Cognitive Behavioral Therapy for Pediatric Chronic Pain: The Problem, Research, and Practice

Article excerpt

The purpose of this article is to outline the rationale and use of cognitive behavioral therapy (CBT) for the treatment of pediatric chronic pain. The article begins by demonstrating the scope and impact of the problem of pediatric chronic pain. It then provides an overview of the framework of CBT for pediatric chronic pain and standard treatment components are outlined. A summary of the current state of research and its efficacy is provided. The article concludes by presenting outcome data from a specific example of a CBT group for pediatric recurrent abdominal pain. Future directions for research in this area are discussed.

Keywords: adolescents; children; chronic pain; cognitive behavioral therapy; pediatric pain; review

Chronic pain in adults is recognized as a serious public health problem, which has debilitating physical and psychological effects for the individual (Dersh, Polatin, & Gatchel, 2002; Fishbain, Cutler, Rosomoff, & Rosomoff, 1997; McWilliams, Cox, & Enns, 2003), as well as enormous costs to society (Phillips et al., 2008). Given the negative impact of chronic pain in adulthood, it is important for researchers and healthcare professionals to also focus on earlier developmental periods when chronic pain often first emerges. Chronic pain poses serious threats to development across a wide range of domains. As such, chronic pain is increasingly conceptualized as being a developmental health problem (Palermo, 2000; Palermo & Chambers, 2005; Perquin et al., 2000; Roth-Isigkeit, Thyen, Raspe, Stöven, & Schumucker, 2004) with the potential for long-lasting negative effects that can follow children throughout their lives (Fearon & Hotopf, 2001). Although prevalence rates vary across research studies and are often dependent on the time period of reporting, there is consensus that chronic and recurrent pains are common among children and adolescents (e.g., median prevalence rates ranging from 11%-38%) and tend to occur more frequently among girls than boys (King et al., 2011). Epidemiological studies indicate that approximately 25% of children report being currently affected by chronic pain-defined as recurrent or continuous pain for more than 3 months (Perquin et al., 2000). Rates for adolescence vary depending on the type of pain being examined, with prevalence rates for pain experienced on a weekly or more frequent basis ranging from 13.6%-22.2% for stomachache to 26.2%-31.8% for headache across different age groups (Stanford, Chambers, Biesanz, & Chen, 2008). The most frequently reported pains among children and adolescents are headache, lower limb pain, and abdominal pain (Huguet & Miró, 2008; Perquin et al., 2000; Roth-Isigkeit et al., 2004). Although the existence of chronic pain is relatively common among pediatric populations, the severity and impact of this pain varies considerably. For example, Huguet and Miró (2008) found that although 37.3% of children reported having chronic pain (continuous or recurrent pain lasting for at least 3 months), only 5.1% of them had moderate or severe chronic pain problems defined as heightened pain-related disability. Indeed, children with chronic pain are increasingly being recognized as a heterogeneous group who differ in the degree of functional impact that their pain causes. Nevertheless, early intervention with children before their pain becomes severe could prevent problems from becoming increasingly entrenched.

The Impact of Pediatric Chronic Pain

The impact of chronic pain on children may be pervasive. Children and adolescents with chronic and recurrent pains suffer negative and sometimes debilitating effects across nearly every domain of functioning, including physical functioning (e.g., obesity; Wilson, Samuelson, & Palermo, 2010), psychological functioning (Fichtel & Larsson, 2002; Palermo, 2000), cognitive and school functioning (Dick & Pillai Riddell, 2010), sleep disturbances (e.g., Gagliese & Chambers, 2007; Huntley, Campo, Dahl, & Lewin, 2007), social and peer relationships (Forgeron et al. …