Non-Cognitive Behavioral Therapy Psychological Interventions May Not Make the Difference in Children and Adolescents With Chronic Pain

Lauren Perlman,1,* Naomi Malka,1,* Oliver Terry,1,* Alex Nguyen,1 Lucas Guimarães Ferreira Fonseca,2 Juan I Ingelmo,3 Pablo Ingelmo2,4– 7 1Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; 2Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, McGill University Health Center, Montreal, QC, Canada; 3Department of Mental Health, Jose de San Martin Clinical Hospital, University of Buenos Aires, Buenos Aires, Argentina; 4Department of Anesthesia, McGill University, Montreal, QC, Canada; 5Division of Pediatric Anesthesia Montreal Children’s Hospital, McGill University Health Center, Montreal, QC, Canada; 6Research Institute, McGill University Health Center, Montreal, QC, Canada; 7The Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada*These authors contributed equally to this workCorrespondence: Pablo Ingelmo, Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital A02-3525.1, 1001 Boul, Decarie, Montreal, QC, H41 3J1, Canada, Tel +1 514 412 4448, Fax +1 514 412 4341, Email [email protected] and Aim: Chronic pain in pediatric populations presents a multifaceted challenge with biopsychosocial impact, requiring a multidisciplinary approach including psychological treatment. At our interdisciplinary pain center, the SARS-CoV-2 pandemic-related disruptions led to the cessation of cognitive-behavioral therapy (CBT) and other psychological interventions during the pandemic. The aim of this retrospective cohort study with secondary retrospective matched case–control analysis was to evaluate the impact of interruption of non-CBT psychological interventions, namely psychoanalysis and psychodynamic psychotherapy, on children and adolescents with chronic pain conditions during the SARS-CoV-2 pandemic.Materials and Methods: We included pediatric patients with primary and secondary chronic pain conditions evaluated by our team during the SARS-CoV-2 pandemic. We excluded patients who did not receive psychological intervention when available, those with incomplete data on initial evaluation or follow-up, and those who received outside psychiatric care or individual or group CBT. The primary outcome was a Patients’ Global Impression of Change (PGIC) score of 6– 7. Secondary outcome measures were pain intensity, use of pain medication, sleep, physical function, school attendance, the incidence of suicidality, and the reason for end of treatment.Results: The study included 146 patients, 77 who received non-CBT psychological interventions and 69 who did not receive any psychological interventions. We found no meaningful difference between the use of non-CBT psychological intervention and no treatment in the incidence of PGIC 6– 7 points, pain intensity, school attendance, physical function, suicidality, and cause of end of treatment. Patients not receiving any psychological interventions were more likely to have normalized sleep at the end of treatment.Conclusion: Non-CBT psychological interventions, namely psychoanalysis and psychodynamic psychotherapy, were not associated with meaningful benefits for children and adolescents with chronic pain during the COVID-19 pandemic. Patients who did not receive psychological interventions reported normalization of their sleep at the end of treatment compared to those who participated in non-CBT interventions.Keywords: psychotherapy, adolescents, children, chronic pain, cognitive behavioral therapy