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

Area of Science:

• Pediatric Pain Management
• Pharmacological Interventions
• Evidence-Based Medicine

Background:

• Pharmacological treatments are commonly used for chronic pain in children and adolescents.
• There is a significant knowledge gap regarding the safety and efficacy of these medications in pediatric populations.

Purpose of the Study:

• To conduct an overview of systematic reviews on pharmacological interventions for chronic noncancer pain (CNCP) and chronic cancer-related pain (CCRP) in children.
• To assess the quality of evidence for pain reduction in these pediatric groups.

Main Methods:

• Searched multiple databases (Cochrane, Medline, EMBASE, DARE) for systematic reviews up to March 2018.
• Included systematic reviews of children (0-18 years) with CNCP or CCRP.
• Extracted data on review characteristics and outcomes such as pain relief and patient global impression of change.

Main Results:

• Included 23 systematic reviews; only 7 contained randomized controlled trials (RCTs) for CNCP (6 trials total).
• No RCTs were found for pharmacological interventions in children with CCRP.
• Evidence quality was consistently very low, with low confidence in effect estimates.

Conclusions:

• The evidence base for pharmacological interventions in pediatric chronic pain, particularly CCRP, is critically poor.
• There is a substantial lack of high-quality RCTs, necessitating further research to guide safe and effective pain management strategies for children.
• Despite evidence gaps, the need for potential pain relief in individual children cannot be disregarded.