The Role of the Mental Health Practitioner in the Assessment and Treatment of Child and Adolescent Chronic Pain

Cognitive behavioural therapy for functional abdominal pain disorders in children and adolescents: A systematic review of randomized controlled trials

AIM

Although Cognitive behavioural therapy (CBT) potentially holds efficacy in addressing functional abdominal pain disorders (FAPDs) amongst children and adolescents, the persistent efficacy is uncertain.

METHODS

We searched three databases to identify related randomized controlled trials (RCTs). Meta-analysis was performed using RevMan and Stata. Subgroup analyses were mainly conducted based on follow-up time. The GRADE approach was used to evaluate the certainty of the evidence.

RESULTS

A total of 14 RCTs evaluating 858 patients were included. All RCTs were rated as having a high risk of bias. Compared with control groups, CBT was associated with improvement of general functional impairment (standardized mean difference (SMD) = -0.77, 95% CI [-1.12, -0.42], p < 0.05), higher treatment success (relative risk (RR) = 2.35, 95% CI [1.50, 3.69], p < 0.05), improvement of abdominal pain symptoms (SMD = -0.48, 95% CI [-0.73, -0.23], p < 0.05), QoL (SMD = 0.42, 95% CI [0.20, 0.64], p < 0.05), and psychological states (SMD = -0.95, 95% CI [-1.62, -0.27], p < 0.05).

CONCLUSION

This meta-analysis provides low to moderate quality evidence that CBT could significantly improve clinical outcomes and QoL for children and adolescents with FAPDs with improvement persisting until short-term follow-up. However, there were discrepancies regarding CBT's effects at mid- and long-term follow-up across different outcomes. More high-quality and longer-duration studies are thus warranted to explore the effectiveness of CBT in the future.

SYSTEMATIC REVIEW REGISTRATION ON PROSPERO

CRD42022369353.

Editorial: Co-occurring problems in children and adolescents - assessment and treatment issues

The scientific literature is replete with evidence of the high prevalence of co-occurring mental health problems in children, adolescents, and adults (e.g., Hawkins, ; Kessler et al., ; Oland & Shaw, ). Such empirical data are substantiated by therapist and clinician assessments of the presenting symptoms in their client populations. The take-away message from this scientific and practitioner work is clear: in the absence of effective prevention or intervention services, children and adolescents with co-occurring mental health problems are at heightened risk for a range of difficulties across multiple domains, including school failure, involvement in criminal activities, drug use, and poor social relationships. Whether at the symptomatic or diagnostic level, co-occurring mental health problems present significant challenges to traditional mental health treatment service delivery systems, in which individuals are often treated for their primary presenting disorder, but other potential mental health problems are not assessed or directly dealt with. Similarly, although there is evidence that mental health symptoms co-occur at high rates, the majority of research continues to focus on one mental health condition, to the neglect of comorbid problems.

The effectiveness of cognitive behavioural therapy for pain in childhood and adolescence: a meta-analytic review

OBJECTIVES

A variety of chronic painful conditions are present in the paediatric population. Patients with chronic pain often experience considerable scepticism and avoidance by health care providers. This meta-analytic review aimed to utilise well-designed studies, in examining the effectiveness of cognitive behavioural therapy (CBT) in the treatment of chronic pain in children and adolescents.

METHODS

Nine randomized controlled trial studies examining CBT for chronic pain were reviewed. Outcome measures were child reported pain intensity, pain duration and functional disability.

RESULTS

CBT had a large effect on pain intensity for recurrent abdominal pain (RAP), a small effect on headaches, and a medium effect on fibromyalgia. CBT had a medium effect on pain duration across pain types. CBT had a large effect on functional disability for RAP, a small effect on fibromyalgia and a moderate effect on headaches. Findings are limited by the small number of studies and varied control conditions.

CONCLUSIONS

CBT may be effective in reducing child reported pain symptomology. Future studies using a larger sample and examining the differential impact of varied control conditions are needed.

Oncologic pain relief: strategies told by adolescents with cancer

In view of the negative impact of pain on the quality of life of cancer patients, identifying and stimulating the use of effective strategies to minimize these painful feelings is highly relevant for care. The aim of this study was to identify painful experiences of adolescents with cancer and to get to know their strategies for pain relief. This is an exploratory research, using qualitative data analysis. Semistructured interviews were held with nine adolescents with cancer, who reported on acute, recurring and chronic, physical and emotional painful experiences. To relieve these pains, they described pharmacological and non-pharmacological strategies, including: distraction, presence of relatives, bed positioning, cooperation to accomplish procedures and keeping up positive thinking. Therefore, it is essential for health professionals to know available evidence for pain relief and to develop skills to articulate this knowledge with their professional experience and with the patients' own strategies.

Psychosocial perspectives in the treatment of pediatric chronic pain

Chronic pain in children and adolescents is associated with major disruption to developmental experiences crucial to personal adjustment, quality of life, academic, vocational and social success. Caring for these patients involves understanding cognitive, affective, social and family dynamic factors associated with persistent pain syndromes. Evaluation and treatment necessitate a comprehensive multimodal approach including psychological and behavioral interventions that maximize return to more developmentally appropriate physical, academic and social activities. This article will provide an overview of major psychosocial factors impacting on pediatric pain and disability, propose an explanatory model for conceptualizing the development and maintenance of pain and functional disability in medically difficult-to-explain pain syndromes, and review representative evidence-based cognitive behavioral and systemic treatment approaches for improving functioning in this pediatric population.