• Wen-Xin Tang, Lu-Feng Zhang, Yan-Qiu Ai, and Zhi-Song Li.
• Department of Anaesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
• Medicine (Baltimore). 2018 Sep 1; 97 (36): e12061.

BackgroundPediatric chronic pain is relatively common in the world. Although cognitive behavior therapy (CBT) has been shown to be efficacious in children and adolescents, it is generally recognized that availability and accessibility of CBT are limited. While Internet-delivered cognitive-behavioral therapy (ICBT) performs better in these areas.ObjectivesThis systematic review aims to evaluate the clinical effects of ICBT for chronic pain in youth when compared with the control treatments.MethodsWe searched electronic databases to identify randomized controlled trials that compared ICBT with the control therapy for pediatric chronic pain. The primary outcomes were 95% confidence intervals and mean difference or standardized mean difference in change of pain intensity and activity limitations.ResultsFour trials met the inclusion criteria with a total of 404 participants of whom 208 received ICBT. Compared with pretreatment, children reported significant, medium to large benefits on pain intensity, activity limitations, and parental protective behaviors after receiving ICBT immediately. Significant small to medium effects were found for outcomes of depressive symptoms, anxiety, and sleep quality from baseline to post-treatment in the ICBT group. But most measures of ICBT did not show statistically significant superiority to those of the control conditions, except parental protective behaviors. Generally children and their parents were highly acceptable and satisfied with ICBT.ConclusionICBT for physical and psychological conditions in youth with chronic pain is a full potential therapy; it can be successful on clinically effects and socioeconomic benefits. However, only limited data supported the conclusion, we require further methodologically robust trials.Systematic Review RegistrationPROSPERO CRD42017069811.

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