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. 2017 Jul 26;7(7):CD012538.
doi: 10.1002/14651858.CD012538.pub2.

Opioids for chronic non-cancer pain in children and adolescents

Tess E Cooper  1 , Emma Fisher, Andrew L Gray, Elliot Krane, Navil Sethna, Miranda Al van Tilburg, Boris Zernikow, Philip J Wiffen
Affiliations

Opioids for chronic non-cancer pain in children and adolescents

Tess E Cooper et al. Cochrane Database Syst Rev. .

Abstract

Background: Pain is a common feature of childhood and adolescence around the world, and for many young people, that pain is chronic. The World Health Organization guidelines for pharmacological treatments for children's persisting pain acknowledge that pain in children is a major public health concern of high significance in most parts of the world. While in the past, pain was largely dismissed and was frequently left untreated, views on children's pain have changed over time, and relief of pain is now seen as importantWe designed a suite of seven reviews on chronic non-cancer pain and cancer pain (looking at antidepressants, antiepileptic drugs, non-steroidal anti-inflammatory drugs, opioids, and paracetamol as priority areas) in order to review the evidence for children's pain utilising pharmacological interventions in children and adolescents.As the leading cause of morbidity in children and adolescents in the world today, chronic disease (and its associated pain) is a major health concern. Chronic pain (lasting three months or longer) can arise in the paediatric population in a variety of pathophysiological classifications: nociceptive, neuropathic, idiopathic, visceral, nerve damage pain, chronic musculoskeletal pain, and chronic abdominal pain, and other unknown reasons.Opioids are used worldwide for the treatment of pain. They bind to opioid receptors in the central nervous system (mu, kappa, delta, and sigma) and can be agonists, antagonists, mixed agonist-antagonists, or partial agonists. Opioids are generally available in healthcare settings across most high-income countries, but access may be restricted in low- and middle-income countries. For example, opioids currently available in the UK include: buprenorphine, codeine, fentanyl, hydromorphone, methadone, morphine, oxycodone, and tramadol. Opioids are used in varying doses (generally based on body weight for paediatric patients) by means of parenteral, transmucosal, transdermal, or oral administration (immediate release or modified release). To achieve adequate pain relief in children using opioids, with an acceptable grade of adverse effects, the recommended method is a lower dose gradually titrated to effect in the child.

Objectives: To assess the analgesic efficacy and adverse events of opioids used to treat chronic non-cancer pain in children and adolescents aged between birth and 17 years, in any setting.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library, MEDLINE via Ovid, and Embase via Ovid from inception to 6 September 2016. We also searched the reference lists of retrieved studies and reviews, and searched online clinical trial registries.

Selection criteria: Randomised controlled trials, with or without blinding, of any dose and any route, treating chronic non-cancer pain in children and adolescents, comparing opioids with placebo or an active comparator.

Data collection and analysis: Two review authors independently assessed studies for eligibility. We planned to use dichotomous data to calculate risk ratio and number needed to treat, using standard methods. We assessed GRADE (Grading of Recommendations Assessment, Development and Evaluation) and planned to create a 'Summary of findings' table.

Main results: No studies were eligible for inclusion in this review. We rated the quality of the evidence as very low. We downgraded the quality of evidence by three levels due to the lack of data reported for any outcome.

Authors' conclusions: There was no evidence from randomised controlled trials to support or refute the use of opioids to treat chronic non-cancer pain in children and adolescents. We are unable to comment about efficacy or harm from the use of opioids to treat chronic non-cancer pain in children and adolescents.We know from adult randomised controlled trials that some opioids, such as morphine and codeine, can be effective in certain chronic pain conditions.This means that no conclusions could be made about efficacy or harm in the use of opioids to treat chronic non-cancer pain in children and adolescents.

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Conflict of interest statement

PW: none known.

TC: none known.

EF: none known.

AG: none known; AG serves on medicines regulatory and selection bodies, and previously contributed to WHO guidance on the management of pain in children.

EK has received consulting fees for attending a research strategy meeting from Pfizer, Inc. (2015) and for protocol and research consultation from Mallinckrodt Pharmaceuticals, Inc. (2014), AstraZeneca, Inc. (2014), and Collegium Pharma (2016); EK is a specialist paediatric pain clinician and treats patients with chronic pain.

NS has received grants from Gebauer Company for conduct of animal studies using a topical anaesthetic (2015). NS has offered consultant expertise to Pfizer in designing a multi‐center study for use of gabapentin in treatment of neuropathic pain in children (2015). NS is a co‐investigator with an ongoing multi‐center Phase 3 trial of an experimental drug SMNRX [antisense oligonucleotide] for treatment of infants and children with spinal muscle atrophy (2012 to present). NS is an anaesthesiologist and manages paediatric patients with chronic pain.

MvT: none known.

BZ has received personal funding from Grünenthal (2014 to 2016) and Pfizer (2016) in designing and monitoring paediatric investigator plans; BZ is a specialist paediatric pain researcher and clinician and treats patients with cancer pain.

This review was identified in a 2019 audit as not meeting the current definition of the Cochrane Commercial Sponsorship policy. At the time of its publication it was compliant with the interpretation of the existing policy. As with all reviews, new and updated, at update this review will be revised according to 2020 policy update.

Figures

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Study flow diagram.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD012538

References

References to studies excluded from this review

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