The research gap in chronic paediatric pain: A systematic review of randomised controlled trials.

Rym Boulkedid ,Antuan Divisic ,B Tourniaire ,Maria Giuseppina Petruzzelli ,Dick Tibboel ,Stefan Jakob Wimmer ,Regina Trollmann ,Emilia Matera ,Sandro Dallorso ,Maria Esther Duran Traverso ,Alketa Hoxha ,Adriana Ceci ,Donjeta Bali ,Saskia N De Wildt ,Florentia Kaguelidou ,Marco Gentile ,D Annequin ,Eleana Garini ,Marcello Allegretti ,Chantal Wood ,É Fournier-Charrière ,Lucia Margari ,Emilie Desselas ,Francesco Craig ,Rebecca Lundin ,Isabelle Desguerre ,Chiara Di Pede ,Luca Manfredini ,Daniela Caprino ,Marlène Monégat ,Luigina Tagliavacca ,Inga Talvik ,Mariagrazia Felisi ,Franca Benini ,Charles Mareau ,Armiya Yousouf Abdou ,Virgilio Pace ,Tom G De Leeuw ,Alessandro Mazza ,Oscar Della Pasqua ,R Blanchet ,Justine Avez-Couturier ,Sabrina Congedi ,Tjitske Van Der Zanden ,Antje Neubert ,Juliette Andrieu‐Galien ,Corinne Alberti ,Donato Bonifazi ,Ermira Kola ,Laura Mangiarini ,Sophie Dugué ,Andrea De Giacomo ,Pieradelchi Ruffini ,Maarten Mensink ,Panagoula Mammi ,Brigitte Charron ,Ornella Bellagamba ,Paul Healy

doi:10.1002/ejp.1137

Abstract

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 (RCTs) evaluating pain management interventions in children and adolescents with chronic pain. We performed a systematic search of PubMed, Embase and the Cochrane Library up to July 2017. We included RCTs that involved children and adolescents (3months-18years) and evaluated the use of pharmacological or non-pharmacological intervention(s) in the context of pain persisting or re-occurring for more than 3months. Methodological quality was evaluated using the Cochrane Risk of Bias (ROB) Tool. A total of 58 RCTs 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 RCTs included both adults and children and the median of the mean ages at inclusion was 12.9years (Q1,Q3: 11, 15). Testing of non-pharmacological interventions was predominant and only 5 RCTs 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 RCTs presenting a high or unclear ROB. Evaluation of analgesics targeting chronic pain relief in children and adolescents through RCTs is marginal. Infants and children with long-lasting painful conditions are insufficiently represented in RCTs. We discuss possible research constraints and challenges as well as methodologies to circumvent them. 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.

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