Pharmacological interventions for pain in children and adolescents with life-limiting conditions

摘要: BACKGROUND: Pain is one of the most common symptoms in children and young people (CYP) with life-limiting conditions (LLCs) which include a wide range diagnoses including cancer. The current literature indicates that pain not well managed, however evidence base to guide clinicians limited. There clear need for from systematic review inform prescribing. OBJECTIVES: To evaluate on effectiveness different pharmacological interventions used CYP LLCs. SEARCH METHODS: following electronic databases were searched up December 2014: CENTRAL (in Cochrane Library), MEDLINE, EMBASE, PsycINFO CINAHL. In addition, we conference proceedings reference lists included studies. For completeness, also contacted experts field. No language restrictions applied. SELECTION CRITERIA: Randomised controlled trials (RCTs), quasi-randomised studies other clearly defined comparator group included. investigated treatments associated LLCs CYP. treatment those specifically developed treat acted as an adjuvant, where was primarily but has relieving properties. LLC identified by its inclusion Richard Hain Directory DATA COLLECTION AND ANALYSIS: Citations screened five authors. Data extracted author checked second. Two authors assessed risk bias A sufficient number using homogeneous outcomes so meta-analysis possible. MAIN RESULTS: We 24,704 citations our database search. Nine 379 participants fulfilled criteria. Participants had cerebral palsy (CP) osteogenesis imperfecta (OI) four. across ranged age 2 19 years. All studies, apart cross-over trial, parallel designed RCTs. Three CP evaluated intrathecal baclofen (ITB) two botulinum toxin (BoNT-A). OI use bisphosphonates (two alendronate pamidronate). commonly analgesic this patient group. secondary outcome eight Overall quality mixed. Only study involved over 100 participants.For ITB CP, same population at time points their disease, both found effect favouring intervention compared control (standard care or placebo) (mean difference (MD) 4.20, 95% confidence interval (CI) 2.15 6.25; MD 26.60, CI 2.61 50.59, respectively). these adverse events related procedure device administration rather than drug, such swelling pump site. trial there serious effects; difficulty swallowing epileptic seizure. did state if occurred At follow-up BoNT-A no between arms among participants. mostly who received drug seizures. Gastrointestinal problems frequent event alendronate. investigating pamidronate reported trial. AUTHORS' CONCLUSIONS: Published, currently available largely drugs all adjuvants always general paediatric palliative pain. Based data unable determine effects Future larger populations should examine analgesics; rising prevalence many becomes more necessary.