Page 125 WHO - Guidelines on the pharmacological treatment of persisting pain in children with medical illness

GRADE Table 16

Author: Wiffen PJ
Date: 27-04-2009
Question: Should cognitive behaviour therapy (CBT) or relaxation be used for the management of
chronic and recurrent non-headache pain in children and adolescents?
Setting: Not stated.
Bibliography: Eccleston C et al. Psychological therapies for the management of chronic and recurrent
pain in children and adolescents. Cochrane Database of Systematic Reviews, 2009, (2):CD003968.

Summary of findings
Quality assessment
No. of patients Effect

No. of studies Design Limitations Inconsistency Indirectness Imprecision Other considerations CBT alone or in combination with other non- pharmacological interventions Control (standard medical care) Relative (95% CI) Absolute Quality

Pain (follow-up 1.5–12 months; measured with: pain scores – variety; range of scores; better
indicated by less)
5 Rand- No No Seri- No None 143 95 – SMD b MOD-
omized serious serious ous a serious -0.94 ERATE
trials limita- incon- impre- (-1.43
tions sist- cision to
ency -0.44)
CBT, cognitive behaviour therapy; CI, confidence interval; SMD, standardized mean difference.
a Participants had a variety of pain including fibromyalgia and recurrent abdominal pain. One study (Hicks 2006)
was with mixed headache and abdominal. No studies included malignant pain. Data extracted as reported.
b Standardized mean difference as calculated in the review.

> 122