Management of chronic pain in children and young people: summary

Appendix 5: Further Cochrane Reviews

The Cochrane collaboration has produced a number of relevant systematic reviews on the pharmacological management of chronic pain in children and young people, since the completion of the literature search for this guideline. As these are highly relevant to the guideline, they have been summarised here. While the methodology of the reviews themselves is of high quality, the published primary research in this area remains limited. The conclusions of these reviews do not change the recommendations of the guideline.

Cooper et al (2017a) investigated the use of antiepileptic drugs for chronic non-cancer pain in children and adolescents. This systematic review identified two small studies but due to a lack of data further analysis could not be completed. As a meta-analysis was not conducted the authors were unable to comment on the efficacy or harm from the use of antiepileptic drugs in the treatment of chronic non-cancer pain in children and adolescents. The authors could not comment on the secondary outcomes of the study: Carer Global Impression of Change; requirement for rescue analgesia; sleep duration and quality; acceptability of treatment; physical functioning; and quality of life. It is recognised that some antiepileptics, including gabapentin and pregabalin, can be effective in adults with certain chronic pain conditions. Therefore, the authors found no evidence to support or contest the use of antiepileptics in the treatment of chronic non-cancer pain in children and adolescents.

The use of non-steroidal anti-inflammatory drugs ( NSAIDs) for chronic non-cancer pain in children and adolescents was explored by Eccleston et al (2017). The authors identified seven studies but the data available were insufficient to undertake a meta-analysis. Due to the inability to conduct further analyses the authors could not comment on the efficacy or harm of the use of NSAIDs in the treatment of chronic non-cancer pain in children and adolescents. There were also no definitive conclusions made on the secondary outcomes: Carer Global Impression of Change; requirement for rescue analgesia; sleep duration and quality; acceptability of treatment; physical functioning; and quality of life. It is known that from randomised controlled studies ( RCTs) in adults with chronic pain some NSAIDs are effective in some conditions.

Cooper et al (2017b) conducted a systematic review investigating the use of paracetamol (acetaminophen) in the treatment of chronic non-cancer pain in children and young people and found no studies that were eligible for inclusion in the review. The quality of evidence was rated as very low. Thence the authors found no evidence from randomised controlled trials to support or refute the use of paracetamol (acetaminophen) to treat chronic non-cancer pain in children and adolescents. The authors were also unable to comment on the efficacy or harm of paracetamol in children and young people. It is known, from randomised controlled trials in adults, that paracetamol can be effective (in certain doses) in certain pain conditions (not always chronic).

Opioids for chronic non-cancer pain in children and adolescents was examined in the systematic review by Cooper et al (2017c). No studies were eligible for inclusion in this review and the evidence was rated as very low quality. As there was no evidence from randomised controlled trails the authors were unable to support or disprove the use of opioids in the treatment of chronic non-cancer pain in children and young people. Evidence from adult randomised controlled trials have found that some opioids, such as morphine and codeine, can be effective in some chronic pain conditions. Therefore, no conclusions could be made in relation to the efficacy or harm of opioids in the treatment of chronic non-cancer pain in children and adolescents.

Cooper et al (2017d) conducted a systematic review examining the efficacy of anti-depressants for chronic non-cancer pain in children and adolescents. Four studies were found with information retrieved from 272 participants (6-18 years of age) who had chronic neuropathic pain, complex regional pain syndrome type 1, irritable bowel syndrome, functional abdominal pain or functional dyspepsia. All studies were small. One study explored amitriptyline versus gabapentin (34 participants), two studies investigated amitriptyline versus placebo (123 participants), and one study examined citalopram versus placebo (115 participants). The authors were unable to complete any quantitative analysis due to a lack of data. As a meta-analysis was not conducted the authors were unable to provide conclusions on the efficacy or harm from the use of antidepressants in children and adolescents with chronic pain. The authors also could not comment on the secondary outcomes of the study: Carer Global Impression of Change; requirement for rescue analgesia; sleep duration and quality; acceptability of treatment; physical functioning; and quality of life. There is evidence from randomised controlled trials in adults which has found that antidepressants, such as amitriptyline, can provide some pain relief in some chronic non-cancer pain conditions.

References

Cooper, T. E., Wiffen, P. J., Heathcote, L. C., Clinch, J., Howard, R., Krane, E., ... & Wood, C. (2017a). Antiepileptic drugs for chronic non‐cancer pain in children and adolescents. The Cochrane Library.

Cooper, T. E., Fisher, E., Anderson, B., Wilkinson, N., Williams, G., & Eccleston, C. (2017b). Paracetamol (acetaminophen) for chronic non-cancer pain in children and adolescents. Cochrane Database of Systematic Reviews, (2).

Cooper, T. E., Fisher, E., Gray, A., Krane, E., Sethna, N. F., van Tilburg, M., ... & Wiffen, P. J. (2017c). Opioids for chronic non-cancer pain in children and adolescents. Cochrane Database of Systematic Reviews, (2).

Cooper, T. E., Heathcote, L. C., Clinch, J., Gold, J. I., Howard, R., Lord, S. M., ... & Wiffen, P. J. (2017d). Antidepressants for chronic non-cancer pain in children and adolescents. Cochrane Database of Systematic Reviews, (2).

Eccleston, C., Cooper, T. E., Fisher, E., Anderson, B., & Wilkinson, N. (2017). Non-steroidal anti-inflammatory drugs ( NSAIDs) for chronic non-cancer pain in children and adolescents. Cochrane Database of Systematic Reviews, (2).