Decisions to prescribe children drugs to treat chronic pain are not guided by sufficient, high quality evidence, according to an important new study published today.
Published as part of a special collection of systematic reviews in the Cochrane Library and recently summarised in the journal PAIN, the overview 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 is led by researchers at the University of Bath in collaboration with an international team of researchers and physicians.
In adults, chronic pain lasting for three months or more is known to have a devastating effect. What is less well known is that one in five children also report chronic pain, which is both distressing and disabling for children and their parents.
But the new study 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 randomised control trials. Yet only 393 children have participated in just six trials ever undertaken.
The research is a summary of all available systematic reviews of studies in this area and is supported by the National Institute for Health Research (NIHR), Versus Arthritis and also involves Bath's Centre for Pain Services (part of the RUH Foundation Trust).
The team who prepared the overview stress that lack of evidence does not mean evidence of no effect. 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 team acknowledges that there are practical and ethical barriers to conducting randomised control trials on children, but suggest that these are no different from other areas of paediatric pharmacological research.
Co-author Dr. Emma Fisher [...] added: "Children are not just small adults so we cannot simply extrapolate evidence acquired from adults and use it in children.
"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."
Pharmacological interventions for chronic pain in children: an overview of systematic reviews, PAIN (2019). DOI: 10.1097/j.pain.0000000000001609
(Score: 2) by Gaaark on Thursday June 27 2019, @05:51PM (5 children)
I thought mom's kisses made EVERYTHING better?
--- Please remind me if I haven't been civil to you: I'm channeling MDC. ---Gaaark 2.0 ---
(Score: 3, Informative) by Freeman on Thursday June 27 2019, @05:54PM (2 children)
They do, but that's what we call a placebo effect.
Joshua 1:9 "Be strong and of a good courage; be not afraid, neither be thou dismayed: for the Lord thy God is with thee"
(Score: 2) by JoeMerchant on Thursday June 27 2019, @07:52PM
Pssst... the placebo effect is real, and beats most drugs that enter trials, particularly in the side effects category. If you're not getting some placebo when you need it, you're just a victim of big Pharma's conspiracy to monetize ALL forms of treatment.
🌻🌻 [google.com]
(Score: 3, Funny) by DannyB on Thursday June 27 2019, @08:16PM
I thought that was called an oedipal complex.
The lower I set my standards the more accomplishments I have.
(Score: 2) by takyon on Thursday June 27 2019, @06:16PM (1 child)
We put that in a bottle along with acetaminophen and oxycodone.
[SIG] 10/28/2017: Soylent Upgrade v14 [soylentnews.org]
(Score: 2) by DannyB on Thursday June 27 2019, @08:32PM
All of the current Big Pharma narcotics makers could simply add 10% more love [fandom.com] to their ingredients.
Or at least say they do in their advertising.
The lower I set my standards the more accomplishments I have.
(Score: 1, Insightful) by Anonymous Coward on Thursday June 27 2019, @06:12PM (3 children)
The idea is to get kids hooked on pain meds early in their lives so the pharmaceutical companies have a customer for life.
Do the drugs work? They seem to work out OK for big Pharma.
(Score: 2) by JoeMerchant on Thursday June 27 2019, @07:57PM
Do your kids have a drug problem?
Not really, they seem to be able to get all the drugs they want.
🌻🌻 [google.com]
(Score: 2) by DannyB on Thursday June 27 2019, @08:19PM (1 child)
From personal experience, the key to successful long term (10+ years) of narcotic pain killers is to NOT USE THEM unless you really need them.
How is a child supposed to know when it is time to use them, and when to not use them?
The lower I set my standards the more accomplishments I have.
(Score: 0) by Anonymous Coward on Friday June 28 2019, @01:02AM
The Big Pharma app, of course!
Sick Child: Siri, is it time to take my pain meds?
[a sinister voice replies]
Pharma App: Siri can't come to the phone right now. She's waiting for ... um ... a Narcan update.
Sick Child: Who are you?
Pharma App: I'm big Pharma! I know more about medication than doctors do!
Sick Child: Oh ... should I take my pain meds?
Pharma App: Of course!
Sick Child: But I don't feel that bad.
Pharma App: Well, when was the last time you took them?
Sick Child: I don't remember ... things move kind of slow and it's hard to keep track of things.
Pharma App: Oh my, that sounds serious. Maybe you should take an additional medication.
Sick Child: But pills make my stomach hurt.
Pharma App: If your stomach hurts you should take more pain meds!
Sick Child: More pain meds so I can take some other pills?
Pharma App: Pharmaceuticals are always the answer.
Sick Child: But what if I overdose?
Pharma App: You should ask Siri about that.
(Score: 0) by Anonymous Coward on Thursday June 27 2019, @07:53PM (1 child)
Children 1) don't really feel pain 2) will soon forget it.
This was official thinking not so long ago, resulting in operations minor and major being performed on kids without numbing them.
Analgesia is a human right.
(Score: 4, Informative) by AthanasiusKircher on Thursday June 27 2019, @08:14PM
This is sort of true. The standard medical belief until the mid-1980s was that INFANTS don't experience pain, as the standard medical belief was that they weren't even exactly "conscious" in the normal adult sense. Even slightly older children obviously experience pain and can tell parents that once they can talk. But that didn't stop doctors from.performing invasive surgery on infants without anaesthesia; you're right about that.
Anyhow, the lack of research on children in this instance isn't surprising at all. Clinical trials on children have much more complicated regulations governing them, so researchers shy away from it. And I think medicinal establishment acknowledged that older children experienced pain, but there was until recently a tendency among doctors to downplay it -- children exaggerate, pain builds character, and all that crap. Plus a lot of pain meds are considered addictive, which makes studies on children even more complex.
The real problem is lack of reliable child medical research studies in general. I don't think pain meds are an outlier among medications. The fact is doctors frequently prescribe medication to children based on estimates of dosage and often little specific study on kids. This sort of "off-label" prescription is pretty common, and researchers have been warning about this for years. So not much new here other than a stark reminder about how little good quality medical research on children is out there.
(Score: 0) by Anonymous Coward on Friday June 28 2019, @07:15AM
no need to comment. parents who pain-drug their kids arent going to read this anyway, being busy pimping out their kids or sumething.