The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding), and by imprecise results (few patients).
A Cochrane review (abstract , review ) included 37 studies with a total of 2 111 children and adolescents (<18 years). 20 studies examined treatments for headache (including migraine), 9 for abdominal pain, 2 for mixed pain conditions including headache pain, 2 for fibromyalgia, 2 for recurrent abdominal pain or irritable bowel syndrome, and 2 for pain associated with sickle cell disease.
Psychological therapies reduced headache pain post-treatment and at follow-up (table ).
| Outcome | Relative effect (95% CI) | Probable outcome with control | Probable outcome with intervention | NNT | Participants (studies) |
|---|---|---|---|---|---|
| *statistical heterogeneity, I2=79% | |||||
| Beneficial reduction in headache pain | RR 2.47 (1.97 to 3.09) | 220 in 1000 | 560 in 1000 | 2.94 | 714 (15 studies) |
| Beneficial reduction in headache pain (at follow-up) | RR 2.89 (1.03 to 8.07)* | 478 in 1000 | 750 in 1000 | 3.67 | 251 (5 studies) |
Psychological therapies also had a small beneficial effect at reducing disability in headache conditions post-treatment and at follow-up (table ). No beneficial effect was found on depression post-treatment. At follow-up, only one study was eligible, therefore no analysis was possible and no conclusions can be drawn. Analyses revealed a small beneficial effect for anxiety post-treatment. However, this was not maintained at follow-up.
| Outcome | Standardized mean difference (95% CI) | Participants (studies) |
|---|---|---|
| *statistical heterogeneity, I2=54% | ||
| Disability | The mean disability in the intervention groups was 0.49 standard deviations lower (0.74 to 0.24 lower) | 263 (3 studies) |
| Disability at follow-up | The mean disability (at follow-up) in the intervention groups was 0.46 standard deviations lower (0.78 to 0.13 lower) | 148 (2 studies) |
| Depression | The mean depression in the intervention groups was 0.18 standard deviations lower (0.49 lower to 0.14 higher) | 164 (3 studies) |
| Anxiety | The mean anxiety in the intervention groups was 0.33 standard deviations lower (0.61 to 0.04 lower) | 203 (4 studies) |
| Anxiety at follow-up | The mean anxiety (at follow-up) in the intervention groups was 0.28 standard deviations lower (1 lower to 0.45 higher)* | 67 (2 studies) |
Non-headache pain was found to improve post-treatment, but not at follow-up (table ). Psychological therapies also had a beneficial effect for disability post-treatment, but this was not maintained at follow-up. No effect was found for depression or anxiety post-treatment or at follow-up.
| Outcome | Standardized mean difference (95% CI) | Participants (studies) |
|---|---|---|
| Pain | The mean pain in the intervention groups was 0.57 standard deviations lower (0.86 to 0.27 lower); I2=75% | 852 (13 studies) |
| Pain at follow-up | The mean pain in the intervention groups was 0.11 standard deviations lower (0.41 lower to 0.19 higher); I2=62% | 543 (7 studies) |
| Disability | The mean disability in the intervention groups was 0.45 standard deviations lower (0.71 to 0.19 lower); I2=63% | 764 (11 studies) |
| Disability at follow-up | The mean disability in the intervention groups was 0.35 standard deviations lower (0.71 lower to 0.02 higher); I2=73% | 508 (6 studies) |
| Depression | The mean depression in the intervention groups was 0.07 standard deviations lower (0.3 lower to 0.17 higher) | 538 (6 studies) |
| Depression at follow-up | The mean anxiety in the intervention groups was 0.06 standard deviations higher (0.16 lower to 0.28 higher) | 473 (5 studies) |
| Anxiety | The mean anxiety in the intervention groups was 0.15 standard deviations lower (0.36 lower to 0.07 higher) | 498 (5 studies) |
| Anxiety at follow-up | The mean anxiety in the intervention groups was 0.05 standard deviations higher (0.24 lower to 0.33 higher); I2=55% | 452 (5 studies) |