Chronic pain treatment in children and adolescents: less is good, more is sometimes better

Background In children with chronic pain, interdisciplinary outpatient and intensive inpatient treatment has been shown to improve pain intensity and disability. However, there are few systematic comparisons of outcomes of the two treatments. The present naturalistic study aimed to compare the clinical presentation and achieved changes at return in three outcome domains (pain intensity, disability, school absence) between a) outpatients vs. inpatients and b) patients who declined intensive inpatient treatment and completed outpatient treatment instead (decliners) vs. those who completed inpatient treatment (completers). Methods The study compared treatment outcomes between n = 992 outpatients vs. n = 320 inpatients (Analysis A) who were treated at a tertiary treatment centre and returned for a return visit within a one-year interval. In Analysis B, treatment outcomes were compared between n = 67 decliners vs. n = 309 completers of inpatient treatment. The three outcome domains were compared by calculating standardized change scores and clinically significant changes. Results In analysis A, outpatients and inpatients reported comparably low levels of pain intensity (NRS 0–10; mean = 4, SD = 2.7) and disability (Paediatric Pain Disability Index (PPDI: 12–60; mean = 24; SD = 10) at the return visit. Compared to outpatients, more inpatients achieved clinically significant changes in pain intensity (52% vs. 45%) and disability (46% vs. 31%). There were also significantly greater changes in disability in the inpatient group (change score outpatients = 1.0; change score inpatients = 1.4; F(1,1138) = 12.6, p = .011). School absence was substantially reduced, with approximately 80% in each group attending school regularly. Analysis B showed that even though inpatient decliners achieved improvements in the outcome domains, they reported greater disability at the return visit (PPDI mean decliners = 27, SD = 9.9; PPDI mean completers = 24, SD = 10) because they had achieved fewer changes in disability (change score decliners = 0.9; change score completers = 1.4; $ F_{(1.334)} $ = 5.7, p = .017). In addition, less decliners than completers achieved clinically significant changes in disability (25% vs. 47%). Conclusions Inpatient and outpatient treatments are able to elicit substantial changes in pain intensity, disability and school absence. The results highlight the necessity of intensive inpatient pain treatment for highly affected children, as children who declined inpatient treatment and were treated as outpatients did less well. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Hechler, Tanja [verfasserIn] Wager, Julia Zernikow, Boris

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2014

Schlagwörter:	Interdisciplinary Outpatient treatment Intensive inpatient treatment Paediatric chronic pain

Anmerkung:	© Hechler et al.; licensee BioMed Central Ltd. 2014

Übergeordnetes Werk:	Enthalten in: BMC pediatrics - London : BioMed Central, 2001, 14(2014), 1 vom: 13. Okt.
Übergeordnetes Werk:	volume:14 ; year:2014 ; number:1 ; day:13 ; month:10

Links:	Volltext

DOI / URN:	10.1186/1471-2431-14-262

Katalog-ID:	SPR027757315

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520			\|a Background In children with chronic pain, interdisciplinary outpatient and intensive inpatient treatment has been shown to improve pain intensity and disability. However, there are few systematic comparisons of outcomes of the two treatments. The present naturalistic study aimed to compare the clinical presentation and achieved changes at return in three outcome domains (pain intensity, disability, school absence) between a) outpatients vs. inpatients and b) patients who declined intensive inpatient treatment and completed outpatient treatment instead (decliners) vs. those who completed inpatient treatment (completers). Methods The study compared treatment outcomes between n = 992 outpatients vs. n = 320 inpatients (Analysis A) who were treated at a tertiary treatment centre and returned for a return visit within a one-year interval. In Analysis B, treatment outcomes were compared between n = 67 decliners vs. n = 309 completers of inpatient treatment. The three outcome domains were compared by calculating standardized change scores and clinically significant changes. Results In analysis A, outpatients and inpatients reported comparably low levels of pain intensity (NRS 0–10; mean = 4, SD = 2.7) and disability (Paediatric Pain Disability Index (PPDI: 12–60; mean = 24; SD = 10) at the return visit. Compared to outpatients, more inpatients achieved clinically significant changes in pain intensity (52% vs. 45%) and disability (46% vs. 31%). There were also significantly greater changes in disability in the inpatient group (change score outpatients = 1.0; change score inpatients = 1.4; F(1,1138) = 12.6, p = .011). School absence was substantially reduced, with approximately 80% in each group attending school regularly. Analysis B showed that even though inpatient decliners achieved improvements in the outcome domains, they reported greater disability at the return visit (PPDI mean decliners = 27, SD = 9.9; PPDI mean completers = 24, SD = 10) because they had achieved fewer changes in disability (change score decliners = 0.9; change score completers = 1.4; $ F_{(1.334)} $ = 5.7, p = .017). In addition, less decliners than completers achieved clinically significant changes in disability (25% vs. 47%). Conclusions Inpatient and outpatient treatments are able to elicit substantial changes in pain intensity, disability and school absence. The results highlight the necessity of intensive inpatient pain treatment for highly affected children, as children who declined inpatient treatment and were treated as outpatients did less well.
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allfields	10.1186/1471-2431-14-262 doi (DE-627)SPR027757315 (SPR)1471-2431-14-262-e DE-627 ger DE-627 rakwb eng Hechler, Tanja verfasserin aut Chronic pain treatment in children and adolescents: less is good, more is sometimes better 2014 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Hechler et al.; licensee BioMed Central Ltd. 2014 Background In children with chronic pain, interdisciplinary outpatient and intensive inpatient treatment has been shown to improve pain intensity and disability. However, there are few systematic comparisons of outcomes of the two treatments. The present naturalistic study aimed to compare the clinical presentation and achieved changes at return in three outcome domains (pain intensity, disability, school absence) between a) outpatients vs. inpatients and b) patients who declined intensive inpatient treatment and completed outpatient treatment instead (decliners) vs. those who completed inpatient treatment (completers). Methods The study compared treatment outcomes between n = 992 outpatients vs. n = 320 inpatients (Analysis A) who were treated at a tertiary treatment centre and returned for a return visit within a one-year interval. In Analysis B, treatment outcomes were compared between n = 67 decliners vs. n = 309 completers of inpatient treatment. The three outcome domains were compared by calculating standardized change scores and clinically significant changes. Results In analysis A, outpatients and inpatients reported comparably low levels of pain intensity (NRS 0–10; mean = 4, SD = 2.7) and disability (Paediatric Pain Disability Index (PPDI: 12–60; mean = 24; SD = 10) at the return visit. Compared to outpatients, more inpatients achieved clinically significant changes in pain intensity (52% vs. 45%) and disability (46% vs. 31%). There were also significantly greater changes in disability in the inpatient group (change score outpatients = 1.0; change score inpatients = 1.4; F(1,1138) = 12.6, p = .011). School absence was substantially reduced, with approximately 80% in each group attending school regularly. Analysis B showed that even though inpatient decliners achieved improvements in the outcome domains, they reported greater disability at the return visit (PPDI mean decliners = 27, SD = 9.9; PPDI mean completers = 24, SD = 10) because they had achieved fewer changes in disability (change score decliners = 0.9; change score completers = 1.4; $ F_{(1.334)} $ = 5.7, p = .017). In addition, less decliners than completers achieved clinically significant changes in disability (25% vs. 47%). Conclusions Inpatient and outpatient treatments are able to elicit substantial changes in pain intensity, disability and school absence. The results highlight the necessity of intensive inpatient pain treatment for highly affected children, as children who declined inpatient treatment and were treated as outpatients did less well. Interdisciplinary (dpeaa)DE-He213 Outpatient treatment (dpeaa)DE-He213 Intensive inpatient treatment (dpeaa)DE-He213 Paediatric chronic pain (dpeaa)DE-He213 Wager, Julia aut Zernikow, Boris aut Enthalten in BMC pediatrics London : BioMed Central, 2001 14(2014), 1 vom: 13. Okt. (DE-627)326643621 (DE-600)2041342-7 1471-2431 nnns volume:14 year:2014 number:1 day:13 month:10 https://dx.doi.org/10.1186/1471-2431-14-262 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 14 2014 1 13 10
spelling	10.1186/1471-2431-14-262 doi (DE-627)SPR027757315 (SPR)1471-2431-14-262-e DE-627 ger DE-627 rakwb eng Hechler, Tanja verfasserin aut Chronic pain treatment in children and adolescents: less is good, more is sometimes better 2014 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Hechler et al.; licensee BioMed Central Ltd. 2014 Background In children with chronic pain, interdisciplinary outpatient and intensive inpatient treatment has been shown to improve pain intensity and disability. However, there are few systematic comparisons of outcomes of the two treatments. The present naturalistic study aimed to compare the clinical presentation and achieved changes at return in three outcome domains (pain intensity, disability, school absence) between a) outpatients vs. inpatients and b) patients who declined intensive inpatient treatment and completed outpatient treatment instead (decliners) vs. those who completed inpatient treatment (completers). Methods The study compared treatment outcomes between n = 992 outpatients vs. n = 320 inpatients (Analysis A) who were treated at a tertiary treatment centre and returned for a return visit within a one-year interval. In Analysis B, treatment outcomes were compared between n = 67 decliners vs. n = 309 completers of inpatient treatment. The three outcome domains were compared by calculating standardized change scores and clinically significant changes. Results In analysis A, outpatients and inpatients reported comparably low levels of pain intensity (NRS 0–10; mean = 4, SD = 2.7) and disability (Paediatric Pain Disability Index (PPDI: 12–60; mean = 24; SD = 10) at the return visit. Compared to outpatients, more inpatients achieved clinically significant changes in pain intensity (52% vs. 45%) and disability (46% vs. 31%). There were also significantly greater changes in disability in the inpatient group (change score outpatients = 1.0; change score inpatients = 1.4; F(1,1138) = 12.6, p = .011). School absence was substantially reduced, with approximately 80% in each group attending school regularly. Analysis B showed that even though inpatient decliners achieved improvements in the outcome domains, they reported greater disability at the return visit (PPDI mean decliners = 27, SD = 9.9; PPDI mean completers = 24, SD = 10) because they had achieved fewer changes in disability (change score decliners = 0.9; change score completers = 1.4; $ F_{(1.334)} $ = 5.7, p = .017). In addition, less decliners than completers achieved clinically significant changes in disability (25% vs. 47%). Conclusions Inpatient and outpatient treatments are able to elicit substantial changes in pain intensity, disability and school absence. The results highlight the necessity of intensive inpatient pain treatment for highly affected children, as children who declined inpatient treatment and were treated as outpatients did less well. Interdisciplinary (dpeaa)DE-He213 Outpatient treatment (dpeaa)DE-He213 Intensive inpatient treatment (dpeaa)DE-He213 Paediatric chronic pain (dpeaa)DE-He213 Wager, Julia aut Zernikow, Boris aut Enthalten in BMC pediatrics London : BioMed Central, 2001 14(2014), 1 vom: 13. Okt. (DE-627)326643621 (DE-600)2041342-7 1471-2431 nnns volume:14 year:2014 number:1 day:13 month:10 https://dx.doi.org/10.1186/1471-2431-14-262 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 14 2014 1 13 10
allfields_unstemmed	10.1186/1471-2431-14-262 doi (DE-627)SPR027757315 (SPR)1471-2431-14-262-e DE-627 ger DE-627 rakwb eng Hechler, Tanja verfasserin aut Chronic pain treatment in children and adolescents: less is good, more is sometimes better 2014 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Hechler et al.; licensee BioMed Central Ltd. 2014 Background In children with chronic pain, interdisciplinary outpatient and intensive inpatient treatment has been shown to improve pain intensity and disability. However, there are few systematic comparisons of outcomes of the two treatments. The present naturalistic study aimed to compare the clinical presentation and achieved changes at return in three outcome domains (pain intensity, disability, school absence) between a) outpatients vs. inpatients and b) patients who declined intensive inpatient treatment and completed outpatient treatment instead (decliners) vs. those who completed inpatient treatment (completers). Methods The study compared treatment outcomes between n = 992 outpatients vs. n = 320 inpatients (Analysis A) who were treated at a tertiary treatment centre and returned for a return visit within a one-year interval. In Analysis B, treatment outcomes were compared between n = 67 decliners vs. n = 309 completers of inpatient treatment. The three outcome domains were compared by calculating standardized change scores and clinically significant changes. Results In analysis A, outpatients and inpatients reported comparably low levels of pain intensity (NRS 0–10; mean = 4, SD = 2.7) and disability (Paediatric Pain Disability Index (PPDI: 12–60; mean = 24; SD = 10) at the return visit. Compared to outpatients, more inpatients achieved clinically significant changes in pain intensity (52% vs. 45%) and disability (46% vs. 31%). There were also significantly greater changes in disability in the inpatient group (change score outpatients = 1.0; change score inpatients = 1.4; F(1,1138) = 12.6, p = .011). School absence was substantially reduced, with approximately 80% in each group attending school regularly. Analysis B showed that even though inpatient decliners achieved improvements in the outcome domains, they reported greater disability at the return visit (PPDI mean decliners = 27, SD = 9.9; PPDI mean completers = 24, SD = 10) because they had achieved fewer changes in disability (change score decliners = 0.9; change score completers = 1.4; $ F_{(1.334)} $ = 5.7, p = .017). In addition, less decliners than completers achieved clinically significant changes in disability (25% vs. 47%). Conclusions Inpatient and outpatient treatments are able to elicit substantial changes in pain intensity, disability and school absence. The results highlight the necessity of intensive inpatient pain treatment for highly affected children, as children who declined inpatient treatment and were treated as outpatients did less well. Interdisciplinary (dpeaa)DE-He213 Outpatient treatment (dpeaa)DE-He213 Intensive inpatient treatment (dpeaa)DE-He213 Paediatric chronic pain (dpeaa)DE-He213 Wager, Julia aut Zernikow, Boris aut Enthalten in BMC pediatrics London : BioMed Central, 2001 14(2014), 1 vom: 13. Okt. (DE-627)326643621 (DE-600)2041342-7 1471-2431 nnns volume:14 year:2014 number:1 day:13 month:10 https://dx.doi.org/10.1186/1471-2431-14-262 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 14 2014 1 13 10
allfieldsGer	10.1186/1471-2431-14-262 doi (DE-627)SPR027757315 (SPR)1471-2431-14-262-e DE-627 ger DE-627 rakwb eng Hechler, Tanja verfasserin aut Chronic pain treatment in children and adolescents: less is good, more is sometimes better 2014 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Hechler et al.; licensee BioMed Central Ltd. 2014 Background In children with chronic pain, interdisciplinary outpatient and intensive inpatient treatment has been shown to improve pain intensity and disability. However, there are few systematic comparisons of outcomes of the two treatments. The present naturalistic study aimed to compare the clinical presentation and achieved changes at return in three outcome domains (pain intensity, disability, school absence) between a) outpatients vs. inpatients and b) patients who declined intensive inpatient treatment and completed outpatient treatment instead (decliners) vs. those who completed inpatient treatment (completers). Methods The study compared treatment outcomes between n = 992 outpatients vs. n = 320 inpatients (Analysis A) who were treated at a tertiary treatment centre and returned for a return visit within a one-year interval. In Analysis B, treatment outcomes were compared between n = 67 decliners vs. n = 309 completers of inpatient treatment. The three outcome domains were compared by calculating standardized change scores and clinically significant changes. Results In analysis A, outpatients and inpatients reported comparably low levels of pain intensity (NRS 0–10; mean = 4, SD = 2.7) and disability (Paediatric Pain Disability Index (PPDI: 12–60; mean = 24; SD = 10) at the return visit. Compared to outpatients, more inpatients achieved clinically significant changes in pain intensity (52% vs. 45%) and disability (46% vs. 31%). There were also significantly greater changes in disability in the inpatient group (change score outpatients = 1.0; change score inpatients = 1.4; F(1,1138) = 12.6, p = .011). School absence was substantially reduced, with approximately 80% in each group attending school regularly. Analysis B showed that even though inpatient decliners achieved improvements in the outcome domains, they reported greater disability at the return visit (PPDI mean decliners = 27, SD = 9.9; PPDI mean completers = 24, SD = 10) because they had achieved fewer changes in disability (change score decliners = 0.9; change score completers = 1.4; $ F_{(1.334)} $ = 5.7, p = .017). In addition, less decliners than completers achieved clinically significant changes in disability (25% vs. 47%). Conclusions Inpatient and outpatient treatments are able to elicit substantial changes in pain intensity, disability and school absence. The results highlight the necessity of intensive inpatient pain treatment for highly affected children, as children who declined inpatient treatment and were treated as outpatients did less well. Interdisciplinary (dpeaa)DE-He213 Outpatient treatment (dpeaa)DE-He213 Intensive inpatient treatment (dpeaa)DE-He213 Paediatric chronic pain (dpeaa)DE-He213 Wager, Julia aut Zernikow, Boris aut Enthalten in BMC pediatrics London : BioMed Central, 2001 14(2014), 1 vom: 13. Okt. (DE-627)326643621 (DE-600)2041342-7 1471-2431 nnns volume:14 year:2014 number:1 day:13 month:10 https://dx.doi.org/10.1186/1471-2431-14-262 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 14 2014 1 13 10
allfieldsSound	10.1186/1471-2431-14-262 doi (DE-627)SPR027757315 (SPR)1471-2431-14-262-e DE-627 ger DE-627 rakwb eng Hechler, Tanja verfasserin aut Chronic pain treatment in children and adolescents: less is good, more is sometimes better 2014 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Hechler et al.; licensee BioMed Central Ltd. 2014 Background In children with chronic pain, interdisciplinary outpatient and intensive inpatient treatment has been shown to improve pain intensity and disability. However, there are few systematic comparisons of outcomes of the two treatments. The present naturalistic study aimed to compare the clinical presentation and achieved changes at return in three outcome domains (pain intensity, disability, school absence) between a) outpatients vs. inpatients and b) patients who declined intensive inpatient treatment and completed outpatient treatment instead (decliners) vs. those who completed inpatient treatment (completers). Methods The study compared treatment outcomes between n = 992 outpatients vs. n = 320 inpatients (Analysis A) who were treated at a tertiary treatment centre and returned for a return visit within a one-year interval. In Analysis B, treatment outcomes were compared between n = 67 decliners vs. n = 309 completers of inpatient treatment. The three outcome domains were compared by calculating standardized change scores and clinically significant changes. Results In analysis A, outpatients and inpatients reported comparably low levels of pain intensity (NRS 0–10; mean = 4, SD = 2.7) and disability (Paediatric Pain Disability Index (PPDI: 12–60; mean = 24; SD = 10) at the return visit. Compared to outpatients, more inpatients achieved clinically significant changes in pain intensity (52% vs. 45%) and disability (46% vs. 31%). There were also significantly greater changes in disability in the inpatient group (change score outpatients = 1.0; change score inpatients = 1.4; F(1,1138) = 12.6, p = .011). School absence was substantially reduced, with approximately 80% in each group attending school regularly. Analysis B showed that even though inpatient decliners achieved improvements in the outcome domains, they reported greater disability at the return visit (PPDI mean decliners = 27, SD = 9.9; PPDI mean completers = 24, SD = 10) because they had achieved fewer changes in disability (change score decliners = 0.9; change score completers = 1.4; $ F_{(1.334)} $ = 5.7, p = .017). In addition, less decliners than completers achieved clinically significant changes in disability (25% vs. 47%). Conclusions Inpatient and outpatient treatments are able to elicit substantial changes in pain intensity, disability and school absence. The results highlight the necessity of intensive inpatient pain treatment for highly affected children, as children who declined inpatient treatment and were treated as outpatients did less well. Interdisciplinary (dpeaa)DE-He213 Outpatient treatment (dpeaa)DE-He213 Intensive inpatient treatment (dpeaa)DE-He213 Paediatric chronic pain (dpeaa)DE-He213 Wager, Julia aut Zernikow, Boris aut Enthalten in BMC pediatrics London : BioMed Central, 2001 14(2014), 1 vom: 13. Okt. (DE-627)326643621 (DE-600)2041342-7 1471-2431 nnns volume:14 year:2014 number:1 day:13 month:10 https://dx.doi.org/10.1186/1471-2431-14-262 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 14 2014 1 13 10
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title_sort	chronic pain treatment in children and adolescents: less is good, more is sometimes better
title_auth	Chronic pain treatment in children and adolescents: less is good, more is sometimes better
abstract	Background In children with chronic pain, interdisciplinary outpatient and intensive inpatient treatment has been shown to improve pain intensity and disability. However, there are few systematic comparisons of outcomes of the two treatments. The present naturalistic study aimed to compare the clinical presentation and achieved changes at return in three outcome domains (pain intensity, disability, school absence) between a) outpatients vs. inpatients and b) patients who declined intensive inpatient treatment and completed outpatient treatment instead (decliners) vs. those who completed inpatient treatment (completers). Methods The study compared treatment outcomes between n = 992 outpatients vs. n = 320 inpatients (Analysis A) who were treated at a tertiary treatment centre and returned for a return visit within a one-year interval. In Analysis B, treatment outcomes were compared between n = 67 decliners vs. n = 309 completers of inpatient treatment. The three outcome domains were compared by calculating standardized change scores and clinically significant changes. Results In analysis A, outpatients and inpatients reported comparably low levels of pain intensity (NRS 0–10; mean = 4, SD = 2.7) and disability (Paediatric Pain Disability Index (PPDI: 12–60; mean = 24; SD = 10) at the return visit. Compared to outpatients, more inpatients achieved clinically significant changes in pain intensity (52% vs. 45%) and disability (46% vs. 31%). There were also significantly greater changes in disability in the inpatient group (change score outpatients = 1.0; change score inpatients = 1.4; F(1,1138) = 12.6, p = .011). School absence was substantially reduced, with approximately 80% in each group attending school regularly. Analysis B showed that even though inpatient decliners achieved improvements in the outcome domains, they reported greater disability at the return visit (PPDI mean decliners = 27, SD = 9.9; PPDI mean completers = 24, SD = 10) because they had achieved fewer changes in disability (change score decliners = 0.9; change score completers = 1.4; $ F_{(1.334)} $ = 5.7, p = .017). In addition, less decliners than completers achieved clinically significant changes in disability (25% vs. 47%). Conclusions Inpatient and outpatient treatments are able to elicit substantial changes in pain intensity, disability and school absence. The results highlight the necessity of intensive inpatient pain treatment for highly affected children, as children who declined inpatient treatment and were treated as outpatients did less well. © Hechler et al.; licensee BioMed Central Ltd. 2014
abstractGer	Background In children with chronic pain, interdisciplinary outpatient and intensive inpatient treatment has been shown to improve pain intensity and disability. However, there are few systematic comparisons of outcomes of the two treatments. The present naturalistic study aimed to compare the clinical presentation and achieved changes at return in three outcome domains (pain intensity, disability, school absence) between a) outpatients vs. inpatients and b) patients who declined intensive inpatient treatment and completed outpatient treatment instead (decliners) vs. those who completed inpatient treatment (completers). Methods The study compared treatment outcomes between n = 992 outpatients vs. n = 320 inpatients (Analysis A) who were treated at a tertiary treatment centre and returned for a return visit within a one-year interval. In Analysis B, treatment outcomes were compared between n = 67 decliners vs. n = 309 completers of inpatient treatment. The three outcome domains were compared by calculating standardized change scores and clinically significant changes. Results In analysis A, outpatients and inpatients reported comparably low levels of pain intensity (NRS 0–10; mean = 4, SD = 2.7) and disability (Paediatric Pain Disability Index (PPDI: 12–60; mean = 24; SD = 10) at the return visit. Compared to outpatients, more inpatients achieved clinically significant changes in pain intensity (52% vs. 45%) and disability (46% vs. 31%). There were also significantly greater changes in disability in the inpatient group (change score outpatients = 1.0; change score inpatients = 1.4; F(1,1138) = 12.6, p = .011). School absence was substantially reduced, with approximately 80% in each group attending school regularly. Analysis B showed that even though inpatient decliners achieved improvements in the outcome domains, they reported greater disability at the return visit (PPDI mean decliners = 27, SD = 9.9; PPDI mean completers = 24, SD = 10) because they had achieved fewer changes in disability (change score decliners = 0.9; change score completers = 1.4; $ F_{(1.334)} $ = 5.7, p = .017). In addition, less decliners than completers achieved clinically significant changes in disability (25% vs. 47%). Conclusions Inpatient and outpatient treatments are able to elicit substantial changes in pain intensity, disability and school absence. The results highlight the necessity of intensive inpatient pain treatment for highly affected children, as children who declined inpatient treatment and were treated as outpatients did less well. © Hechler et al.; licensee BioMed Central Ltd. 2014
abstract_unstemmed	Background In children with chronic pain, interdisciplinary outpatient and intensive inpatient treatment has been shown to improve pain intensity and disability. However, there are few systematic comparisons of outcomes of the two treatments. The present naturalistic study aimed to compare the clinical presentation and achieved changes at return in three outcome domains (pain intensity, disability, school absence) between a) outpatients vs. inpatients and b) patients who declined intensive inpatient treatment and completed outpatient treatment instead (decliners) vs. those who completed inpatient treatment (completers). Methods The study compared treatment outcomes between n = 992 outpatients vs. n = 320 inpatients (Analysis A) who were treated at a tertiary treatment centre and returned for a return visit within a one-year interval. In Analysis B, treatment outcomes were compared between n = 67 decliners vs. n = 309 completers of inpatient treatment. The three outcome domains were compared by calculating standardized change scores and clinically significant changes. Results In analysis A, outpatients and inpatients reported comparably low levels of pain intensity (NRS 0–10; mean = 4, SD = 2.7) and disability (Paediatric Pain Disability Index (PPDI: 12–60; mean = 24; SD = 10) at the return visit. Compared to outpatients, more inpatients achieved clinically significant changes in pain intensity (52% vs. 45%) and disability (46% vs. 31%). There were also significantly greater changes in disability in the inpatient group (change score outpatients = 1.0; change score inpatients = 1.4; F(1,1138) = 12.6, p = .011). School absence was substantially reduced, with approximately 80% in each group attending school regularly. Analysis B showed that even though inpatient decliners achieved improvements in the outcome domains, they reported greater disability at the return visit (PPDI mean decliners = 27, SD = 9.9; PPDI mean completers = 24, SD = 10) because they had achieved fewer changes in disability (change score decliners = 0.9; change score completers = 1.4; $ F_{(1.334)} $ = 5.7, p = .017). In addition, less decliners than completers achieved clinically significant changes in disability (25% vs. 47%). Conclusions Inpatient and outpatient treatments are able to elicit substantial changes in pain intensity, disability and school absence. The results highlight the necessity of intensive inpatient pain treatment for highly affected children, as children who declined inpatient treatment and were treated as outpatients did less well. © Hechler et al.; licensee BioMed Central Ltd. 2014
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title_short	Chronic pain treatment in children and adolescents: less is good, more is sometimes better
url	https://dx.doi.org/10.1186/1471-2431-14-262
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author2	Wager, Julia Zernikow, Boris
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doi_str	10.1186/1471-2431-14-262
up_date	2024-07-03T14:58:20.416Z
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