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The research gap in chronic paediatric pain: A systematic review of randomised controlled trials
Author(s) -
Boulkedid R.,
Abdou A.Y.,
Desselas E.,
Monégat M.,
Leeuw T.G.,
AvezCouturier J.,
Dugue S.,
Mareau C.,
Charron B.,
Alberti C.,
Kaguelidou F.
Publication year - 2018
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1002/ejp.1137
Subject(s) - medicine , physical therapy , chronic pain , systematic review , randomized controlled trial , medline , political science , law
Abstract 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 ( RCT s) 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 RCT s 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 RCT s 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 RCT s 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 RCT s 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 RCT s presenting a high or unclear ROB . Conclusions Evaluation of analgesics targeting chronic pain relief in children and adolescents through RCT s is marginal. Infants and children with long‐lasting painful conditions are insufficiently represented in RCT s. 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.