Decisions to prescribe children drugs to treat chronic pain are not guided by sufficient, high-quality evidence and more is needed, according to researchers from the University of Bath in collaboration with an international team of researchers and physicians.
An overview of studies that have been conducted, recently summarized in the journal PAIN, highlights a dearth of information available about treating childhood chronic pain and concludes that much more needs to be done to improve the quality and quantity of evidence available.

It reveals a stark contrast between the evidence available for the drugs used to treat adults with chronic pain, compared with that conducted in children. For adults with chronic pain, 300,000 patients have been studied in hundreds of individual randomized control trials. Yet only 393 children have participated in just six trials ever undertaken, notes a media release from University of Bath.

Lack of evidence does not mean evidence of no effect, the researchers stress. But they argue there has been very little investment in researching which drugs can best help children with chronic pain and suggest that this issue should be urgently addressed to increase confidence that children are getting the best treatment.

The most common types of chronic pain experienced by children include recurrent abdominal pain, headaches and migraines, and musculoskeletal pain. Children who suffer from chronic pain regularly miss school, become isolated and have more anxiety and depression compared to children without pain. Drug therapy is typically the first resort for treatment.

“Overall, there is no high-quality evidence to help us understand the efficacy or safety of the common drugs used to help children with chronic pain. The lack of data means that we are uncertain about how to optimally manage pain. Doctors, children and their families all deserve better,” says professor Christopher Eccleston, co-ordinating editor for the Cochrane Pain, Palliative and Supportive Care Review Group and director of the Centre for Pain Research at the University of Bath, who led the overview.

“This study is a collective effort from 23 leading researchers and physicians from around the world. Healthcare policy-makers need to grapple this issue if we are to break down the barriers that exist to producing sufficient evidence in pediatric chronic pain pharmacotherapy,”  he adds.

The team acknowledges that there are practical and ethical barriers to conducting randomized control trials on children, but suggest that these are no different from other areas of pediatric pharmacological research, the release continues.

“Children are not just small adults, so we cannot simply extrapolate evidence acquired from adults and use it in children,” states co-author Dr Emma Fisher, Versus Arthritis Research Fellow from the Centre for Pain Research at the University of Bath.

“With the evidence available currently, we cannot say for sure whether the drugs used are the best approach. Yet at the current rate of clinical trial reporting – only one every 3.5 years – it would take us over 1,000 years to have a good enough evidence base to properly inform decisions. This lack of knowledge requires new funding and urgent attention.”

Other non-drug-based treatments are also available to children and adolescents with chronic pain. Psychological therapies, such as cognitive behavioral therapy (CBT), show small effects at reducing pain and disability in this population, but once again the evidence needs to be improved.

The researchers suggest funding and incentives are needed to drive this field forward in order to deliver evidence-based research that doctors treating patients can reliably use to inform their decisions.

[Source(s): University of Bath, EurekAlert]