Effectiveness of a Psychosocial Aftercare Program for Youth Aged 8 to 17 Years With Severe Chronic Pain: A Randomized Clinical Trial
Severe chronic pediatric pain causes individual suffering and significantly affects social functioning and psychological well-being. For children with high pain severity, intensive interdisciplinary pain treatment (IIPT) is a well-established treatment. However, across specialized centers, it is not...
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| Veröffentlicht in: | JAMA network open 2021-09, Vol.4 (9), p.e2127024-e2127024 |
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| creator | Dogan, Meltem Hirschfeld, Gerrit Blankenburg, Markus Frühwald, Michael Ahnert, Rosemarie Braun, Sarah Marschall, Ursula Pfenning, Ingo Zernikow, Boris Wager, Julia |
| description | Severe chronic pediatric pain causes individual suffering and significantly affects social functioning and psychological well-being. For children with high pain severity, intensive interdisciplinary pain treatment (IIPT) is a well-established treatment. However, across specialized centers, it is not sufficient for all patients.
To evaluate the effectiveness of a psychosocial aftercare (PAC) program for pediatric patients with severe chronic pain followed up for 6 months after discharge from IIPT.
This multicenter randomized clinical trial with 4 assessment points (pre-IIPT, immediately post-IIPT, 3 months, and 6 months) was conducted at 3 pediatric specialized tertiary care pain centers in Germany between September 11, 2018, and March 31, 2020. Included patients were aged 8 to 17 with a severe chronic pain condition who had been admitted for IIPT. Data were analyzed from June 8 to September 4, 2020.
Patients and their families were randomly assigned to 1 of 2 study groups at inpatient IIPT admission. Both groups received standardized 3- to 4-week IIPT. After IIPT discharge, the intervention group received PAC and the control group received usual care. PAC involved ongoing contact with a social worker for as long as the family requested the support, up to a maximum of 6 months.
The primary outcome measure was pain at 6 months, measured using the Chronic Pain Grading (CPG), an instrument based on an algorithm indicating severity of the chronic pain disorder. Secondary outcomes included other pain-related and emotional parameters.
A total of 419 patients were randomized (mean [SD] age, 14.3 [2.1] years; 303 [72.3%] girls; 116 [27.7%] boys), with 218 assigned to usual care and 201 assigned to PAC. At baseline in both groups, the median (IQR) CPG was 3 (2-4). Superiority of PAC compared with usual care was demonstrated at 6 months (median [IQR] CPG: usual care, 2 [2-3]; PAC, 1 [1-2]; r = 0.30; 95% CI, 0.17-0.41). Additionally, PAC significantly improved emotional parameters (eg, significant time × group interaction: b = -8.84; P |
| doi_str_mv | 10.1001/jamanetworkopen.2021.27024 |
| format | Article |
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To evaluate the effectiveness of a psychosocial aftercare (PAC) program for pediatric patients with severe chronic pain followed up for 6 months after discharge from IIPT.
This multicenter randomized clinical trial with 4 assessment points (pre-IIPT, immediately post-IIPT, 3 months, and 6 months) was conducted at 3 pediatric specialized tertiary care pain centers in Germany between September 11, 2018, and March 31, 2020. Included patients were aged 8 to 17 with a severe chronic pain condition who had been admitted for IIPT. Data were analyzed from June 8 to September 4, 2020.
Patients and their families were randomly assigned to 1 of 2 study groups at inpatient IIPT admission. Both groups received standardized 3- to 4-week IIPT. After IIPT discharge, the intervention group received PAC and the control group received usual care. PAC involved ongoing contact with a social worker for as long as the family requested the support, up to a maximum of 6 months.
The primary outcome measure was pain at 6 months, measured using the Chronic Pain Grading (CPG), an instrument based on an algorithm indicating severity of the chronic pain disorder. Secondary outcomes included other pain-related and emotional parameters.
A total of 419 patients were randomized (mean [SD] age, 14.3 [2.1] years; 303 [72.3%] girls; 116 [27.7%] boys), with 218 assigned to usual care and 201 assigned to PAC. At baseline in both groups, the median (IQR) CPG was 3 (2-4). Superiority of PAC compared with usual care was demonstrated at 6 months (median [IQR] CPG: usual care, 2 [2-3]; PAC, 1 [1-2]; r = 0.30; 95% CI, 0.17-0.41). Additionally, PAC significantly improved emotional parameters (eg, significant time × group interaction: b = -8.84; P < .001).
This randomized clinical trial found that PAC improved pain-related and emotional parameters during the intervention 6 months after discharge from IIPT. Future research is needed to investigate the intervention's long-term effects.
German Clinical Trials Register ID: DRKS00015230.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2021.27024</identifier><identifier>PMID: 34570203</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Adolescent ; Aftercare - methods ; Aftercare - statistics & numerical data ; Anxiety - psychology ; Child ; Chronic pain ; Chronic Pain - psychology ; Chronic Pain - therapy ; Clinical trials ; Depression - psychology ; Female ; Germany ; Humans ; Intervention ; Male ; Online Only ; Original Investigation ; Pain ; Pain Measurement ; Patient Satisfaction - statistics & numerical data ; Pediatrics ; Treatment Outcome</subject><ispartof>JAMA network open, 2021-09, Vol.4 (9), p.e2127024-e2127024</ispartof><rights>2021. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright 2021 Dogan M et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-a364t-cb1d90c5caf085c9fd84be72a8222a51cb0e511e6d2f86a434f335d119b91a913</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,861,882,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34570203$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dogan, Meltem</creatorcontrib><creatorcontrib>Hirschfeld, Gerrit</creatorcontrib><creatorcontrib>Blankenburg, Markus</creatorcontrib><creatorcontrib>Frühwald, Michael</creatorcontrib><creatorcontrib>Ahnert, Rosemarie</creatorcontrib><creatorcontrib>Braun, Sarah</creatorcontrib><creatorcontrib>Marschall, Ursula</creatorcontrib><creatorcontrib>Pfenning, Ingo</creatorcontrib><creatorcontrib>Zernikow, Boris</creatorcontrib><creatorcontrib>Wager, Julia</creatorcontrib><title>Effectiveness of a Psychosocial Aftercare Program for Youth Aged 8 to 17 Years With Severe Chronic Pain: A Randomized Clinical Trial</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>Severe chronic pediatric pain causes individual suffering and significantly affects social functioning and psychological well-being. For children with high pain severity, intensive interdisciplinary pain treatment (IIPT) is a well-established treatment. However, across specialized centers, it is not sufficient for all patients.
To evaluate the effectiveness of a psychosocial aftercare (PAC) program for pediatric patients with severe chronic pain followed up for 6 months after discharge from IIPT.
This multicenter randomized clinical trial with 4 assessment points (pre-IIPT, immediately post-IIPT, 3 months, and 6 months) was conducted at 3 pediatric specialized tertiary care pain centers in Germany between September 11, 2018, and March 31, 2020. Included patients were aged 8 to 17 with a severe chronic pain condition who had been admitted for IIPT. Data were analyzed from June 8 to September 4, 2020.
Patients and their families were randomly assigned to 1 of 2 study groups at inpatient IIPT admission. Both groups received standardized 3- to 4-week IIPT. After IIPT discharge, the intervention group received PAC and the control group received usual care. PAC involved ongoing contact with a social worker for as long as the family requested the support, up to a maximum of 6 months.
The primary outcome measure was pain at 6 months, measured using the Chronic Pain Grading (CPG), an instrument based on an algorithm indicating severity of the chronic pain disorder. Secondary outcomes included other pain-related and emotional parameters.
A total of 419 patients were randomized (mean [SD] age, 14.3 [2.1] years; 303 [72.3%] girls; 116 [27.7%] boys), with 218 assigned to usual care and 201 assigned to PAC. At baseline in both groups, the median (IQR) CPG was 3 (2-4). Superiority of PAC compared with usual care was demonstrated at 6 months (median [IQR] CPG: usual care, 2 [2-3]; PAC, 1 [1-2]; r = 0.30; 95% CI, 0.17-0.41). Additionally, PAC significantly improved emotional parameters (eg, significant time × group interaction: b = -8.84; P < .001).
This randomized clinical trial found that PAC improved pain-related and emotional parameters during the intervention 6 months after discharge from IIPT. Future research is needed to investigate the intervention's long-term effects.
German Clinical Trials Register ID: DRKS00015230.</description><subject>Adolescent</subject><subject>Aftercare - methods</subject><subject>Aftercare - statistics & numerical data</subject><subject>Anxiety - psychology</subject><subject>Child</subject><subject>Chronic pain</subject><subject>Chronic Pain - psychology</subject><subject>Chronic Pain - therapy</subject><subject>Clinical trials</subject><subject>Depression - psychology</subject><subject>Female</subject><subject>Germany</subject><subject>Humans</subject><subject>Intervention</subject><subject>Male</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>Pain</subject><subject>Pain Measurement</subject><subject>Patient Satisfaction - statistics & numerical data</subject><subject>Pediatrics</subject><subject>Treatment Outcome</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkVtvEzEQhS0EolXpX0AWvPCS4Mt6L31AiqJykSoRQRHqkzXrHScOu3Zq7waVZ344Di1V6ZMtzzlnZvwR8oqzOWeMv93CAB7HnyH-CDv0c8EEn4uKieIJORaqKmayZurpg_sROU1pyxgTjMumVM_JkSxUdjB5TH6fW4tmdHv0mBINlgJdpRuzCSkYBz1d2BGjgYh0FcM6wkBtiPQqTOOGLtbY0ZqOgfKKXiHERL-7_P4V95gNy00M3hm6AufP6IJ-Ad-Fwf3KpmXvciXHX8bc5AV5ZqFPeHp3npBv788vlx9nF58_fFouLmYgy2KcmZZ3DTPKgGW1Mo3t6qLFSkAthADFTctQcY5lJ2xdQiELK6XqOG_ahkPD5Ql5d5u7m9oBO4N-jNDrXXQDxBsdwOn_K95t9DrsdV1UlShVDnhzFxDD9YRp1INLBvs-IwlT0vnPy4arksssff1Iug1T9Hk9LcqyqmpRVIeJzm5VJoaUItr7YTjTB976EW994K3_8s7mlw_Xubf-oyv_AKFVrF0</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Dogan, Meltem</creator><creator>Hirschfeld, Gerrit</creator><creator>Blankenburg, Markus</creator><creator>Frühwald, Michael</creator><creator>Ahnert, Rosemarie</creator><creator>Braun, Sarah</creator><creator>Marschall, Ursula</creator><creator>Pfenning, Ingo</creator><creator>Zernikow, Boris</creator><creator>Wager, Julia</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210901</creationdate><title>Effectiveness of a Psychosocial Aftercare Program for Youth Aged 8 to 17 Years With Severe Chronic Pain: A Randomized Clinical Trial</title><author>Dogan, Meltem ; 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For children with high pain severity, intensive interdisciplinary pain treatment (IIPT) is a well-established treatment. However, across specialized centers, it is not sufficient for all patients.
To evaluate the effectiveness of a psychosocial aftercare (PAC) program for pediatric patients with severe chronic pain followed up for 6 months after discharge from IIPT.
This multicenter randomized clinical trial with 4 assessment points (pre-IIPT, immediately post-IIPT, 3 months, and 6 months) was conducted at 3 pediatric specialized tertiary care pain centers in Germany between September 11, 2018, and March 31, 2020. Included patients were aged 8 to 17 with a severe chronic pain condition who had been admitted for IIPT. Data were analyzed from June 8 to September 4, 2020.
Patients and their families were randomly assigned to 1 of 2 study groups at inpatient IIPT admission. Both groups received standardized 3- to 4-week IIPT. After IIPT discharge, the intervention group received PAC and the control group received usual care. PAC involved ongoing contact with a social worker for as long as the family requested the support, up to a maximum of 6 months.
The primary outcome measure was pain at 6 months, measured using the Chronic Pain Grading (CPG), an instrument based on an algorithm indicating severity of the chronic pain disorder. Secondary outcomes included other pain-related and emotional parameters.
A total of 419 patients were randomized (mean [SD] age, 14.3 [2.1] years; 303 [72.3%] girls; 116 [27.7%] boys), with 218 assigned to usual care and 201 assigned to PAC. At baseline in both groups, the median (IQR) CPG was 3 (2-4). Superiority of PAC compared with usual care was demonstrated at 6 months (median [IQR] CPG: usual care, 2 [2-3]; PAC, 1 [1-2]; r = 0.30; 95% CI, 0.17-0.41). Additionally, PAC significantly improved emotional parameters (eg, significant time × group interaction: b = -8.84; P < .001).
This randomized clinical trial found that PAC improved pain-related and emotional parameters during the intervention 6 months after discharge from IIPT. Future research is needed to investigate the intervention's long-term effects.
German Clinical Trials Register ID: DRKS00015230.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>34570203</pmid><doi>10.1001/jamanetworkopen.2021.27024</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Aftercare - methods Aftercare - statistics & numerical data Anxiety - psychology Child Chronic pain Chronic Pain - psychology Chronic Pain - therapy Clinical trials Depression - psychology Female Germany Humans Intervention Male Online Only Original Investigation Pain Pain Measurement Patient Satisfaction - statistics & numerical data Pediatrics Treatment Outcome |
| title | Effectiveness of a Psychosocial Aftercare Program for Youth Aged 8 to 17 Years With Severe Chronic Pain: A Randomized Clinical Trial |
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