Exercise and Psychological Training May Help to Ease Chronic Pain in Juvenile Arthritis

Exercise and Psychological Training May Help to Ease Chronic Pain in Juvenile Arthritis

Non-pharmacological treatments, such as psychological and exercise-based interventions, may be a viable way of easing pain in children and teenagers with pediatric rheumatic disease, also known as juvenile arthritis, a review study suggests.

The review, “Non-pharmacological options for managing chronic musculoskeletal pain in children with pediatric rheumatic disease: a systematic review,” was published in the journal Rheumatology International.

Pediatric rheumatic diseases (PRDs) comprise a group of chronic inflammatory conditions that affect the joints, causing swelling, stiffness, and pain. It is estimated that up to 86% of children with juvenile idiopathic arthritis experience joint pain.

While acute pain is caused by local tissue inflammation and can usually be treated with anti-inflammatories, once pain becomes chronic it tends to persist into adulthood, even when disease activity is low.

Children and adolescents with chronic musculoskeletal pain often experience sleep problems, fatigue, and stress, and are more likely to suffer from anxiety and depression than those without such chronic pain. These conditions are also likely to impact their social and academic life.

Unlike acute pain, chronic musculoskeletal pain can require treatments other than medications alone.

Researchers in this systematic review focused on summarizing and discussing the recent findings regarding non-pharmacological treatment options to minimize chronic musculoskeletal pain in PRD patients.

The review compiled data from 11 studies involving a total of 420 children and adolescents, age 5 to 18, with PRD. All studies were relatively short and small, with the majority focused on evaluating potential benefits of psychological and exercise-based interventions for pain management.

Psychological treatments given included cognitive behavior therapy, attention control, and physical therapy with biofeedback, while exercises water resistance exercises, strength-building, Pilates, and conventional exercises.

Results showed that some studies reported a modest positive outcome concerning pain reduction for these two approaches, with no associated side effects.

But other “studies found no clear benefits associated with active non-pharmacological treatments with respect to reducing pain or improving function. This discrepancy may have been due — at least in part — to the difficulty differentiating between acute and chronic pain among the patients in the included studies,” the researchers wrote.

Nevertheless, the team believes that when pharmacological therapies fail or are insufficient at alleviating pain, non-pharmacological interventions could be a viable alternative — or additional treatment — for easing the chronic musculoskeletal pain in PRD patients and for improving joint function.

“Importantly, chronic pain and acute pain may be etiologically different in PRD, and future studies should take this difference into account to identify the optimal therapeutic window for non-pharmacological approaches,” and the “different effects in patients with or without active inflammation,” the researchers wrote.

The team also emphasized that further studies are needed to investigate the long-term effectiveness of these interventions in PRD patients.

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