Clinical Impact and Evidence Base for Physiotherapy in Treating Childhood Chronic Pain

Abstract

Purpose: As part of the special series on pain, our objectives are to describe the key features of chronic pain in children, present the rationale for interdisciplinary treatment, report a case study based on our biopsychosocial approach, and highlight the integral role of physiotherapy in reducing children's pain and improving function. We also evaluate the evidence base supporting physiotherapy for treating chronic neuropathic pain in children. Summary of Key Points: Chronic pain affects many children and adolescents. Certain challenging pain conditions begin primarily during adolescence and disproportionately affect girls and women. Children with these conditions require an interdisciplinary treatment programme that includes physiotherapy as well as medication and/or psychological intervention. Converging lines of evidence from cohort follow-up studies, retrospective chart reviews, and one randomized controlled trial support the effectiveness of physiotherapy within an interdisciplinary programme for treating children with chronic pain. Conclusions: Evidence-based practice dictates that health care providers adopt clear guidelines for determining when treatments are effective and for identifying children for whom such treatments are most effective. Thus, additional well-designed trials are required to better identify the specific physiotherapy modalities that are most important in improving children's pain and function.Key Words: biopsychosocial, evidence base for physiotherapy in treating chronic pain, interdisciplinary, inter-professional, paediatric chronic pain management, paediatric complex regional pain syndrome (CRPS), paediatric neuropathic pain, paediatric physiotherapy RÉ SUMÉObjectif : Dans le cadre d'une sé rie spé ciale sur la douleur, nos objectifs é taient de dé crire les principales caracté ristiques de la douleur chronique chez les enfants, de pré senter l'argumentaire favorisant un traitement multidisciplinaire, de pré parer un rapport sur une é tude de cas reposant sur notre approche biopsychosociale et de souligner le rô le global de la physiothé rapie pour ré duire la douleur et amé liorer la fonction des enfants. Nous é valuons é galement les faits scientifiques appuyant le recours à la physiothé rapie pour le traitement de la douleur neuropathique chronique chez les enfants. Ré sumé des principaux points : La douleur chronique touche de nombreux enfants et adolescents. Certains é tats douloureux particuliè rement difficiles voient le jour principalement au cours de l'adolescence et touchent les filles et les femmes de maniè re disproportionnelle. Les enfants aux prises avec un tel problè me ont besoin d'un programme de traitement multidisciplinaire incluant de la physiothé rapie, de mê me que des mé dicaments et /ou une intervention en psychologie. Des preuves convergentes issues du suivi de cohortes à la suite d'é tudes, d'analyse ré trospective de dossiers et d'une é tude randomisé e contrô lé e appuient l'efficacité de la physiothé rapie dans le cadre d'un programme multidis...

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