Ann-Kristin Ruhe

Inpatient-based intensive interdisciplinary pain treatment for highly impaired children with severe chronic pain: Randomized controlled trial of efficacy and economic effects

Summary Intensive interdisciplinary pain treatment is effective for highly impaired children with chronic pain in terms of the childs well‐being and the economic effects. ABSTRACT Pediatric chronic pain, which can result in deleterious effects for the child, bears the risk of aggravation into adulthood. Intensive interdisciplinary pain treatment (IIPT) might be an effective treatment, given the advantage of consulting with multiple professionals on a daily basis. Evidence for the effectiveness of IIPT is scarce. We investigated the efficacy of an IIPT within a randomized controlled trial by comparing an intervention group (IG) (n = 52) to a waiting‐list control group (WCG) (n = 52). We made assessments before treatment (PRE), immediately after treatment (POST), as well as at short‐term (POST6MONTHS) and long‐term (POST12MONTHS) follow‐up. We determined a combined endpoint, improvement (pain intensity, disability, school absence), and investigated 3 additional outcome domains (anxiety, depression, catastrophizing). We also investigated changes in economic parameters (health care use, parental work absenteeism, subjective financial burden) and their relationship to the childs improvement. Results at POST showed that significantly more children in the IG than in the WCG were assigned to improvement (55% compared to 14%; Fisher P < .001; 95% confidence interval for incidence difference: 0.21% to 0.60%). Although immediate effects were achieved for disability, school absence, depression, and catastrophizing, pain intensity and anxiety did not change until short‐term follow‐up. More than 60% of the children in both groups were improved long‐term. The parents reported significant reductions in all economic parameters. The results from the present study support the efficacy of the IIPT. Future research is warranted to investigate differences in treatment response and to understand the changes in economic parameters in nonimproved children.

Familiäre finanzielle Belastung durch chronische Schmerzen im Kindes- und Jugendalter

BACKGROUND Chronic pain in children and adolescents causes a high utilization of the health care system and thereby significant costs. The aim of the present study is to describe the economic effects of pediatric chronic pain from the familys perspective. MATERIAL AND METHODS Six months before and 6 and 12 months after a 3-week inpatient-based intensive interdisciplinary pain treatment, the parents of 101 children with chronic pain filled in a standardized cost questionnaire containing the following parameters: (1) childs utilization of medical and social services, (2) subjective financial burden, and (3) type and extent of direct costs. RESULTS During the 6 months before inpatient-based intensive interdisciplinary pain treatment, children used a median of four different services. After inpatient pain treatment, service utilization has been reduced significantly (p < 0.001). One fifth of the families report a high or very high financial burden before treatment. Familys direct costs are most often caused by travelling (86 %) and drugs (60 %). After inpatient pain treatment, familys financial burden decreased significantly (p < 0.001). The frequency of additional expenditures is also reduced after treatment: parents report less additional costs due to travelling and drugs (p < 0.001, respectively). CONCLUSION The present study emphasizes the pronounced utilization of health and social care due to pediatric chronic pain. In the future, the use of appropriate diagnostic and therapeutic standards that contribute to avoiding unnecessary and expensive interventions is preferred.

Clinical and Economic Long-Term Treatment Outcome of Children and Adolescents with Disabling Chronic Pain

Objective Disabling pediatric chronic pain is accompanied by a significant burden to those affected and by high societal costs. Furthermore, it bears the risk of aggravation into adulthood. Studies have shown intensive interdisciplinary pain treatment to result in short-term positive effects on pain-related and psychological outcomes. In this study, we aimed to prove the stability of the long-term effects of intensive interdisciplinary pain treatment four years after treatment. Methods This longitudinal observational study followed adolescents who had received intensive interdisciplinary pain treatment over four years. We defined a combined end point, overall improvement (pain intensity, pain-related disability, and school/work absence), and investigated three additional psychological outcome domains (anxiety, depression, pain catastrophizing). We also examined changes to economic parameters (health care utilization, subjective financial burden) and their relationship to patient improvement. Results Similar patterns were observed for pain-related and psychological outcome domains, with data showing statistically and clinically significant reductions from admission to four-year follow-up. These positive effects were stable from one- to four-year follow-up. Approximately 60% of the adolescents showed an overall long-term improvement. Older age was found to be a risk factor for treatment failure. Economic parameters decreased statistically significantly, particularly for those with an overall improvement of the chronic pain disorder. Conclusions The results of this study support the long-term effectiveness of intensive interdisciplinary pain treatment and indicate that it can interrupt pain chronification. Future research is warranted to investigate why some of the adolescents did not show improvement and to allow for a more individualized treatment.

Health Care Utilization and Cost in Children and Adolescents With Chronic Pain: Analysis of Health Care Claims Data 1 Year Before and After Intensive Interdisciplinary Pain Treatment

Objectives: The aim of this study was to analyze changes in health care utilization and cost among a sample of highly impaired children and adolescents who sought a 3-week intensive interdisciplinary pain treatment (IIPT). Materials and Methods: Claims data from 7 statutory health insurance companies were analyzed for 65 children and adolescents who sought IIPT at the German Paediatric Pain Centre. The annual health care utilization and cost were determined for the following 4 areas: outpatient care, inpatient care, medications, and remedies and aids. We analyzed the changes in resource utilization in the year before (pre_1 y) IIPT and in the subsequent year (post_1 y). Results: Within the first year after IIPT, overall health care costs did not decrease significantly. However, the pattern of health care utilization changed. First, significantly more children and adolescents started outpatient psychotherapy (P=0.001). Second, the number of hospitalized children decreased significantly from 1-year pre to 1-year post (P=0.001). Accordingly, there were significantly fewer hospitalizations for primary chronic pain disorders at 1-year post (P<0.001). The prescription of nonopioids, co-analgesics and opioids was significantly reduced from 1-year pre to 1-year post (all P<0.013). Discussion: The present results indicate that the health care costs of children and adolescents with severe chronic pain disorders do not significantly decrease 1 year after IIPT; however, the treatment becomes more goal-focused. Differential diagnosis measures and nonindicated therapeutic interventions decreased, and more indicated interventions, such as psychotherapy, were used. Future research is needed to investigate the economic long-term changes after IIPT.

[Economic effects of chronic pain in childhood and adolescence: self-assessment of health care costs for affected families before and after a multidisciplinary inpatient pain therapy].

BACKGROUND Chronic pain in children and adolescents causes a high utilization of the health care system and thereby significant costs. The aim of the present study is to describe the economic effects of pediatric chronic pain from the familys perspective. MATERIAL AND METHODS Six months before and 6 and 12 months after a 3-week inpatient-based intensive interdisciplinary pain treatment, the parents of 101 children with chronic pain filled in a standardized cost questionnaire containing the following parameters: (1) childs utilization of medical and social services, (2) subjective financial burden, and (3) type and extent of direct costs. RESULTS During the 6 months before inpatient-based intensive interdisciplinary pain treatment, children used a median of four different services. After inpatient pain treatment, service utilization has been reduced significantly (p < 0.001). One fifth of the families report a high or very high financial burden before treatment. Familys direct costs are most often caused by travelling (86 %) and drugs (60 %). After inpatient pain treatment, familys financial burden decreased significantly (p < 0.001). The frequency of additional expenditures is also reduced after treatment: parents report less additional costs due to travelling and drugs (p < 0.001, respectively). CONCLUSION The present study emphasizes the pronounced utilization of health and social care due to pediatric chronic pain. In the future, the use of appropriate diagnostic and therapeutic standards that contribute to avoiding unnecessary and expensive interventions is preferred.

Ambulante und stationäre multimodale Schmerztherapie

In der multimodalen, interdisziplinaren Behandlung chronischer Schmerzen arbeiten verschiedene Berufsgruppen zeitgleich zusammen. Auf der biologischen, psychologischen und sozialen Ebene werden Angebote gemacht, die miteinander interagieren und sich in ihrer Wirkung verstarken. Struktur- und Prozessqualitat ambulanter oder stationarer multimodaler Schmerztherapieprogramme werden ebenso ausfuhrlich dargestellt wie deren wissenschaftliche Evidenz. Aktuelle Studien legen eine Kosteneffizienz nahe.

Familiäre finanzielle Belastung durch chronische Schmerzen im Kindes- und Jugendalter@@@Economic effects of chronic pain in childhood and adolescence: Selbsteinschätzung der Krankheitskosten für betroffene Familien vor und nach einer stationären interdisziplinären Schmerztherapie@@@Self-assessment of health care costs for affected families before and after a multidisciplinary inpatient pain therapy

BACKGROUND Chronic pain in children and adolescents causes a high utilization of the health care system and thereby significant costs. The aim of the present study is to describe the economic effects of pediatric chronic pain from the familys perspective. MATERIAL AND METHODS Six months before and 6 and 12 months after a 3-week inpatient-based intensive interdisciplinary pain treatment, the parents of 101 children with chronic pain filled in a standardized cost questionnaire containing the following parameters: (1) childs utilization of medical and social services, (2) subjective financial burden, and (3) type and extent of direct costs. RESULTS During the 6 months before inpatient-based intensive interdisciplinary pain treatment, children used a median of four different services. After inpatient pain treatment, service utilization has been reduced significantly (p < 0.001). One fifth of the families report a high or very high financial burden before treatment. Familys direct costs are most often caused by travelling (86 %) and drugs (60 %). After inpatient pain treatment, familys financial burden decreased significantly (p < 0.001). The frequency of additional expenditures is also reduced after treatment: parents report less additional costs due to travelling and drugs (p < 0.001, respectively). CONCLUSION The present study emphasizes the pronounced utilization of health and social care due to pediatric chronic pain. In the future, the use of appropriate diagnostic and therapeutic standards that contribute to avoiding unnecessary and expensive interventions is preferred.

Forschung in der pädiatrischen Palliativversorgung

Forschung dient primar dazu, Wissen zu generieren und zu verbreiten, um so mithilfe einer engen Theorie- Praxis-Vernetzung die Patientenversorgung zu optimieren und kritisch zu reflektieren. Die Palliativversorgung, speziell die padiatrische Palliativversorgung, ist eine noch sehr junge Forschungsdisziplin.