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) |
|---|---|---|---|---|---|
| *statistical heterogeneity, I2 =77% | |||||
| 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) |
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.
| Outcome | Standardized mean difference (95% CI) | Participants (studies) |
|---|---|---|
| *statistical heterogeneity, I2 =55%, ** I2 =72% | ||
| Disability | The mean disability in the intervention groups was 0.26 lower (-0.56 to 0.03)* | 446 (6 studies) |
| Disability at follow-up | The mean disability (at follow-up) in the intervention groups was 0.37 lower (-0.65 to -0.10) | 209 (3 studies) |
| Depression | The mean depression in the intervention groups was 0.08 lower (-0.28 to 0.11) | 400 (6 studies) |
| Depression at follow-up | The mean depression (at follow-up) in the intervention groups was 0.05 lower (-0.62 to 0.52)** | |
| Anxiety | The mean anxiety in the intervention groups was 0.11 lower (-0.39 to 0.17) | 439 (7 studies) |
| Anxiety at follow-up | The mean anxiety (at follow-up) in the intervention groups was 0.12 lower (-0.46 to 0.21) | 271 (4 studies) |
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.
| Outcome | Standardized mean difference (95% CI) | Participants (studies) |
|---|---|---|
| Pain | The mean pain in the intervention groups was 0.43 lower (-0.67 to -0.19); I2 =73% | 1 210 (16 studies) |
| Pain at follow-up | The mean pain in the intervention groups was 0.08 lower (-0.30 to 0.13); I2 =51% | 763 (9 studies) |
| Disability | The mean disability in the intervention groups was 0.34 lower (-0.54 to -0.15); I2 =59% | 1 226 (14 studies) |
| Disability at follow-up | The mean disability in the intervention groups was 0.27 lower (-0.49 to -0.06); I2 =59% | 866 (9 studies) |
| Depression | The mean depression in the intervention groups was 0.05 lower (-0.23 to 0.12) | 757 (8 studies) |
| Depression at follow-up | The mean depression in the intervention groups was 0.09 higher(-0.10 to 0.28) | 667 (7 studies) |
| Anxiety | The mean anxiety in the intervention groups was 0.16 lower (-0.29 to -0.03) | 883 (8 studies) |
| Anxiety at follow-up | The mean anxiety in the intervention groups was 0.01 lower (-0.20 to 0.18) | 805 (85 studies) |
Primary/Secondary Keywords