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Pharmacological interventions for chronic pain in children

an overview of systematic reviews

Eccleston, Christophera,b,*; Fisher, Emmaa,c; Cooper, Tess E.d; Grégoire, Marie-Claudee; Heathcote, Lauren C.f; Krane, Elliotg; Lord, Susan M.h,i; Sethna, Navil F.j; Anderson, Anna-Kareniak; Anderson, Brianl; Clinch, Jacquelinem,n; Gray, Andrew L.o; Gold, Jeffrey I.p,q; Howard, Richard F.r; Ljungman, Gustafs; Moore, R. Andrewt; Schechter, Neilu; Wiffen, Philip J.t; Wilkinson, Nick M.R.v; Williams, David G.w; Wood, Chantalx; van Tilburg, Miranda A.L.y,z; Zernikow, Borisaa,bb

doi: 10.1097/j.pain.0000000000001609
Systematic Review and Meta-Analysis: PDF Only
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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.

aCentre for Pain Research, University of Bath, Bath, United Kingdom

bDepartment of Clinical and Health Psychology, Ghent University, Ghent, Belgium

cPain, Palliative, and Supportive Care, Oxford University Hospitals, Oxford, United Kingdom

dFaculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia

eDepartment of Pediatrics, Dalhousie University, Halifax, NS, Canada

fDepartment of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States

gDepartment of Anesthesiology, Perioperative, and Pain Medicine, Pediatrics, Stanford University School of Medicine, Stanford, Palo Alto, CA, United States

hChildren's Complex Pain Service, John Hunter Children's Hospital, Hunter Medical Research Institute, Newcastle, New South Wales, Australia

iFaculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia

jDepartment of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States

kRoyal Marsden Hospital, London, United Kingdom

lDepartment of Anaesthesiology, University of Auckland, Auckland, New Zealand

mBristol Royal Children's Hospital, University of Bristol, Bristol, United Kingdom

nRoyal National Hospital for Rheumatic Diseases, Bath, United Kingdom

oDivision of Pharmacology, Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa

pAnesthesiology, Pediatrics, and Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States

qPediatric Pain Management Clinic, Children's Hospital Los Angeles, Los Angeles, CA, United States

rDepartment of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom

sPediatric Oncology, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden

tPain Research, Nuffield, Department of Clinical Neurosciences, University of Oxford, The Churchill, Oxford, United Kingdom

uDepartment of Anesthesiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States

vDepartment of Paediatrics, Evelina London Children's Hospital, Kings College London, United Kingdom

wThe Anaesthetic Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom

xDepartment of Rheumatology, Chronic Pain Centre, University Hospital of Limoges, University of Limoges, Haute Vienne, France

yCollege of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC, United States

zDivision of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, United States

aaGerman Paediatric Pain Centre, Children's and Adolescent's Hospital, Datteln, Germany

bbChildren's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany

Corresponding author. Address: University of Bath, Centre for Pain Research, Claverton Down, Bath BA27AY, United Kingdom. Tel.: 01225386439. E-mail address: c.eccleston@bath.ac.uk (C. Eccleston).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Received February 22, 2019

Received in revised form April 03, 2019

Accepted April 04, 2019

© 2019 International Association for the Study of Pain