Management of chronic pain in children and young people: summary

10. Implementation

10.1 The aim of this guideline is to provide a resource based on the best available evidence, and expert consensus to inform the management of children and young people with chronic pain. Integrated joint boards need to consider existing resources and services, and to ensure that this guideline is used appropriately.

10.2 Research Recommendations

As there is a paucity of literature in this area there are too many specific research gaps identified throughout this document to present them all usefully. From the evidence discussed throughout this guideline it is clear that high quality evidence is needed in all areas of paediatric chronic pain. The list below is a summary of some of the key gaps.

1. What are the effects of early detection and management of chronic/persistent pain on outcomes?
2. What interventions are effective?
3. What is the best type and intensity of exercise for improving pain and function in children and young people with chronic pain?
4. What is the configuration, intensity and duration of interdisciplinary management and the efficacy of remote versus direct delivery of some or all components?
5. How common is the chronic use of (strong) opioids in children and has prescribing changed in line with patterns seen for adults with chronic pain?
6. How effective are opioids for chronic pain in children?
7. What are the long term effects of opioid use in children and adolescents?
8. What is the efficacy and safety of topical therapies in children?
9. What is the effectiveness of nutritional supplementation in other pain conditions; e.g. headache, musculoskeletal pain?
10. What is the role and effectiveness of ‘nutraceutical’ dosing of dietary compounds, e.g. Vitamins C, D and E, Magnesium, Co-enzyme Q10, in diverse pain conditions?
11. What is the economic impact for patients and families acquiring these compounds?
12. What are the potential underlying mechanisms of action in acupuncture for children and young people with pain? Does it reduce pain and improve function in children?