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Eccleston C, Yorke L, Morley S, Williams AC,
Mastroyannopoulou K.
Cochrane Database Syst Rev. 2003;(1):CD003968
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Pain Management Unit, University of Bath and Royal National Hospital
for Rheumatic Diseases, University of Bath, Claverton Down Road, Bath, UK,
BS16 6PJ. C.Eccleston@bath.ac.uk
BACKGROUND: An increasing number of children suffer with pain that lasts
for six months or longer. Traditional treatment for such pain has been
pharmacological and/or physical. Increasingly, following developments in
the field of adult chronic pain management, psychological therapies are
being employed to treat children with chronic or recurrent pain.
OBJECTIVES: To assess the effectiveness of psychological therapies in
treating chronic or recurrent pain in children and adolescents, and to
test the null hypothesis that psychological therapies are no more
effective than placebo, waiting list control or standard medical care.
SEARCH STRATEGY: Electronic searches of the Cochrane Register of
Randomised Controlled Trials, MEDLINE (1966-1999), Social Sciences
Citation Index (1981-1999) and PsycLit (1974-1999) were made. RCTs were
also sought in references of all identified studies, meta-analyses and
reviews, and first authors and experts within the field were contacted.
Date of the most recent search: December 1999. SELECTION CRITERIA: RCTs
with at least five participants in each study arm which compared
psychological therapies with placebo, waiting list or standard medical
care for children or adolescents with chronic or recurrent pain were
eligible for inclusion. DATA COLLECTION AND ANALYSIS: Data were inspected
for heterogeneity. For homogeneous dichotomous data the odds ratio with
95% confidence interval were calculated on an intention to treat basis.
MAIN RESULTS: Thirty papers were recovered, representing 28 RCTs. Of
these, 18 were analysable and included a total of 808 patients, 438 of
whom entered treatment conditions. Fifteen were trials of chronic or
recurrent headache; two for recurrent abdominal pain; and one for sickle
cell pain. Only pain experience data from 13 trials were meta-analysable.
Two meta-analyses were conducted. The first analysis of single treatments
versus controls gave a pooled odds ratio of 8.83 (95% CI 4.33 to 18.03;
z=5.98, P < 0.00001, df = 12 ). The second analysis (combined treatment
versus control) produced a similar estimate: pooled odds ratio = 8.64 (
95% CI = 4.13 to 18.07; z-5.73, P < 0.00001, df = 9 ). Both analyses
indicate that psychological treatment is effective when compared with a
pooled group of control conditions. From the pooled data set the NNT was
2.32 (95%CI 1.96 to 2.88).
Reviewers' Conclusions: There is very good evidence that
psychological treatments, principally relaxation and cognitive behavioural
therapy, are effective in reducing the severity and frequency of chronic
headache in children and adolescents. There is at present no evidence for
the effectiveness of psychological therapies in attenuating pain in
conditions other than headache, and little evidence for the effectiveness
of psychological therapies in improving non-pain outcomes.
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