Chronic pain in children and adolescents: 24–42 month outcomes of an inpatient/day hospital interdisciplinary pain rehabilitation program

Article type: Research Article

Authors: Banez, Gerard A.^{; ;} | Frazier, Thomas W. | Wojtowicz, Andrea A. | Buchannan, Kristen | Henry, Douglas E.^; | Benore, Ethan^;

Affiliations: Pediatric Pain Rehabilitation Program, Cleveland Clinic, Cleveland, OH, USA | Center for Pediatric Behavioral Health, Cleveland Clinic, Cleveland, OH, USA | Department of Developmental and Rehabilitation Pediatrics, Cleveland Clinic, Cleveland, OH, USA

Note: [] Corresponding author: Gerard A. Banez, Pediatric Pain Rehabilitation Program, Cleveland Clinic Children's Hospital for Rehabilitation, 2801 MLK Jr. Drive/CR 11, Cleveland, OH 44104, USA. Tel.: +1 216 448 6253; Fax: +1 216 448 6207; E-mail: [email protected]

Abstract: PURPOSE: The purpose of this research was to describe 24–42 month outcomes of a combined inpatient/day hospital interdisciplinary pain rehabilitation program for children and adolescents with chronic pain and functional disability. METHODS: One-hundred-seventy-three children and adolescents (mean age=15.1 years, SD=2.5) were treated in the three-week program. Mixed effects regression models (MERM) examined changes over time in pain ratings (0–10), school days missed by children and work days missed by parents in the preceding week, and the number of days hospitalized in the preceding month. RESULTS: Participants reported a significant decline in pain from admission to 24–42 month follow-up. The largest declines in pain occurred from discharge to 1-month follow-up (6.20 vs. 4.81 on a 0–10 numerical rating scale) and from 12 months to 24–42 month follow-up (4.90 vs. 3.56). Two distinct trajectories of treatment response were identified using growth mixture modeling: children with initially high pain ratings exhibited large reductions in pain ratings, while those with lower pain ratings at admission showed minimal reductions. Treatment resulted in significant reductions in school and work days missed and the number of days hospitalized (all p's < 0.001), with reductions evident at 1-month follow-up and maintained through 24–42 month follow-up. CONCLUSIONS: These results suggest that interdisciplinary pain rehabilitation is a promising approach to chronic pain and associated disability in children, with enduring improvements found 24–42 months following program completion. Distinct trajectories of treatment response were identified.

Keywords: Adolescents, pain, interdisciplinary health team, rehabilitation, outcomes assessment

DOI: 10.3233/PRM-140289

Journal: Journal of Pediatric Rehabilitation Medicine, vol. 7, no. 3, pp. 197-206, 2014