Treatment of children and adolescents with chronic pain in occupational therapy

Uvod: Kronična bolečina je bolečina, ki traja vsaj 3 mesece in zahteva skrbno obravnavo. Opredelimo jo kot bio-psiho-socialno bolezen in vpliva na vsa področja človekovega delovanja. Za doživljanje bolečine je pomemben vpliv psihičnih in socialnih dejavnikov. Delovni terapevti ocenjujejo analizo vsakdanjih življenjskih aktivnosti otrok in mladostnikov ter jim pomagajo razumeti njihove težave in izzive. Namen: Ugotoviti, kaj je do sedaj znanega v delovni terapiji pri otrocih in mladostnikih s kronično bolečino ter raziskati, katere vrste intervencij uporabljajo delovni terapevti pri obvladovanju kronične bolečine. Metode dela: Naredili smo sistematični pregled literature. Literaturo smo iskali v podatkovnih bazah CINAHL, Web of Science, Pub Med, OTSeeker in COBISS. Pri kriterijih za izbiro literature smo upoštevali populacijo, intervencijo, rezultate, vrste študij in jezik, leta objave nismo omejili. Postopek iskanja člankov smo predstavili v PRISMA diagramu. Članke smo ocenili po relevantnosti, izbranih 11 člankov pa še po kakovosti in ravni dokazov. Rezultati: Iz prebrane literature smo izpeljali tri teme, in sicer: delovnoterapevtske prakse, kognitivno-vedenjska terapija in debelost. Najpogosteje omenjene intervencije so bile kognitivno-vedenjska terapija in navidezna resničnost ter igra, saj slednji otrokom ter mladostnikom odvrneta pozornost od bolečine in se lažje spoprijema z njo. Veliko verjetnost za nastanek invalidnosti povzroča debelost, ki je velikokrat povezana s kronično bolečino, saj imajo posamezniki omejeno udeležbo pri različnih aktivnostih. Zato je potrebno prepoznavanje povezanosti obeh in zdravljenje njunih posledic. Razprava in zaključek: Delovnim terapevtom primanjkuje specifičnega znanja o bolečinah pri otrocih, prav tako je tudi njihovo spoprijemanje z bolečino površinsko, vendar obstajajo terapevti, ki se poleg tradicionalnih intervencij, poslužujejo tudi alternativnih metod. Pregled literature je pokazal večji napredek in zmanjšanje bolečine pri intervencijah, ki niso sodile med standardne metode obravnave. Navidezna resničnost in igra sta med raziskavami najbolj priljubljeni metodi. Poleg teh pa je zanesljiva tudi kognitivno-vedenjska terapija, saj kronična bolečina ni samo nevrološko, ampak predvsem psihološko stanje.Introduction: Chronic pain is pain that lasts for at least 3 months and requires careful treatment. It is defined as a bio-psycho-social disease and affects all areas of human activity. The influence of psychological and social factors is important for experiencing pain. Occupational therapists evaluate the analysis of the daily life activities of children and adolescents and help them understand their problems and challenges. Purpose: To identify what is known so far in occupational therapy for children and adolescents with chronic pain and to investigate the types of interventions used by occupational therapists in chronic pain management. Methods: We made a systematic literature review. Literature was searched in CINAHL, Web of Science, Pub Med, OTSeeker and COBISS databases. The criteria for selecting the literature included population, intervention, outcomes, study types and language, and we did not limit the year of publication. The process of searching for articles is presented in the PRISMA diagram. We assessed the articles for relevance, and the 11 selected articles for quality and level of evidence. Results: Three themes were derived from the literature review: interventions used by occupational therapists, the lack of knowledge of occupational therapists, and obesity. The most frequently mentioned interventions were cognitive behavioural therapy, virtual reality, and play, as the latter distract children and adolescents from the pain and make it easier for them to cope with it. Obesity, often associated with chronic pain, is a major cause of disability, as individuals have limited participation in various activities. This calls for recognizing the link between the two and treating their consequences. Discussion and Conclusion: Occupational therapists lack specific knowledge about pain in children, and their coping with pain is also superficial, but there are therapists who, in addition to traditional interventions, also use alternative methods. The literature review showed greater progress and pain reduction with interventions that were not standard treatment methods. Virtual reality and play are the most popular methods in research. In addition, cognitive behavioural therapy is also reliable, as chronic pain is not only a neurological condition, but also primarily a psychological one