneficial effect for disability post-treatment, and at follow-up. No effect was found for depression, but a beneficial effect on anxiety was found post-treatment although this was not maintained at follow-up.
Across all pain conditions, adverse events were reported in 7 studies, of which 2 studies reported adverse events that were study-related. Psychological therapies compared with any control for children and adolescents with mixed chronic pain
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References | |||||||||||||||||||||||||||
Fisher E, Law E, Dudeney J et al. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev 2018;(9):CD003968. [PubMed].
Primary/Secondary Keywords
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