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Efficacy of adding interoceptive exposure to intensive interdisciplinary treatment for adolescents with chronic pain

a randomized controlled trial

Flack, Florentinaa,b,*; Stahlschmidt, Lorina,b; Dobe, Michaela,b; Hirschfeld, Gerritc; Strasser, Alexad; Michalak, Johannesd; Wager, Juliaa,b; Zernikow, Borisa,b

doi: 10.1097/j.pain.0000000000001321
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Global Year 2018

Fear of pain plays an important role in the maintenance of chronic pain. It may be reduced through exposure therapy. This 2-arm parallel samples randomized controlled trial aimed to investigate whether interoceptive exposure (IE) therapy enhances reductions in fear of pain (primary outcome), pain (pain intensity, pain-related disability, and school absence), and emotional characteristics (anxiety and catastrophizing) when implemented as an adjunctive treatment in the context of intensive interdisciplinary pain treatment for pediatric chronic pain patients. N = 126 adolescents, aged 11 to 17 years, who were receiving standard intensive interdisciplinary pain treatment were randomly assigned to either receive additional IE (n = 64) or additional relaxation therapy (RT) (n = 62). All patients were assessed at admission, discharge, and 3 months after discharge. The data of N = 104 patients were analyzed. Significant large reductions were found in the total score and subscale scores of the Fear of Pain Questionnaire for Children in both study groups (eg, total score [range 0-60; IE/RT]: admission M = 23.5/24.9; discharge M = 16.0/19.7; P < 0.001,

= 0.27) and mainly large reductions in pain characteristics. There were no greater decreases in the IE group (P > 0.1). The exploratory analyses revealed that the patients with high fear of pain before treatment (P < 0.05,

> 0.03) and the patients with abdominal pain (P < 0.04,

> 0.25) showed greater decreases in their fear of pain (total and subscale score) in the IE group than in the RT group. In conclusion, the results suggest that IE is not particularly effective for all the pediatric chronic pain patients, but the patients with high fear of pain before treatment and with abdominal pain strongly benefit from this intervention.

This randomized controlled trial showed the effectiveness of interoceptive exposure in reducing fear of pain in certain subgroups of pediatric chronic pain patients.

aGerman Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany

bDepartment of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany

cFaculty of Business Management and Social Sciences, University of Applied Sciences Osnabrück, Osnabrück, Germany

dFaculty of Health, Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany

Corresponding author. Address: German Paediatric Pain Centre, Children's and Adolescent's Hospital, Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Dr.-Friedrich Steiner Str 5, 45711 Datteln, Germany. Tel.: +49-2363-975-875; fax: +49-2363-975-181. E-mail address: f.flack@kinderklinik-datteln.de (F. Flack).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received December 07, 2017

Received in revised form June 11, 2018

Accepted June 14, 2018

© 2018 International Association for the Study of Pain
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