The Effectiveness of School-Based Interventions on Pain and Disability Outcomes in Adolescents With Persistent Pain. A Systematic Review.

Background And Objective: Persistent pain is common among adolescents, with significant consequences. School-based interventions have the potential to reach most adolescents, but there is a lack of systematic reviews addressing school-based pain interventions. This systematic review aimed to identify and evaluate the effectiveness of school-based interventions for reducing persistent pain and disability in adolescents compared to control interventions.

Databases And Data Treatment: The PRISMA guidelines were followed (CRD42023477721). Searches in Medline, EMBASE, PEDro, CINAHL, Web of Science, Cochrane, AMED, PsycINFO, and Google Scholar identified 6651 studies. We included randomised controlled trials (RCTs) and controlled trials (CTs) of interventions conducted at schools involving adolescents aged 10-19 years with persistent pain lasting ≥ 3 months. Risk of bias was measured using the Cochrane RoB 2 tool for RCTs and ROBINS-I for CTs. Results were synthesised narratively.

Results: Sixteen studies met the inclusion criteria (n = 12 RCTs, n = 3 CTs, n = 1 pilot RCT) including 2873 participants. The identified interventions were relaxation, education, exercise, taping, and tailored pain management. Relaxation reduced headache activity in four out of five studies; exercise was effective for back and menstrual pain; education showed conflicting results; and person-centred care was not better than usual school health care for reducing pain. All included studies had a high risk of bias.

Conclusion: Relaxation and exercise showed promising effectiveness on reducing persistent pain in adolescents, although with a high risk of bias. The need for higher-quality studies remains imperative to strengthen the evidence base and inform future interventions.

Significance Statement: This systematic review highlights the potential of school-based interventions, particularly relaxation and exercise, in reducing persistent pain among adolescents, although in studies with a high risk of bias. These findings underscore the need for higher-quality studies to establish robust evidence and inform effective, equitable pain management strategies in school settings.