Gadi Revivo1,2, Diane K Amstutz1, Christine M Gagnon1,3, Zachary L McCormick4. 1. Pain Management Center, Shirley Ryan Abilitylab, Chicago, IL. 2. Pain Management Center, Department of Physical Medicine and Rehabilitation, McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 3. Department of Physical Medicine and Rehabilitation, McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 4. Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, University of California, San Francisco, California.
Abstract
BACKGROUND: The relation between chronic musculoskeletal pain and joint hypermobility in a small percentage of the pediatric population is well described. However, literature discussing the treatment of chronic pain associated with joint hypermobility in pediatrics is limited. The present study examines the impact of interdisciplinary treatment on chronic pain in pediatrics with joint hypermobility syndrome. OBJECTIVE: To determine if pediatric patients with chronic pain related to joint hypermobility can be effectively treated with an intensive, interdisciplinary pain management program, as measured by changes in pain, psychosocial and physical functioning, as well as parental coping. DESIGN: Retrospective cohort study. SETTING: Urban academic tertiary intensive outpatient interdisciplinary pain management clinic. PARTICIPANTS: The study involved 30 patients who met the criteria for a diagnosis of joint hypermobility and chronic pain and completed an interdisciplinary pain management program. INTERVENTION: All patients were treated in an intensive pediatric interdisciplinary pain management program for a duration of 6 to 8 weeks. The program provided physical therapy, occupational therapy, psychological counseling, and weekly pediatric rehabilitation medicine follow-up. MAIN OUTCOME MEASURES: Outcome measures included numeric rating scale pain scores, the Bath Adolescent Pain Questionnaire, and the Bath Adolescent Pain-Parent Impact Questionnaire. Changes from pre- to post-treatment were analyzed using paired-samples t tests. RESULTS: Patients endorsed pre- to post-treatment improvements in pain, depression, general anxiety, pain-related anxiety, social functioning, and physical functioning (P < .05). The patients' parents showed significant improvements in depression, anxiety, catastrophic thinking, self-blame and helplessness, leisure functioning, and parental behavior (P < .05). CONCLUSION: The present findings suggest that an intensive interdisciplinary rehabilitation pain management program yields short-term improvements in pain, emotional and physical function, and daily activity in a pediatric population diagnosed with joint hypermobility. Parents also experienced benefits from the program. A larger prospective study with longer-term follow-up is needed. LEVEL OF EVIDENCE: III.
BACKGROUND: The relation between chronic musculoskeletal pain and joint hypermobility in a small percentage of the pediatric population is well described. However, literature discussing the treatment of chronic pain associated with joint hypermobility in pediatrics is limited. The present study examines the impact of interdisciplinary treatment on chronic pain in pediatrics with joint hypermobility syndrome. OBJECTIVE: To determine if pediatric patients with chronic pain related to joint hypermobility can be effectively treated with an intensive, interdisciplinary pain management program, as measured by changes in pain, psychosocial and physical functioning, as well as parental coping. DESIGN: Retrospective cohort study. SETTING: Urban academic tertiary intensive outpatientinterdisciplinary pain management clinic. PARTICIPANTS: The study involved 30 patients who met the criteria for a diagnosis of joint hypermobility and chronic pain and completed an interdisciplinary pain management program. INTERVENTION: All patients were treated in an intensive pediatric interdisciplinary pain management program for a duration of 6 to 8 weeks. The program provided physical therapy, occupational therapy, psychological counseling, and weekly pediatric rehabilitation medicine follow-up. MAIN OUTCOME MEASURES: Outcome measures included numeric rating scale pain scores, the Bath Adolescent Pain Questionnaire, and the Bath Adolescent Pain-Parent Impact Questionnaire. Changes from pre- to post-treatment were analyzed using paired-samples t tests. RESULTS:Patients endorsed pre- to post-treatment improvements in pain, depression, general anxiety, pain-related anxiety, social functioning, and physical functioning (P < .05). The patients' parents showed significant improvements in depression, anxiety, catastrophic thinking, self-blame and helplessness, leisure functioning, and parental behavior (P < .05). CONCLUSION: The present findings suggest that an intensive interdisciplinary rehabilitation pain management program yields short-term improvements in pain, emotional and physical function, and daily activity in a pediatric population diagnosed with joint hypermobility. Parents also experienced benefits from the program. A larger prospective study with longer-term follow-up is needed. LEVEL OF EVIDENCE: III.
Authors: Lauren E Harrison; Joshua W Pate; Patricia A Richardson; Kelly Ickmans; Rikard K Wicksell; Laura E Simons Journal: J Clin Med Date: 2019-08-21 Impact factor: 4.241