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Updated: Feb 19, 2026
Author Spotlight: Methodologies and Advancements of Chronic Pain Management Research
Published on: January 5, 2024
The research gap in chronic paediatric pain: A systematic review of randomised controlled trials
R Boulkedid1,2,3, A Y Abdou1, E Desselas4,5
1AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France.
Insights
Research on pain management for children and adolescents shows a significant gap in evaluating analgesics. Most studies focus on non-pharmacological methods and suffer from poor methodological quality, particularly for infants and younger children.
Area of Science:
- Pediatric Pain Management
- Clinical Trial Methodology
- Evidence-Based Medicine
Background:
- Chronic pain significantly impairs functioning and social engagement in children and adolescents.
- There is a need to evaluate the quality and characteristics of research on pain management interventions for this population.
Purpose of the Study:
- To assess the characteristics and methodological quality of randomized controlled trials (RCTs) for pain management in pediatric chronic pain patients.
- To identify research gaps in the evaluation of pharmacological and non-pharmacological interventions.
Main Methods:
- Systematic literature search of PubMed, Embase, and Cochrane Library up to July 2017.
- Inclusion of RCTs involving children and adolescents (3 months–18 years) with chronic pain (persisting >3 months).
- Methodological quality assessed using the Cochrane Risk of Bias (ROB) Tool.
Main Results:
- 58 RCTs were identified, with increasing numbers over time.
- Non-pharmacological interventions were predominantly tested; only 5 RCTs evaluated analgesics.
- 90% of RCTs exhibited high or unclear risk of bias, indicating poor methodological quality.
- Abdominal pain, headache/migraine, and musculoskeletal pain were common conditions.
Conclusions:
- There is a marginal evaluation of analgesics for chronic pain in children and adolescents via RCTs.
- Infants and children with long-lasting painful conditions are underrepresented in research.
- Significant research gaps and methodological challenges exist in pediatric pain management trials.
Background And Objective:
Chronic pain is associated with significant functional and social impairment. The objective of this review was to assess the characteristics and quality of randomized controlled trials (RCTs) evaluating pain management interventions in children and adolescents with chronic pain.
Methods:
We performed a systematic search of PubMed, Embase and the Cochrane Library up to July 2017. We included RCTs that involved children and adolescents (3 months-18 years) and evaluated the use of pharmacological or non-pharmacological intervention(s) in the context of pain persisting or re-occurring for more than 3 months. Methodological quality was evaluated using the Cochrane Risk of Bias (ROB) Tool.
Results:
A total of 58 RCTs were identified and numbers steadily increased over time. The majority were conducted in single hospital institutions, with no information on study funding. Median sample size was 47.5 participants (Q1,Q3: 32, 70). Forty-five percent of RCTs included both adults and children and the median of the mean ages at inclusion was 12.9 years (Q1,Q3: 11, 15). Testing of non-pharmacological interventions was predominant and only 5 RCTs evaluated analgesics or co-analgesics. Abdominal pain, headache/migraine and musculoskeletal pain were the most common types of chronic pain among participants. Methodological quality was poor with 90% of RCTs presenting a high or unclear ROB.
Conclusions:
Evaluation of analgesics targeting chronic pain relief in children and adolescents through RCTs is marginal. Infants and children with long-lasting painful conditions are insufficiently represented in RCTs. We discuss possible research constraints and challenges as well as methodologies to circumvent them.
Significance:
There is a substantial research gap regarding analgesic interventions for children and adolescents with chronic pain. Most clinical trials in the field focus on the evaluation of non-pharmacological interventions and are of low methodological quality. There is also a specific lack of trials involving infants and children and adolescents with long-lasting diseases.
