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A155: Development of an Intensive Interdisciplinary Pediatric Pain Rehabilitation Program: Improving Pain, Functioning, and Psychological Outcomes
Author(s) -
Hoffart Cara,
Anderson Rawni,
Wallace Dustin
Publication year - 2014
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.38581
Subject(s) - physical therapy , medicine , rehabilitation , visual analogue scale , anxiety , pain catastrophizing , depression (economics) , psychological intervention , chronic pain , psychiatry , economics , macroeconomics
Background/Purpose: We examined functional, psychological, and pain‐related outcomes among children with amplified pain syndromes completing an intensive interdisciplinary pediatric pain rehabilitation program. We hypothesized that baseline psychological measures and disability would predict a longer treatment course. Methods: This outpatient program provides 5–6 hours of daily intensive physical and occupational therapy in addition to yoga, self‐regulation, and behavioral health intervention. All pain medications are discontinued, and no invasive therapeutic procedures are utilized. 30 patients (26 female) aged 11–18 with chronic musculoskeletal pain completed Functional Disability Inventory, 100mm Visual Analog Scale, PROMIS Anxiety, Depression, and PRCQ‐catastrophizing at baseline and the end of each week; 22 have completed a one‐month follow‐up, and 6 completed six‐month follow‐up. The mean program duration was 3.7 (SD 0.91) weeks, determined by achievement of functional goals. Analyses were conducted with SPSS and supplemented with hierarchical linear modeling (HLM7) for time‐series analyses of pain and functioning. Results: There is linear improvement in parent‐reported FDI (25.2 to 7.3, P < .001) and patient‐reported FDI (27.5 to 13.9, P < .001) between baseline and program end. Patient‐reported function showed additional significant gains at 1 and 6‐month follow‐up with FDI of 7.2 and 2.8, respectively ( P < .001). Patient‐reported pain did not consistently change during the program ( P = .975); however, longitudinal patterns demonstrated significant decrease in pain between program end and follow‐up ( P < .001). Pain is significantly affected by conversion symptoms, which are associated with higher levels of pain ( P = .005) but did not affect the pattern of pain resolution. Patient reported anxiety and depression decline significantly (P = 0.004 and P = 0.001, respectively) as does patient catastrophizing following treatment ( P = .001). Duration of treatment correlated with baseline functional disability (FDI r = .664; P = .001), and presence of conversion symptoms ( r = .548; P = .008).Conclusion: Children with amplified pain syndromes successfully restore and maintain function and improve pain without pharmacotherapy. Baseline functional disability and psychological factors correlate with treatment program duration. Prospective studies are warranted to determine long‐term efficacy and effectiveness of this interdisciplinary program.