Overall, there is no high-quality evidence for delivering any pharmacological intervention to a child or adolescent with chronic pain, concludes a comprehensive review of the literature.
Researchers led by the University of Bath conducted a review of systematic reviews of pharmacological interventions that claimed to reduce pain in children with chronic non-cancer pain (CNCP) or chronic cancer-related pain (CCRP).
A search of the Cochrane Database of Systematic Reviews, Medline, EMBASE and DARE from inception to March 2018 identified 23 systematic reviews investigating children with CNCP or CCRP. Seven of those 23 reviews included six trials that involved children with CNCP. There were no randomised controlled trials in reviews relating to CCRP.
Despite calls for more evidence, few attempts have been made to improve the number or quality of trials, the authors say. Of the six trials in CNCP, the first was published in 1995 and the most recent in 2016. The average number of patients recruited to each trial was 66.
“At this rate of one trial of 19 patients entering into evidence every 3.5 years, it will take a conservative 1,000 years to establish the evidence to substantially reduce the uncertainty around the estimates of effect for any pharmacological intervention for paediatric chronic pain management; 1,000 years will not be enough to establish evidence in cancer pain,” they conclude.
