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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald

4 Issues per year

CiteScore 2017: 0.84

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Risk severity moderated effectiveness of pain treatment in adolescents

Hanna Vuorimaa
  • Corresponding author
  • Department of Pediatrics, Päijät-Häme Central Hospital, Keskussairaalankatu 7, Lahti 15850, Finland, Phone: +358-44-440-6870
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Leena Leppänen / Hannu Kautiainen
  • Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
  • Folkhälsan Research Center, Helsinki, Finland
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Marja Mikkelsson
  • Rehabilitation, Päijät-Häme Central Hospital, Lahti, Finland
  • Rehabilitation, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Maiju Hietanen / Heli Vilen / Heini Pohjankoski
Published Online: 2018-11-09 | DOI: https://doi.org/10.1515/sjpain-2018-0312


Background and aims

A targeted pain program may prevent the progression and subsequent occurrence of chronic pain in adolescents. This study tested the effectiveness of a new acceptance and commitment therapy -based pain management intervention, using physical and psychological functions as the outcomes. The objective was also to determine whether Pediatric Pain Screening Tool risk profiles function as outcome moderator in the current sample. A valid screening tool would enable the program development.


Thirty-two consecutive adolescent patients (13–17 years old) with idiopathic recurrent musculoskeletal pain completed the study. The intervention comprised acceptance and commitment therapy-oriented multidisciplinary treatment. Pediatric Pain Screening Tool, pain frequency, functional disability, school attendance, physical endurance, depressive symptoms, and catastrophizing coping style were measured before treatment (baseline) and again at 6 and 12 months after the initiation of treatment. To test the effectiveness of the new program, we also determined whether the original risk classification of each patient remained constant during the intervention.


The intervention was effective for high-risk patients. In particular, the pain frequency decreased, and psychosocial measures improved. In post-intervention, the original risk classification of seven patients in the high-risk category changed to medium-risk. PPST classification acted as a moderator of the outcome of the current program.


The categorization highlighted the need to modify the program content for the medium-risk patients. The categorization is a good tool to screen adolescent patients with pain.


The results support using the Pediatric Pain Screening Tool in developing rehabilitation program for pediatric musculoskeletal pain patients. According to the result, for adolescent prolonged musculoskeletal pain patients the use of ACT-based intervention program is warranted.

Keywords: chronic pain; adolescence; acceptance and commitment therapy; pain screening; rehab


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About the article

Received: 2018-09-20

Revised: 2018-10-11

Accepted: 2018-10-22

Published Online: 2018-11-09

Authors’ statements

Research funding: This study was financially supported by the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital.

Conflict of interest: Hanna Vuorimaa has received a lecture fee from AbbVie. Heini Pohjankoski has received travel and congress fees from Pfizer, AbbVie, and Roche. Maiju Hietanen has received travel and congress fees from Pfizer, AbbVie, Roche, and Celgene. Marja Mikkelsson has received lecture fees from Orionpharma, Medtronic, Pfizer, and MSD. The authors have no conflicts of interest to declare regarding this study.

Informed consent: All patients and their parents received both oral and written information about the study. Informed consent was obtained from all individual participants included in the study.

Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol and procedures were approved by the Ethics Committee of the Päijät-Häme Hospital District. Approval number EC, R12119.

Citation Information: Scandinavian Journal of Pain, 20180312, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1515/sjpain-2018-0312.

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