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Pharmacological Interventions for Chronic Pain in Pediatric Patients: A Review of Guidelines

Last updated: May 5, 2020
Project Number: RC1275-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What are the evidence-based guidelines regarding on- and off-label pharmacological interventions for pediatric and youth patients with chronic pain?

Key Message

One relevant evidence-based guideline on the management of chronic pain in children and young people was identified. The level of evidence going from the highest to the lowest was scored as 1++, 1+, 1-, 2++, 2+, 2-, 3, or 4 for the evidence presented in the guideline. Recommendations on various pharmacological treatments were presented but the strengths of recommendations were not provided and were based mainly on expert opinion (evidence level: 4). Lidocaine (5%) patches should be considered in the management of children and young people with localized neuropathic pain, particularly when improving compliance with physiotherapy interventions (evidence level: 3). Low dose amitriptyline should be considered for treating children and young people with functional gastrointestinal disorders (evidence level: 1-), chronic daily headache, chronic widespread pain or mixed nociceptive/neuropathic back pain (evidence level: 3).Recommendations for use of acetaminophen, NSAIDs, gabapentin, pregabalin, bisphosphonate, baclofen, pizotifen, and famotidine for management of chronic pain varied depending on the types of chronic pain and were based on expert opinion.Based on expert opinion, opioids are rarely recommended for chronic pain because of their adverse effect profile, and if used should be used as short a duration as possible.The recommendations need to be considered in the light of the limitations (such as evidence available was of limited amount and limited quality, and recommendations were based on expert opinion; and it was unclear if generalizable to the Canadian context).