The natural history of chronic pain in children shows that, in many cases, outcome is improved compared to that in adults (73-75). It has been shown that early, multidisciplinary input (including cognitive behavioral therapy) has favorable outcome. In our outcome study we showed that the "back to school" rate significantly improved after an intensive, residential, multi-disciplinary programme (71), as did functional ability, anxiety (parents and young person) and mood.
CRPSs in children have a favorable prognosis if early physiotherapy is initiated (with psychological support) (15). A prolonged time to treatment and the presence of marked autonomic changes are not good prognostic indicators. Relapses of pain are relatively common but, in our experience, if the young person and his/her family recognize the onset of similar pains and put into practice the physical and emotional strategies that have previously been taught, the impact of the pains can be significantly reduced. In some cases, despite a variety of interventions, the impact of pain remains disabling on the young person and family. We do not yet have prognostic indicators to show us, at initial assessment, how to identify this very small, but complex group.
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