A new study published in the journal, Pain, highlights that there is insufficient, high quality evidence behind decisions to prescribe to children drugs to treat chronic pain. The international study, led by researchers at the Bath Centre for Pain Services (BCPS), recommends that far more needs to be done to improve both the quality and quantity of the available evidence.
To put the problem into context, the study reveals that whilst 300,000 people with chronic pain have been studied in hundreds of randomised controlled trials worldwide, only 393 children have participated in just six trials ever undertaken. That’s a disparity of almost 1000:1 which, understandably, is described as “unacceptable”, particularly when set against the background of one in five children suffering some form of chronic pain.
Not just small adults
The researchers’ stress that children cannot be viewed simply as small adults. What has been learnt from research on adults with chronic pain cannot accurately be applied to children whose physiology and metabolism work differently.
Professor Christopher Eccleston, Director of the Centre for Pain Research at the University of Bath, explained “Overall, there is no high-quality evidence to help us understand the efficacy or safety of the common drugs used to help children with chronic pain. The lack of data means that we are uncertain about how to optimally manage pain. Doctors, children and their families all deserve better.
“This study is a collective effort from 23 leading researchers and physicians from around the world. Healthcare policy-makers need to grapple this issue if we are to break down the barriers that exist to producing sufficient evidence in paediatric chronic pain pharmacotherapy.”
Whilst a lack of evidence does not amount to evidence of no effect, there is an urgent need for investment to determine which drugs can best help children with chronic pain. Only then will doctors be in a position to make informed decisions to ensure that children are getting the most effective treatment.
The researchers acknowledge that there are both practical and ethical issues regarding randomised controlled trials on children. However, they also suggest that this situation is no different from other areas of pharmacological research on children.