P2B346: Pediatric Patients with Chronic Pain and the Role of Nature Exposure Therapy in Pain Rehabilitation

Background: Chronic pain is a complex condition that can have detrimental effects on the physical and psychosocial health of both adults and children. It is estimated that approximately 8% of children experience chronic pain worldwide. Nature exposure therapy is a unique non-pharmacological intervention that has been explored in the rehabilitation of chronic pain. This systematic review aimed to examine the effects of nature exposure therapy on pain experience and psychosocial quality of life in patients with chronic pain.

Methods: Studies were identified through the MEDLINE, Embase, and Cumulative Index for Nursing and Allied Health Literature (CINAHL) databases. Inclusion criteria were controlled trials comparing nature exposure therapy to standard care for patients with chronic pain. Physical and virtual nature exposure therapies were considered and no limitations were imposed on the form of nature exposure intervention, encompassing both active and passive experiences. Trials using secondary treatments, pharmacological interventions, or subjective measures of pain as primary outcomes were excluded. Primary outcomes were quantitative pain intensity and pain-related anxiety scores.

Results: Of 6056 studies screened, 2 were included for meta-analysis (199 participants, 99 nature exposure therapy, 100 control; pooled mean age = 47.8 years ± 7.9). A quasi-experimental trial using nature exposure therapy in pediatric patients with cancer-related chronic pain revealed significant differences in pain intensity (-37.6%) and anxiety (-67.8%) reductions between intervention and control groups . Similarly, significant differences in pain intensity (-23.4%) and anxiety (-23.7%) reductions were demonstrated in a randomized controlled trial investigating nature exposure therapy in adults with fibromyalgia (p = 0.001). Meta-analysis showed mean pain intensity reduction among all participants receiving nature exposure therapy was -32.0% (95% CI: -38.0, -26.0) compared to -1.47% (95% CI: -5.29, 2.35) among controls. Mean anxiety reduction was -47.6% (95% CI: -87.7, -7.5) among participants receiving nature exposure therapy and -1.8% (95% CI: -4.0, 0.30) among controls. There was no significant difference in pain intensity and pain-related anxiety score reductions between children and adult participants receiving nature exposure therapy.

Conclusion: The available data from the included studies suggests that nature exposure therapy may have promising therapeutic effects in pediatric patients with chronic pain and could be an effective and low-risk intervention in chronic pain rehabilitation. However, the evidence is limited, and this systematic review highlights the need for more well-designed randomized controlled trials to investigate the use of nature exposure therapy in the rehabilitation of children with chronic pain. Additionally, this review emphasizes the potential value of nature spaces in communities and their significance in urban planning.