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The treatment of chronic pain in children and adolescents

Multiprofessional team discussing a case

The treatment of children with chronic pain conditions demands an interdisciplinary therapeutic approach, which is often difficult to realize in a regular day-to-day inpatient or outpatient practice.

In the German Paediatric Pain Centre of the Vestische Children’s and Adolescents’ Clinic in the University of Witten/Herdecke, we offer multimodal pain therapy for children and adolescents with chronic pain in both outpatient and inpatient settings.

Treating chronic pain early

Childhood chronic pain that is left untreated or is not successfully treated often continues into adulthood.

Early therapy resulting in prevention of progressive chronification alleviates personal suffering and is the prerequisite for the education and future of children and adolescents, since freedom from pain makes regular, successful school life possible.

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First consultation: diagnosis and therapy stratification

Family discussion in the German Paediatric Pain Centre

In the first outpatient consultation, the doctor and psychologist get an overview of the diagnostic and therapeutic measures that have so far taken place and answer any questions the patient and his or her parents may have. Together we decide if further therapy should proceed on an outpatient or inpatient basis. Outpatient therapy is usually sufficient; subsequent consultations follow every three to six months.

Our treatment spectrum covers all illnesses that include chronic pain. Among these are:

  • Cluster headaches
  • Chronic abdominal pain
  • Chronic headaches with and without migraine (according to IHS criteria)
  • Chronic pain resulting from physical illnesses such as epidemolysis bullosa, juvenile idiopathic arthritis, severe cerebral palsy, etc.
  • Chronic pain resulting from accidents (for example, post-traumatic headaches)
  • Chronic pain condition with somatic and psychological factors, with most pain located in the muscles and joints, such as juvenile fibromyalgia syndrome
  • Hemicrania
  • Complex regional pain syndrome (CRPS), formerly morbus sudeck
  • Medication-induced headaches
  • Nerve pain, neuropathic pain
  • Somatoform pain condition
  • Tension headaches

If it becomes clear in the first consultation or subsequently that inpatient therapy is required, the patient will be placed on a wait list. The inpatient multimodal therapy program lasts three weeks, in rare cases five weeks, and is carried out in the children’s pain ward of the Vestische Children’s and Adolescents’ Pain Clinic.

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Multimodal pain therapy

Effectiveness studies have shown that the multimodal pain therapy program (outpatient, inpatient) can achieve substantial improvement in affected children; many of the improvements occur after only three months. Even two years after therapy most of the children are still going to school regularly and are developing normally. You can read more about our multimodal inpatient therapy program as well as the results of the effectiveness studies in the following publications.

M. Dobe, T. Hechler, J. Behlert, J. Kosfelder, B. Zernikow
Pain therapy with children and adolescents severely disabled due to chronic pain. Long-term outcome after inpatient pain therapy
Der Schmerz 2011; 4: 411-422 (Article in German)

T Hechler, A Martin, M Blankenburg, S Schroeder, J Kosfelder, L Hölscher, H Denecke, B Zernikow
Specialized multimodal outpatient treatment for children with chronic pain: Treatment pathways and long-term outcome
Eur J Pain 2011, 15(9): 976-984

T Hechler, M Blankenburg, M Dobe, J Kosfelder, B Hübner, B Zernikow
Effectiveness of a multimodal inpatient treatment for pediatric chronic pain: A comparison between children and adolescents
Eur J Pain 2010; 14(1):97.e1-97.e9

T Hechler, M Dobe, J Kosfelder, U Damschen, B Hübner, M Blankenburg, C Sauer, B Zernikow
Effectiveness of a 3-week multimodal inpatient pain treatment for adolescents suffering from chronic pain. Statistical and clinical significance
Clin J Pain 2009; 25(2): 156-166

M Dobe, U Damschen, B Reiffer-Wiesel, C Sauer, B Zernikow
Three-week mul ti mo dal in pa tient treat ment of chil dren with chron ic
pain. First re sults of the long-term fol low-up
Der Schmerz 2006;20:51-60

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Further information on our studies and results of research can be found on the page of the Chair of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University