Addressing the gap in knowledge on chronic pain in childhood

Cochrane Pain, Palliative and Supportive Care  (PaPaS)  group addresses the gap in knowledge on chronic  pain in childhood and helps push solutions forward.

On July 12th at the Wellcome Trust in London, UK,  world-leading experts came together to look at evidence, policy and practice in the area of childhood pain.

Clinicians, researchers, funders and policy makers from charities, universities and hospitals discussed the lack of knowledge in this area and shared their collective ambition to increase the quality of evidence in this field.

Professor Christopher Eccleston, Coordinating Editor of the Cochrane Pain, Palliative and Supportive (PaPaS)  Review Group, who initiated the event explained, “Four years ago the Cochrane PaPaS Group promised a programme of systematic reviews on the evidence for interventions for adults with chronic pain (both neuropathic and cancer related) and children with chronic pain. The work was supported by the NIHR. We produced 49 systematic reviews in a three year period, 10 of which for children and adolescents with chronic pain. The principal finding from these ten reviews was a distinct lack of evidence,  with too few trials in this area. The lack of research in this important field is so striking that we wanted to gather a group of influencers together fast  to address this gap in knowledge and think creatively about what the solutions could be.”

Presentations were shared on pain in babies, pharmalogical treatments in chronic pain, pharmalogical treatments for disease related pain and psychological treatments for chronic pain followed by discussions which highlighted the lack of large, high quality trials in this area.

 Group discussions reflected;

  • clinical concerns about how pain is identified and measured in children and how adult measures don’t work for children
  • how cost effectiveness is used as evidence for decision-making in the absence of other knowledge
  • the lack of interest in researching old drugs
  • personalised medicine and how this effects creation of systematic reviews
  • the suitability of longitudinal studies for this age group (but the challenge of including them in systematic reviews.) 
  • how social media feeds a desire for immediate solutions and responses, but smart phones offer an opportunity to collect data differently 

The initiative led by the Cochrane PaPaS Group was funded by NIHR and backed by partners including the European Pain Federation, Wellcome Trust, and Arthritis Research UK. 

Co-organiser Systematic reviewer and editorial assistant Dr Emma Fisher from the PaPaS Group, explained, “All the attendees are working in some way to mitigate the lack of data in this field, for some it is a daily challenge - treating young patients, knowing they can’t help them as much as they would like. This is a springboard and just the beginning. As an academic collective we have to focus on taking our recommendations forward.” 

Following the event, Cochrane PaPaS are considering next steps, this might be a prioritization series for a journal, or a commentary style piece. They are also hoping to see more funding coming into this area and to continue to advocate for more and better research into chronic pain in children.