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Author Spotlight: Methodologies and Advancements of Chronic Pain Management Research
Published on: January 5, 2024
Interventions to treat pain in paediatric CFS/ME: a systematic review
Caitlin Ascough1, Hayley King1, Teona Serafimova1
1Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK.
Insights
Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) treatment rarely measures pain. Limited evidence suggests recovery improves pain, but specific pain management strategies are needed for non-recovered children.
Area of Science:
- Pediatric rheumatology and neurology
- Chronic illness management
- Pain medicine
Background:
- Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) affects 1%-2% of children.
- Pain is a common symptom, impacting fatigue and physical function in two-thirds of affected children.
- The effect of CFS/ME treatment on pain in children is not well understood.
Approach:
- A systematic literature search was conducted across major databases (MEDLINE, EMBASE, PsycINFO, Cochrane Library).
- Studies published between 1994 and 2019 were included if they involved participants under 19 with CFS/ME and measured pain before and after intervention.
- Randomized controlled trials and observational studies were considered.
Key Points:
- Only five studies out of 26 investigating paediatric CFS/ME treatments measured pain.
- None of the reviewed interventions specifically targeted pain management.
- Two studies found no pain improvement, one showed subgroup improvement, and two indicated pain reduction in recovered patients.
Conclusions:
- Few paediatric CFS/ME treatment studies assess pain outcomes.
- Current treatments focus on overall CFS/ME management, not specific pain relief.
- Further research is required to determine optimal pain management strategies, especially for non-recovered children.
Background:
Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is common (prevalence 1%-2%). Two-thirds of children experience moderate or severe pain, which is associated with increased fatigue and poorer physical function. However, we do not know if treatment for CFS/ME improves pain.
Objective:
Identify whether specialist treatment of paediatric CFS/ME improves pain.
Methods:
We conducted a detailed search in MEDLINE, EMBASE, PsycINFO and the Cochrane Library. Two researchers independently screened texts published between 1994 and 24 January 2019 with no language restrictions. Inclusion criteria were (1) randomised controlled trials and observational studies; (2) participants aged <19 years with CFS/ME; and (3) measure of pain before and after an intervention.
Results:
Of 1898 papers screened, 26 studies investigated treatment for paediatric CFS/ME, 19 of which did not measure pain at any time point. Only five treatment studies measured pain at baseline and follow-up and were included in this review. None of the interventions were specifically targeted at treating pain. Of the included studies, two showed no improvement in pain scores, one suggested an improvement in one subgroup and two studies identified improvements in pain measures in 'recovered' patients compared with 'non-recovered' patients.
Conclusions:
Despite the prevalence and impact of pain in children with CFS/ME surprisingly few treatment studies measured pain. In those that did measure pain, the treatments used focused on overall management of CFS/ME and we identified no treatments that were targeted specifically at managing pain. There is limited evidence that treatment helps improve pain scores. However, patients who recover appear to have less pain than those who do not recover. More studies are needed to determine if pain in paediatric CFS/ME requires a specific treatment approach, with a particular focus on patients who do not recover following initial treatment.
Prospero Registration Number:
CRD42019117540.
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