Literature Reviews
Interventional Procedures in Children and Adolescents With Chronic Non-Cancer Pain as Part of a Multi-Disciplinary Pain Treatment Program
Vega E, Rivera G, Echevarria G, et al. Pediatric Anesthesia 2018;28 (Nov):999-1006
Although multidisciplinary pain treatment for non-cancer pain conditions includes interventional procedures, their benefits are not well defined. This study aimed to assess efficacy of interventional procedures in a multidisciplinary pain treatment program.
Methods
A retrospective review was performed including records of 98/350 (28%) patients seen in a multidisciplinary clinic within a three-year period. Eligible patients had undergone one or more (total of 314) diagnostic or therapeutic procedures and were followed for at least six months post intervention. Efficacy was defined based on short-term (>50% reduction in pain intensity for >4 weeks) and long-term (>50% reduction for >6 months) therapeutic effect, as well as full recovery (no pain and no analgesic use with normal functioning >6 months after last procedure).
Results
Patients (76% female, age 14-17 years) had pain for >1 year in 59%. First consultations occurred an average of 12 months after pain onset. Psychiatric co-morbidities were diagnosed in 40% with anxiety being most common. Treatment included medications (95%), physiotherapy (93%), psychological (76%), and psychiatric (14%) management. Blocks most commonly (58%) consisted of peripheral nerve or interfascial plane single injection and local infiltration. First interventions occurred in 62% of the patients within one month of the first assessment. Short-term benefit of procedures (median N/patient=2) was observed in 76/112 (68%) of diagnostic and in 176/202 (82%) of therapeutic blocks. Long-term benefits after six months were seen in 73% of patients either as a full recovery (56%) or at least a reduction in pain intensity (17%). Failure of an intervention was more commonly seen in older patients and those with psychiatric co-morbidities.
Conclusion
Interventional procedures may be a valuable therapeutic tool within a multi-disciplinary pain program. Limitations of the study include: retrospective nature, single tertiary care center location, and the lack of systematic use of validated assessment tools. (Comment: The time between the initial assessment and the procedure was also shorter than in other studies making comparisons more difficult and resulting in possible selection bias).
