Pharmacological interventions for chronic pain in children: an overview of systematic reviews

Christopher Eccleston^{1

2}, Emma Fisher^{1

3}, Tess E Cooper⁴, Marie-Claude Grégoire⁵, Lauren C Heathcote⁶, Elliot Krane⁷, Susan M Lord^{8

9}, Navil F Sethna¹⁰, Anna-Karenia Anderson¹¹, Brian Anderson¹², Jacqueline Clinch^{13

14}, Andrew L Gray¹⁵, Jeffrey I Gold^{16

17}, Richard F Howard¹⁸, Gustaf Ljungman¹⁹, R Andrew Moore²⁰, Neil Schechter²¹, Philip J Wiffen²⁰, Nick M R Wilkinson²², David G Williams²³, Chantal Wood²⁴, Miranda A L van Tilburg^{25

26}, Boris Zernikow^{27

28}

Affiliations

¹ Centre for Pain Research, University of Bath, Bath, United Kingdom.
² Department of Clinical and Health Psychology, Ghent University, Ghent, Belgium.
³ Pain, Palliative, and Supportive Care, Oxford University Hospitals, Oxford, United Kingdom.
⁴ Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
⁵ Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.
⁶ Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States.
⁷ Department of Anesthesiology, Perioperative, and Pain Medicine, Pediatrics, Stanford University School of Medicine, Stanford, Palo Alto, CA, United States.
⁸ Children's Complex Pain Service, John Hunter Children's Hospital, Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
⁹ Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.
¹⁰ Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States.
¹¹ Royal Marsden Hospital, London, United Kingdom.
¹² Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.
¹³ Bristol Royal Children's Hospital, University of Bristol, Bristol, United Kingdom.
¹⁴ Royal National Hospital for Rheumatic Diseases, Bath, United Kingdom.
¹⁵ Division of Pharmacology, Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa.
¹⁶ Anesthesiology, Pediatrics, and Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
¹⁷ Pediatric Pain Management Clinic, Children's Hospital Los Angeles, Los Angeles, CA, United States.
¹⁸ Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
¹⁹ Pediatric Oncology, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
²⁰ Pain Research, Nuffield, Department of Clinical Neurosciences, University of Oxford, The Churchill, Oxford, United Kingdom.
²¹ Department of Anesthesiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
²² Department of Paediatrics, Evelina London Children's Hospital, Kings College London, United Kingdom.
²³ The Anaesthetic Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
²⁴ Department of Rheumatology, Chronic Pain Centre, University Hospital of Limoges, University of Limoges, Haute Vienne, France.
²⁵ College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC, United States.
²⁶ Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, United States.
²⁷ German Paediatric Pain Centre, Children's and Adolescent's Hospital, Datteln, Germany.
²⁸ Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.

PMID: 31335640
DOI: 10.1097/j.pain.0000000000001609

Meta-Analysis

Pharmacological interventions for chronic pain in children: an overview of systematic reviews

Christopher Eccleston et al. Pain. 2019 Aug.

. 2019 Aug;160(8):1698-1707.

doi: 10.1097/j.pain.0000000000001609.

Authors

Affiliations

¹ Centre for Pain Research, University of Bath, Bath, United Kingdom.
² Department of Clinical and Health Psychology, Ghent University, Ghent, Belgium.
³ Pain, Palliative, and Supportive Care, Oxford University Hospitals, Oxford, United Kingdom.
⁴ Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
⁵ Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.
⁶ Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States.
⁷ Department of Anesthesiology, Perioperative, and Pain Medicine, Pediatrics, Stanford University School of Medicine, Stanford, Palo Alto, CA, United States.
⁸ Children's Complex Pain Service, John Hunter Children's Hospital, Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
⁹ Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.
¹⁰ Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States.
¹¹ Royal Marsden Hospital, London, United Kingdom.
¹² Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.
¹³ Bristol Royal Children's Hospital, University of Bristol, Bristol, United Kingdom.
¹⁴ Royal National Hospital for Rheumatic Diseases, Bath, United Kingdom.
¹⁵ Division of Pharmacology, Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa.
¹⁶ Anesthesiology, Pediatrics, and Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
¹⁷ Pediatric Pain Management Clinic, Children's Hospital Los Angeles, Los Angeles, CA, United States.
¹⁸ Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
¹⁹ Pediatric Oncology, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
²⁰ Pain Research, Nuffield, Department of Clinical Neurosciences, University of Oxford, The Churchill, Oxford, United Kingdom.
²¹ Department of Anesthesiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
²² Department of Paediatrics, Evelina London Children's Hospital, Kings College London, United Kingdom.
²³ The Anaesthetic Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
²⁴ Department of Rheumatology, Chronic Pain Centre, University Hospital of Limoges, University of Limoges, Haute Vienne, France.
²⁵ College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC, United States.
²⁶ Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, United States.
²⁷ German Paediatric Pain Centre, Children's and Adolescent's Hospital, Datteln, Germany.
²⁸ Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.

PMID: 31335640
DOI: 10.1097/j.pain.0000000000001609

Abstract

We know little about the safety or efficacy of pharmacological medicines for children and adolescents with chronic pain, despite their common use. Our aim was to conduct an overview review of systematic reviews of pharmacological interventions that purport to reduce pain in children with chronic noncancer pain (CNCP) or chronic cancer-related pain (CCRP). We searched the Cochrane Database of Systematic Reviews, Medline, EMBASE, and DARE for systematic reviews from inception to March 2018. We conducted reference and citation searches of included reviews. We included children (0-18 years of age) with CNCP or CCRP. We extracted the review characteristics and primary outcomes of ≥30% participant-reported pain relief and patient global impression of change. We sifted 704 abstracts and included 23 systematic reviews investigating children with CNCP or CCRP. Seven of those 23 reviews included 6 trials that involved children with CNCP. There were no randomised controlled trials in reviews relating to reducing pain in CCRP. We were unable to combine data in a meta-analysis. Overall, the quality of evidence was very low, and we have very little confidence in the effect estimates. The state of evidence of randomized controlled trials in this field is poor; we have no evidence from randomised controlled trials for pharmacological interventions in children with cancer-related pain, yet cannot deny individual children access to potential pain relief. Prospero ID: CRD42018086900.

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Comment in

Pain relief in children and adolescents.
Battell E, Hathway GJ. Battell E, et al. Pain. 2019 Aug;160(8):1687-1688. doi: 10.1097/j.pain.0000000000001613. Pain. 2019. PMID: 31335636 No abstract available.
Clinical management in an evidence vacuum: pharmacological management of children with persistent pain.
O'Connell N. O'Connell N. Cochrane Database Syst Rev. 2019 Jun 26;6(6):ED000135. doi: 10.1002/14651858.ED000135. Cochrane Database Syst Rev. 2019. PMID: 31390043 Free PMC article. No abstract available.

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Pharmacological interventions for chronic pain in children: an overview of systematic reviews

Affiliations

Pharmacological interventions for chronic pain in children: an overview of systematic reviews

Authors

Affiliations

Abstract

Comment in

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical