Pain rehab may boost children’s ownership of self management

By Piriya Mahendra

Pediatric pain rehabilitation may lead to an increased willingness to self-manage pain, which is associated with improvements in function and psychologic wellbeing, say researchers.

Deirdre Logan found that from pretreatment to posttreatment, children with chronic pain and their parents showed an increased sense of personal responsibility for managing pain and more active involvement in learning self-management strategies, as reflected by decreased numbers of both classified as being in the Contemplation stage and increased numbers in the Action/Maintenance stages of the adult Pain Stages of Change Questionnaire (PSOCQ).

In addition, these changes were maintained at the 1- to 3-month follow-up periods, they report in Pain.

At pretreatment, the researchers classified 33.3% of the 157 children (aged 10-18) involved in the study as being in the Precontemplation stage (defined as little perceived personal responsibility for pain management) according to the PSOCQ, 41.7% in the Contemplation stage (awareness of personal responsibility for pain management), and 25% in the Action/Maintenance (active involvement in learning self-management strategies) stage.

Of the 131 children who were available for analysis at the posttreatment stage, 4.6% were classified as being in Precontemplation, 11.5% in Contemplation, and 84% in Action/Maintenance.

Further analysis showed that the parents of the children involved in the study also showed significant decreases in Precontemplation and Contemplation scores, and an increase in Action/Maintenance score from pretreatment to posttreatment.

Regression analysis showed that increases in children's readiness to self-manage pain from pretreatment to posttreatment were associated with decreases in functional disability, depressive symptoms, fear of pain, and use of adaptive coping strategies.

Increases in parents' readiness to adopt a pain self-management approach were associated with significant changes in parent-reported fear of pain but not with changes in child disability and child's pain intensity.

The rehabilitation program is designed for pediatric patients with persistent pain and significant impairment of mobility and daily function. Patients receive intensive daily physical, occupational, and psychologic therapy 8 hours per day, 5 days a week for 3-4 weeks. Throughout the program, self-management of pain is encouraged, with children taking on increasing responsibility over their treatment regimen, such as selecting which physical exercises to complete in a given therapy session or identifying the specific cognitive-behavioral pain management skills that are most effective for them.

"This is the first known study to demonstrate this effect among children and their parents in the context of pediatric pain rehabilitation," remark the authors.

"Using measures such as the pediatric PSOCQ during the course of treatment provides a simple but reliable means of assessing a patient's openness and a degree of engagement in this approach."

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