Management of chronic pain in children and young people: summary

7. Surgical interventions or other invasive procedures

7.1 Surgery

There is no significant literature in the surgical management of chronic pain in children other than that which details the transition of acute post-operative pain into chronic post-operative pain and those studies that look at chronic pain as a consequence of specific procedures (e.g. long-term pain after hernia repair in childhood) or site-specific chronic pain (e.g. chronic abdominal pain/headache/knee pain/back pain et cetera).

In the main, the role of surgery relates to investigation of chronic pain (principally chronic abdominal pain) rather than looking at the pain reduction effects of any specific surgical procedure or intervention.

7.2 Nerve blocks

Two systematic reviews have investigated the role of local anaesthetic sympathetic blockade ( LASB) on Complex Regional Pain Syndrome ( CRPS) in children and adults together. Neither looked specifically at children, with the majority of studies having a small sample size. There was not enough evidence to make any conclusions about the safety and efficacy of LASB in children and young people [84, 85].
1−

7.3 Other Interventions

Intravenous regional blockade with guanethidine, sympathetic block with botulinum toxin A, along with bupivacaine, intravenous lidocaine and IV phentolamine have all been used in the management of sympathetically maintained pain. There is no evidence of effectiveness in long-term pain relief in any of the groups studied. Quality of pain score differences between groups were not statistically compared [84, 85]. There is therefore no evidence base to support the recommendation of these other interventions.

No literature was available upon which to base a recommendation in the following interventions: sympathectomy, dorsal root rhizotomy, epidural, caudal or trigger point injection, Bier’s block, neuromodulation, plexus block.

Recommendations

• Local anaesthetic blockade or other interventions should be considered on an individual patient basis in specialist centres.