Trickle-down healthcare in paediatric chronic pain

McCarthy, Kevin F.; Leeuw, Tom G. de

doi:10.1016/j.bja.2019.04.043

Cited by 4 publications

(3 citation statements)

References 28 publications

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“…Suggested mechanisms are that oestrogen, the female gonadal hormone, has a role to play in connective tissue strength (Bjelland et al., 2011; Kvalheim et al., 2016) and pain processing at a central level (Kvalheim et al., 2016; Silberstein & Merriam, 2000). Also that females are more at risk of LBP (Minghelli et al., 2014; Silva et al., 2014), and more frequently experience chronic pain conditions (McCarthy & Leeuw, 2019), chronic headache (Marcus, 2001) and widespread musculoskeletal pain (Kvalheim et al., 2016). Recent systematic and meta‐analytic reviews confirm an increased frequency of LBP with increasing age approaching maturity in females (Beynon et al., 2019a, 2019b; Wedderkopp et al., 2005).…”

Section: Introductionmentioning

confidence: 99%

Early age at menarche is associated with post‐menarche back pain: An analysis of the Raine Study

Innes

Jacques

Scott

et al. 2021

European Journal of Pain

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Introduction Back pain (BP) experienced by females during adolescent years appears to predispose them to an increased likelihood of its presence in adulthood. Understanding this phenomenon by identifying risk factors of those at risk potentially fosters preventative strategies and effective treatments. Objectives To investigate for associations between post‐menarche BP and low back pain (LBP) and age at menarche (AAM) in Australian adolescents using the Western Australian pregnancy cohort (The Raine Study). Methods This study used data from a longitudinal cohort study. BP data were collected retrospectively using a questionnaire. Menarche data was split into three established age classifications early (<12‐years), normal (≥12 to >14‐years) and late (≥14‐years). Logistic regression models examined the effect of AAM on BP. Results 666 female participants provided valid menarche data with 183 (27.5%) early AAM, 429 (64.4%) normal AAM and 54 (8.1%) with late AAM. The mean AAM was 12.59 years. BP was disclosed by 27.5% in the 14‐year follow‐up and 31.5% in the 17‐year follow‐up. Participants who had early AAM had 79% higher odds of experiencing BP compared to participants who had normal AAM, after adjusting for confounders at the 14‐year follow‐up (adjOR 1.79, 95% CI 1.18–2.64). Conclusion There is evidence of an association, in this cohort, of early AAM with post‐menarche BP. This result identifies an area for future exploration, including understanding this mechanism which may lead to the development of effective intervention measures. Significance Age at menarche is related to a range of health issues. This study sought to investigate if it was a risk factor for spinal pain. We used an existing Australian data base to explore this possibility and found an association with early age onset and post‐menarche back pain. This result identifies an area for future exploration, including understanding this mechanism which may lead to the development of effective intervention measures.

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Section: Introductionmentioning

confidence: 99%

Early age at menarche is associated with post‐menarche back pain: An analysis of the Raine Study

Innes

Jacques

Scott

et al. 2021

European Journal of Pain

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“…A recent overview review of the evidence for pharmacological interventions has highlighted a dearth of evidence in this field. 10 Physical and psychological treatments often form part of interdisciplinary treatment for long-term pain in children, 29 but although there is evidence for the use of psychological interventions, 13,14 trials investigating physical interventions are lacking.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of pharmacological, physical, and psychological interventions for the management of chronic pain in children: a WHO systematic review and meta-analysis

Fisher

Villanueva

Henschke

et al. 2021

Pain

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Chronic pain in childhood is an international public health problem. We conducted a systematic review and meta-analysis to provide a summary of the published evidence of pharmacological, physical, and psychological therapies for children with chronic pain conditions. We searched CENTRAL, MEDLINE, EMBASE, and PsycINFO from inception to April 2020; clinical trial registries; and other sources for randomised controlled trials or comparative observational trials. We extracted critical outcomes of pain intensity, quality of life, physical functioning, role functioning, emotional functioning, sleep, and adverse events. We assessed studies for risk of bias and certainty of the evidence using GRADE. We included 34 pharmacological (4091 participants), 25 physical therapy (1470 participants), and 63 psychological trials (5025 participants). Participants reported a range of chronic pain conditions. Most studies were assessed to have unclear or high risk of bias across multiple domains. Pharmacological, physical, and psychological therapies showed some benefit for reducing pain, posttreatment, but only physical and psychological therapies improved physical functioning. We found no benefit of any treatment modality for health-related quality of life, role functioning, emotional functioning, or sleep. Adverse events were poorly reported, particularly for psychological and physical interventions. The largest evidence base for the management of chronic pain in children supports the use of psychological therapies, followed by pharmacological and physical therapies. However, we rated most outcomes as low or very low certainty, meaning further evidence is likely to change our confidence in the estimates of effects. This protocol was registered on PROSPERO (CRD42020172451).

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“…Although most of the children are treated in dedicated pediatric centers, almost half of the professionals do not spend more than 30% of their time dealing with chronic pain in children or do not work in a dedicated Pediatric Pain Center. One could debate, considering the complexity of chronic pediatric pain, that all chronic pediatric pain treatment should preferably take place in a Pediatric Pain Center [4,39].…”

Section: Practitionersmentioning

confidence: 99%

Diagnosis and Treatment of Chronic Neuropathic and Mixed Pain in Children and Adolescents: Results of a Survey Study amongst Practitioners

et al. 2020

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Validated diagnostic tools to diagnose chronic neuropathic and mixed pain in children are missing. Therapeutic options are often derived from therapeutics for adults. To investigate the international practice amongst practitioners for the diagnosis and treatment of chronic, neuropathic pain in children and adolescents, we performed a survey study among members of learned societies or groups whose members are known to treat pediatric pain. The survey included questions concerning practitioners and practice characteristics, assessment and diagnosis, treatment and medication. We analyzed 117 returned questionnaires, of which 41 (35%) were fully completed and 76 (65%) were partially completed. Most respondents based the diagnosis of neuropathic pain on physical examination (68 (58.1%)), patient history (67 (57.3%)), and underlying disease (59 (50.4%)) combined. Gabapentin, amitriptyline, and pregabalin were the first-choice treatments for moderate neuropathic pain. Tramadol, ibuprofen, amitriptyline, and paracetamol were the first-choice treatments for moderate mixed pain. Consensus on the diagnostic process of neuropathic pain in children and adolescents is lacking. Drug treatment varies widely for moderate, severe neuropathic, and mixed pain. Hence, diagnostic tools and therapy need to be harmonized and validated for use in children.

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Trickle-down healthcare in paediatric chronic pain

Cited by 4 publications

References 28 publications

Early age at menarche is associated with post‐menarche back pain: An analysis of the Raine Study

Early age at menarche is associated with post‐menarche back pain: An analysis of the Raine Study

Efficacy and safety of pharmacological, physical, and psychological interventions for the management of chronic pain in children: a WHO systematic review and meta-analysis

Diagnosis and Treatment of Chronic Neuropathic and Mixed Pain in Children and Adolescents: Results of a Survey Study amongst Practitioners

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