Introduction. Chronic pain among children and adolescents is an important public health problem [9]. Primary headache is the most common type in the 11 - 17 ...
Music Therapy for Chronic Headache in Adolescents Koenig, J.1, Oelkers-Ax, R.2, Parzer, P.2, Kaess, M.2, Lenzen, C.2, Schäfer, A.1, 1 2 Hillecke, T. , Resch, F. 1School
of Therapeutic Sciences, SRH University of Applied Sciences, Heidelberg, Germany 2Department of Child and Adolescents Psychiatry, University of Heidelberg, Germany
Introduction
Pilot study: design and results
Chronic pain among children and adolescents is an important public health problem [9]. Primary headache is the most common type in the 11 - 17 year olds in Germany [3]. With regards to a clinical problem so prevalent there is a disappointing lack of evidence for the appropriate pharmacological treatment [6] in this agegroup. A review concluded that psychotherapeutic interventions (e. g. relaxation techniques, biofeedback and CBT) show significant benefits in reducing pain intensity [11].
Within a pilot study two different time models of treatment were tested in clinical practice (compact: 12 sessions within one week vs. standard: 12 weekly sessions over three months). Participants (n = 19) reported the frequency and intensity of headache symptoms in a daily diary over two months before and after therapy. Both alternatives were found to be effective in redudicing the pain frequency and intensity - none was significantly superior to the other (see figure 1) [not published yet].
Music therapy and pain Listening to music reduces pain intensity levels and opioid requirements in the perioperative setting, although clinical relevance is still unclear [2]. Existing therapy concepts showed significant benefits in the treatment of adult patients with chronic pain [12]. Music therapy was superior to placebo capsules in the treatment of paediatric migraine [8] and might be a promising prophylactic treatment approach.
Aim of the studies The aim of the pilot study was to adapt an existing music therapy treatment concept for children with migraine [5] for adolescent patients with primary headache. The aim of the main study is to evaluate the clinical effectiveness of the treatment model under controlled conditions.
Treatment model The applied treatment model is theoretically based on the phase model of therapeutic change [7] (remoralization, remediation and rehabilitation). It consists of 12 sessions (45 minutes each) and three family councelings. The concept itself is devided into three phases containing three modules of treatment, specific music therapeutic factors and interventions [Table 1]. Within both studies presented, therapists recieved a special training and got supervision after each session. Every session was video documented for reasons of quality control and manual adherence. Therapy rooms and equipment were standardised.
Main study: design The main study is evaluating the treatment model in 6 sessions, 90 minutes each within 8 weeks in an ambulatory setting. An experimental group (n = 35) ist tested against a controll group (n = 35) participating in a music pedagogics programm (constant dose, therapists). Patients are randomized to a group after psychiatric diagnostics concerning exclusion from the study in cases of a primary psychiatric disorder or a likewise health impairment. Frequency and intensity of pain is measured by a 8 week daily diary before and after the intervention and again in a 6-months follow-up assessment (see figure 2). Further psychometric scales such as SES (sensory and affective pain scale), SDQ (strenghts and weaknesses scale) and KIDSCREEN (quality of life measures) are used.
Spotlight: questioning specific factors in music therapy Acknowledgement We like to thank the Else Kröner-Fresenius-Stiftung for funding the main study and the Landesstiftung Baden-Württemberg and SRH Gruppe for financial support during the pilot phase. The studies have been approved concerning the Helsinki declaration by positive vote of the ethics comittee.
The discussion about common and specific factors in psychotherapy has a long history [10, 1] and retains intereset in the context of actual debates about evidence based medicine (EBM) - also in psychotherapeutic treatment of adolescents [4]. When music therapy is applied in a psychotherapeutic understandment its specific factors and the effect of specific techniques must be questioned. By this design we try to shed some light upon these issues.
State of the main study By the time of this poster presentation the clinical phase of the study is done. All 74 adolescent patients have been treated. Final results of the main study are expected for summer 2012. References [1] Butler, SF, Strupp, HH (1986): Specific and nonspecific factors in psychotherapy: A problematic paradigm for psychotherapy research. Psychotherapy: Theory, Research, Practice, Training, Vol 23(1), Spr 1986, 30-40. doi: 10.1037/h0085590. [2] Cepeda MS, Carr DB, Lau J, Alvarez H. Music for pain relief. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD004843. [3] Ellert U, Neuhauser H, Roth-Isigkeit A (2007) Schmerzen bei Kindern und Jugendlichen in Deutschland: Prävalenz und Inanspruchnahme medizinischer Leistungen. Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS). Bundesgesundheitsbl-Gesundheitsforsch-Gesundheitsschutz 50:711-717. [4] Kelley, SD, Bickman, L, Norwood, E (2010): Evidence-based treatments and common factors in youth psychotherapy. The heart and soul of change: Delivering what works in therapy (2nd ed.). Duncan, Barry L. (Ed); Miller, Scott D. (Ed); Wampold, Bruce E. (Ed); Hubble, Mark A. (Ed), (2010). The heart and soul of change: Delivering what works in therapy (2nd ed.), (pp. 325-355). Washington, DC, US: American Psychological Association, xxix, 455 pp. doi: 10.1037/12075-011. [5] Leins, A. K. (2006) Heidelberger Therapiemanual: Migräne bei Kindern. In: Bolay, H. V., Dulger, A., Resch, F. (Hrsg.): Evidenzbasierte Musiktherapie. [6] Lewis D, Ashwal S, Hershey A, Hirtz D, Yonker M, Silberstein S (2004) Practice parameter: Pharmacological treatment of migraine headache in children and adolescents: Report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society. Neurology 63:2215. [7] Lueger RJ (1995) Ein Phasenmodell der Veränderung in der Psychotherapie. Psychotherapeut; 40:267-278. [8] Oelkers-Ax R, Nickel AK, Parzer P, Hillecke, TK, Bolay HV, Fischer J, Bender S, Hermanns U, Resch F (2008) Butterbur root extract and music therapy in the prevention of childhood migraine: An explorative study. European Journal of Pain 12:301-313. [9] Perquin CW, Hazebroek-Kampschreur AA, Hunfeld JA, et al. Pain in children and adolescents: a common experience. Pain. 2000;87 :51 58. [10] Strupp, HH (1970): Specific vs. nonspecific factors in psychotherapy and the problem of control. Archives of General Psychiatry, Vol 23(5), Nov 1970, 393-401. [11] Trautmann E, Lackschewitz H, Kröner-Herwig B (2006). Psychological treatment of recurrent headache in children and adolescents. A meta-analysis. Cephalalgia 26:1411-1426. [12] Wormit AF, Hillecke TK, Leins AK, Resch F, Bardenheuer HJ (2007) Musiktherapie bei chronischen, nicht-malignen Schmerzen. In: Hillecke TK (Hrsg) Themenheft "Musiktherapie" VTVM 28:100-114
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