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Outpatient Pain Management in Children With Chronic Pancreatitis: A Scoping Systematic Review
Emily R Perito1, John F Pohl2, Caitlin Bakker3
1From the Department of Pediatrics, University of California San Francisco, San Francisco, CA.
Insights
Evidence-based guidelines for pediatric chronic pancreatitis (CP) pain are lacking. This review found no high-quality studies supporting specific therapies for children with CP, highlighting the need for multicenter research.
Area of Science:
- Pediatric Gastroenterology
- Pain Management
- Systematic Review
Background:
- Pain management is crucial for pediatric chronic pancreatitis (CP) care.
- No evidence-based guidelines currently exist for managing pain in children with CP.
Purpose of the Study:
- To conduct a scoping systematic review to identify effective pain management strategies for pediatric chronic pancreatitis.
- To evaluate existing literature on pain treatment for children with CP, drawing comparisons with adult CP and related conditions.
Main Methods:
- Systematic literature review of studies on pain management in pediatric and adult CP.
- Inclusion of studies on juvenile idiopathic arthritis and sickle cell disease for comparative pain course analysis.
- Screening of 8997 identified studies, with 287 meeting inclusion criteria.
Main Results:
- No published studies were found on specific treatments like medications, antioxidants, dietary changes, or nerve blocks for children with CP.
- Studies in adults with CP showed mixed results for nonopioid analgesics, pancreatic enzymes, and dietary interventions.
- Retrospective data suggest endoscopic retrograde cholangiopancreatography and surgical procedures, including total pancreatectomy with islet autotransplant, may improve pain in children with CP, but follow-up durations were short.
Conclusions:
- Currently, no therapy for pediatric chronic pancreatitis pain has sufficient high-quality evidence for strong support.
- There is a critical need for multicenter studies to establish evidence-based "best practices" for pain management in children with CP.
Objectives:
Although pain management is central to pediatric chronic pancreatitis (CP) care, no evidence-based guidelines exist. In this scoping systematic review, we sought promising strategies for CP pain treatment in children.
Methods:
We systematically reviewed literature on pain management in children and adults with CP, and 2 conditions with similar pain courses: juvenile idiopathic arthritis and sickle cell disease.
Results:
Of 8997 studies identified, 287 met inclusion criteria. There are no published studies of analgesic medications, antioxidants, dietary modification, integrative medicine, or regional nerve blocks in children with CP. In adults with CP, studies of nonopioid analgesics, pancreatic enzymes, and dietary interventions have mixed results. Retrospective studies suggest that endoscopic retrograde cholangiopancreatography and surgical procedures, most durably total pancreatectomy with islet autotransplant, improve pain for children with CP. Follow-up was short relative to a child's life. Large studies in adults also suggest benefit from endoscopic therapy and surgery, but lack conclusive evidence about optimal procedure or timing. Studies on other painful pediatric chronic illnesses revealed little generalizable to children with CP.
Conclusions:
No therapy had sufficient high-quality studies to warrant untempered, evidence-based support for use in children with CP. Multicenter studies are needed to identify pain management "best practices."
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