Interventional procedures in children and adolescents with chronic non‐cancer pain as part of a multidisciplinary pain treatment program

Abstract

Summary Background Interventional procedures are part of multidisciplinary pain treatment programs to treat chronic non‐cancer pain conditions in children and adolescents. However, the real benefit of these interventions remains unclear. Aims The aim of this study was to analyze the potential benefits of the interventional procedures in children and adolescents with chronic non‐cancer pain in the setting of a multidisciplinary pain treatment program. Methods We retrospectively reviewed the charts of 98 children and adolescents receiving 314 diagnostic or therapeutic interventional procedures. We applied the following definitions of efficacy Short‐term positive therapeutic effect: block that produced a minimum of 50% reduction in pain intensity for at least 4 weeks. Long‐term positive therapeutic effect: a patient with a minimum of 50% reduction in pain intensity for at least 6 months Full recovery: a patient free of pain, not taking analgesics with normal physical and role functioning 6 months after the last procedure. Results Seventy‐six of 112 diagnostic blocks (68%) were associated with a 50% reduction in pain intensity for at least 4 weeks after the procedure. One hundred and sixty‐six of 202 therapeutics blocks (82%) were associated with a short‐term benefit. Seventy‐two of 98 patients (73%) referred a 50% reduction in their pain intensity (17%) or had full recovery 6 months after the procedures (56%) and a MPTP. Psychiatric comorbidity and more advanced age were factors associated with failure to respond to interventional procedures. Conclusion The use of interventional procedures may represent a valid therapeutic option, associated with positive clinical outcomes within a multidisciplinary program.

Use of bisphosphonates in a retrospective case series of children and adolescents with complex regional pain syndrome

“…Interventional treatments were offered if the patient was unable to complete physiotherapy or had limited benefit from medications after 8 weeks within the program. Single‐shot or continuous peripheral nerve blocks were commonly used, since epidural or sympathetic blocks were less frequently indicated 7 …”

“…peripheral nerve blocks were commonly used, since epidural or sympathetic blocks were less frequently indicated. 7 Patients not responding or declining these interventional treatments were offered three to 5 days of intravenous infusions of ketamine and/or lidocaine administered under the supervision of the Chronic Pain Service within the day hospital. Ketamine doses were given at 0.1-0.5 mg/kg/h, while lidocaine doses were given at 1-3 mg/kg/h for 3-8 h each day with incremental increase in doses if tolerated.…”

“…23 Four out of the five Canadian multidisciplinary pediatric pain centers offer in their interventional treatments leading to varying clinical practices. 7,24 Some centers rarely use invasive therapies, some use interventional treatments to facilitate physical rehabilitation, and others offer sympathetic neurolysis. 7,24 Information is inconsistent regarding their effectiveness and safety in children with chronic noncancer pain, especially for CRPS.…”

“…7,24 Some centers rarely use invasive therapies, some use interventional treatments to facilitate physical rehabilitation, and others offer sympathetic neurolysis. 7,24 Information is inconsistent regarding their effectiveness and safety in children with chronic noncancer pain, especially for CRPS. 7 The main strength of our study is that we found a potential association between the use of intravenous bisphosphonates and a positive change in the health condition of pediatric patients with CRPS I.…”

“…7,24 Information is inconsistent regarding their effectiveness and safety in children with chronic noncancer pain, especially for CRPS. 7 The main strength of our study is that we found a potential association between the use of intravenous bisphosphonates and a positive change in the health condition of pediatric patients with CRPS I. This association was established in a heterogenous population, who did not perceive benefits with our standard of care treatments.…”