Effectiveness of interdisciplinary interventions in paediatric chronic pain management: a systematic review and subset meta-analysis

Citation

Liossi C, Johnstone L, Lilley S, Caes L, Williams G & Schoth DE (2019) Effectiveness of interdisciplinary interventions in paediatric chronic pain management: a systematic review and subset meta-analysis. British Journal of Anaesthesia, 123 (2), pp. e359-e371. https://doi.org/10.1016/j.bja.2019.01.024

Abstract
Background Paediatric chronic pain is a significant problem that can have devastating impacts on quality of life. Multimodal interdisciplinary interventions are the mainstay of paediatric treatment. The aim of this article is to provide a comprehensive review of the effectiveness of interdisciplinary interventions in the management of paediatric chronic pain. Methods Studies were identified via a search of nine databases. The search strategy included concept blocks pertaining to type of pain, study population, and type of intervention. Eligible studies reported the effects of an intervention co-ordinated by two or more healthcare professionals of different disciplines, and recruited a sample aged 22 yr or below with chronic pain. Twenty-eight studies were included, and 21 provided data for inclusion in between- and within-groups meta-analyses. Results Patients randomised to interdisciplinary interventions reported significantly lower pain intensity 0–1 month post-intervention compared with patients randomised to the control groups. Within-groups analysis of patients receiving interdisciplinary interventions showed significant improvements pre- to post-intervention in pain intensity, functional disability, anxiety, depression, catastrophising, school attendance, school functioning, and pain acceptance. Few differences were found between interventions delivered in inpatient vs outpatient settings. Significant heterogeneity due mainly to differing outcome variables and intervention content was found in most analyses. Conclusions Overall, interdisciplinary interventions show promise in providing a range of clinical benefits for children with chronic pain. Methodologically robust randomised controlled trials using standardised outcome measures are needed, however, to guide clinical care.

Keywords
meta-analysis; interdisciplinary pain clinic; multimodal analgesia; paediatrics; chronic pain; systematic review

Journal
British Journal of Anaesthesia: Volume 123, Issue 2