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

Christopher Eccleston; Emma Fisher; Tess E. Cooper; Marie Claude Grégoire; Lauren C. Heathcote; Elliot Krane; Susan M. Lord; Navil F. Sethna; Anna Karenia Anderson; Brian Anderson; Jacqueline Clinch; Andrew L. Gray; Jeffrey I. Gold; Richard F. Howard; Gustaf Ljungman; R. Andrew Moore; Neil Schechter; Philip J. Wiffen; Nick M.R. Wilkinson; David G. Williams; Chantal Wood; Miranda A.L. van Tilburg; Boris Zernikow

doi:10.1097/j.pain.0000000000001609

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

Christopher Eccleston, Emma Fisher, Tess E. Cooper, Marie Claude Grégoire, Lauren C. Heathcote, Elliot Krane, Susan M. Lord, Navil F. Sethna, Anna Karenia Anderson, Brian Anderson, Jacqueline Clinch, Andrew L. Gray, Jeffrey I. Gold, Richard F. Howard, Gustaf Ljungman, R. Andrew Moore, Neil Schechter, Philip J. Wiffen, Nick M.R. Wilkinson, David G. WilliamsChantal Wood, Miranda A.L. van Tilburg, Boris Zernikow

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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.

Original language	English
Pages (from-to)	1698-1707
Number of pages	10
Journal	Pain
Volume	160
Issue number	8
DOIs	https://doi.org/10.1097/j.pain.0000000000001609
Publication status	Published - 1 Aug 2019

ASJC Scopus subject areas

Neurology
Clinical Neurology
Anesthesiology and Pain Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/j.pain.0000000000001609

Overview_manuscript_Accepted.PDF
This is the authors' accepted manuscript of an article published in final form as Eccleston, C, Fisher, E, Cooper, TE, Grégoire, MC, Heathcote, LC, Krane, E, Lord, SM, Sethna, NF, Anderson, AK, Anderson, B, Clinch, J, Gray, AL, Gold, JI, Howard, RF, Ljungman, G, Moore, RA, Schechter, N, Wiffen, PJ, Wilkinson, NMR, Williams, DG, Wood, C, van Tilburg, MAL & Zernikow, B 2019, 'Pharmacological interventions for chronic pain in children: an overview of systematic reviews', Pain, vol. 160, no. 8, pp. 1698-1707.and available online via: https://doi.org/10.1097/j.pain.0000000000001609
Accepted author manuscript, 1.35 MB

Cite this

Eccleston, C., Fisher, E., Cooper, T. E., Grégoire, M. C., Heathcote, L. C., Krane, E., Lord, S. M., Sethna, N. F., Anderson, A. K., Anderson, B., Clinch, J., Gray, A. L., Gold, J. I., Howard, R. F., Ljungman, G., Moore, R. A., Schechter, N., Wiffen, P. J., Wilkinson, N. M. R., ... Zernikow, B. (2019). Pharmacological interventions for chronic pain in children: an overview of systematic reviews. Pain, 160(8), 1698-1707. https://doi.org/10.1097/j.pain.0000000000001609

Eccleston, C , Fisher, E, Cooper, TE, Grégoire, MC, Heathcote, LC, Krane, E, Lord, SM, Sethna, NF, Anderson, AK, Anderson, B, Clinch, J, Gray, AL, Gold, JI, Howard, RF, Ljungman, G, Moore, RA, Schechter, N, Wiffen, PJ, Wilkinson, NMR, Williams, DG, Wood, C, van Tilburg, MAL & Zernikow, B 2019, 'Pharmacological interventions for chronic pain in children: an overview of systematic reviews', Pain, vol. 160, no. 8, pp. 1698-1707. https://doi.org/10.1097/j.pain.0000000000001609

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title = "Pharmacological interventions for chronic pain in children: an overview of systematic reviews",

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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AU - Grégoire, Marie Claude

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AU - Krane, Elliot

AU - Lord, Susan M.

AU - Sethna, Navil F.

AU - Anderson, Anna Karenia

AU - Anderson, Brian

AU - Clinch, Jacqueline

AU - Gray, Andrew L.

AU - Gold, Jeffrey I.

AU - Howard, Richard F.

AU - Ljungman, Gustaf

AU - Moore, R. Andrew

AU - Schechter, Neil

AU - Wiffen, Philip J.

AU - Wilkinson, Nick M.R.

AU - Williams, David G.

AU - Wood, Chantal

AU - van Tilburg, Miranda A.L.

AU - Zernikow, Boris

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

Abstract

ASJC Scopus subject areas

UN SDGs

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Addressing the Unmet Need of Chronic Pain: Providing the Evidence for Treatments of Pain

Emma Fisher

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

Abstract

ASJC Scopus subject areas

UN SDGs

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Addressing the Unmet Need of Chronic Pain: Providing the Evidence for Treatments of Pain

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Emma Fisher

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