Table 1.
Summary of characteristics of included studies.
| Study | Design | Sample | Stage of Pain (Baseline)/ Condition | Intervention/ Exposure (N) |
Length of Intervention (Weeks) | Mediator Variables (Measure) | Outcome Variables (Measure) | Schedule of Assessment (M = Mediator; O = Outcome) |
Analysis Method; Single/Multiple Mediator Model; Confounders | Number of Mediation Models Tested |
|---|---|---|---|---|---|---|---|---|---|---|
| Acute pain | ||||||||||
| Olbrecht, et al. [31]) | Two arm, Observational longitudinal | USA, n = 114 [78 female (68%), age 14.4 (SD = 2.0) | Acute pain/ Post posterior spinal fusion for idiopathic scoliosis or kyphosis | Intravenous acetaminophen (n = 70) No intravenous acetaminophen (n = 44) |
<1 | Morphine consumption (mg/kg) | Length of stay in hospital (days) | M: post-operatively (varied), while inpatient O: at point of discharge |
Product of coefficients [20] with Sobel’s test [34]; Single; Controlled | 1 |
| Chronic pain | ||||||||||
| Bonnert, et al. [32] | Two arm, RCT | Sweden, n = 101 [62 female (61%), age 15.5 (SD = 1.6)] | Chronic pain/IBS | Exposure-based Internet-CBT (n = 47) Wait-list control (n = 54) |
10 | GI-specific avoidance behavior (IBS-BRQ) * Perceived stress (PSS-10) * |
GI symptoms (GSRS-IBS) * | M & O: weekly during treatment | Product of coefficients [20,35] with bootstrapped CIs; Single and multiple; Controlled. | 2 |
| Lalouni, et al. [29]) | Two arm, RCT | Sweden, n = 90 [62 female (69%), age 10.2 (SD = 1.4)] | Chronic pain/Functional abdominal pain | Exposure-based Internet-CBT (n = 46) Treatment as usual (n= 44) |
10 | GI-specific avoidance behavior (BRQ-C) * GI-specific anxiety (VSI-C) * |
GI-symptoms (PedQL-GI) *† | M: bi-weekly (every 2 weeks) during treatment O: weekly during treatment |
Product of coefficients [36,37] with bootstrapped CIs; Single; Uncontrolled. | 2 |
| Levy, et al. [28] | Two arm, RCT | USA, n = 200 [145 female (73%), age 11.2 (SD = 2.6)] | Chronic pain/Functional abdominal pain | Social learning and CBT (n = 100) Education (n = 100) |
3 | Perceived pain threat (PBQ) † Solicitousness (ARCS) † Pain catastrophizing (PRI) * |
GI symptom severity (CSI) *† Pain intensity (FPS-R) *† |
M: post-treatment O: 3-, 6-, 12-months post-treatment |
Structural equation modelling [35,38]; Multiple; Controlled | 18 |
| Kashikar-Zuck, et al. [33] | Two arm, RCT | USA, n = 100 [93 female (93%), age 15.0 (SD = 1.8)] | Chronic pain/ Juvenile fibromyalgia | CBT (n = 50) Fibromyalgia education (n = 50) |
8 | Pain coping (PCQ) * Pain catastrophizing (PCQ) * Coping efficacy (PCQ) * |
Functional disability (FDI) * Depression (CDI)* |
M: post-treatment O: 6-months post treatment |
Product of coefficients [39] with bootstrapped CIs; Multiple; Uncontrolled | 6 |
| Wicksell, et al. [30] | Two arm, RCT | Sweden, n = 30 [23 female (77%), age 14.7 (range = 10.8–18.1)] | Chronic pain/Mixed chronic pain | ACT (n = 15) MDT + amitriptyline (n = 15) |
10 | Pain impairment beliefs (PAIRS) * Pain reactivity (PRS) * Self-efficacy (SES) * Kinesiophobia (TSK) * Pain catastrophizing (PCQ) * Pain intensity (VAS) |
Pain interference (PII) * Depression (CES-DC) * |
M: post-treatmentO: 3.5-, 7-months post treatment | Product of coefficients [11] with bootstrapped CIs; Single; Uncontrolled | 24 |
* = child report; † = parent report; ACT, Acceptance and Commitment Therapy; ARCS, Adult Responses to Children’s Symptoms; BRQ-C, Irritable Bowel Syndrome Behavioral Responses Questionnaire–Child; CES-DC, Centre for Epidemiological Studies Depression Scale for Children; CDI, Children’s Depression Inventory; CBT, Cognitive Behavioral Therapy; CI, confidence interval; CSI, Children’s Somatization Inventory; FDI, Functional Disability Inventory; FPS-R, Faces Pain Scale–Revised; GSRS-IBS, Gastrointestinal Symptom Rating Scale–Irritable Bowel Syndrome; IBS, Irritable Bowel Syndrome; IBS-BRQ, IBS-specific Behavioral Response Questionnaire; MDT, Multi-Disciplinary Therapy; PBQ, Pain Beliefs Questionnaire; PCQ, Pain Coping Questionnaire; PedQL-GI, Pediatric Quality of Life Gastrointestinal symptoms scale; PPII, Pain Interference Index; PAIRS, Pain and Impairment Relationship Scale; PRI, Pain Response Inventory; PRS, Pain Reactivity Scale; PSS-10, Perceived Stress Scale-10; RCT, Randomized Controlled Trial; SES, Self-Efficacy Scale; TSK, Tampa Scale of Kinesiophobia; VAS, Visual Analogue Scale; VSI-C, Visceral Sensitivity Index for Children.