Palmero and colleagues conducted a meta-analytic review to quantify the effects of psychological therapies for the management of chronic pain in youth. Specifically, the authors updated previous systematic reviews of randomized controlled trials by including new trials, and by adding disability and emotional functioning to pain as treatment outcomes. Electronic searches of the Cochrane Register of Randomized Controlled Trials, MEDLINE, PsycLIT, EMBASE, and the Social Sciences Citation Index were conducted from inception through August 2008. Methodological quality of the studies was assessed, and data extracted on the three primary outcomes of interest. Twenty-five trials including 1247 young people met inclusion criteria and were included in the meta-analysis. Meta-analytic findings demonstrated a large positive effect of psychological intervention on pain reduction at immediate post-treatment and follow-up in youth with headache, abdominal pain, and fibromyalgia. Small and non-significant effects were found for improvements in disability and emotional functioning, although there were limited data on these outcomes available in the included studies. Omnibus cognitive-behavioral therapy, relaxation therapy, and biofeedback all produced significant and positive effects on pain reduction. Studies directly comparing the effects of self-administered versus therapist-administered interventions found similar effects on pain reduction.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that psychological therapies result in improvement in pain relief across several different pain conditions in children. Future trials are needed that incorporate non-pain outcome domains that focus significant therapeutic content on reductions in disability, and that include extended follow-up to better understand maintenance of treatment effects.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The components that proved effective, particularly cognitive-behavior and relaxation therapies, are incorporated into most self-management programs. On omnibus self-management program that included these procedures, as well as self-monitoring, self-evaluation, decision-making, and action, should prove high efficient and effective, in treating pain in adolescents and children with pain.

TM Palermo et al. Randomized controlled trials of psychological therapies for management of chronic pain in children and adolescents: An updated meta-analytic review. Pain, November 10, 2009.