Management of chronic pain in children and young people: summary

A summary of the available evidence, combined with a consensus group agreement on key recommendations and suggested patient pathways.


1. IASP, Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl, 1986. 3: p. S1-226.

2. Perquin, C.W., et al., Pain in children and adolescents: a common experience. Pain, 2000. 87(1): p. 51-8.

3. Roth-Isigkeit, A., et al., Pain Among Children and Adolescents: Restrictions in Daily Living and Triggering Factors. Pediatrics, 2005. 115(2): p. e152-e162.

4. Stanford, E.A., et al., The frequency, trajectories and predictors of adolescent recurrent pain: a population-based approach. Pain, 2008. 138(1): p. 11-21.

5. King, S., et al., The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain, 2011. 152(12): p. 2729-38.

6. Mathews, L., Pain in Children: Neglected, Unaddressed and Mismanaged. Indian Journal of Palliative Care, 2011. 17(Suppl): p. S70-S73.

7. Sleed, M., et al., The economic impact of chronic pain in adolescence: Methodological considerations and a preliminary costs-of-illness study. Pain, 2005. 119(1-3): p. 183-190.

8. Groenewald, C.B., et al., The economic costs of chronic pain among a cohort of treatment-seeking adolescents in the United States. J Pain, 2014. 15(9): p. 925-33.

9. Dell'Api, M., J.E. Rennick, and C. Rosmus, Childhood chronic pain and health care professional interactions: shaping the chronic pain experiences of children. J Child Health Care, 2007. 11(4): p. 269-86.

10. Carter, B.D. and B.M. Threlkeld, Psychosocial perspectives in the treatment of pediatric chronic pain. Pediatric Rheumatology, 2012. 10(1): p. 15.

11. SIGN 136, Management of Chronic Pain. SIGN 136, 2013. 8(1).

12. SIGN Guideline Development Group (chair L Colvin), SIGN 136: Management of Chronic Pain. SIGN, 2013.

13. SIGN 50, A guideline developer’s handbook. Scottish Intercollegiate Guidelines Network, 2014.

14. Parliament, S., The Children and Young People (Scotland) Act. 2014 asp 8.

15. Medicines and Healthcare Products Regulatory Agency, Off-label use or unlicensed medicines: prescribers’ responsibilities. Drug Safety Update, 2009. 2(9): p. 6-7.

16. Larsson, B. and J. Carlsson, A school-based, nurse-administered relaxation training for children with chronic tension-type headache. J Pediatr Psychol, 1996. 21(5): p. 603-14.

17. Larsson, B., et al., Relaxation treatment of adolescent headache sufferers: results from a school-based replication series. Headache, 2005. 45(6): p. 692-704.

18. Eccleston, C., et al., Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev, 2014(5): p. CD003968.

19. Smartt, The assessment and management of chronic pain in children and adolescents: an overview of selected literature. Heath Services Assessment Collaboration, 2009.

20. Simons, L.E., et al., Pediatric Pain Screening Tool: rapid identification of risk in youth with pain complaints. Pain, 2015. 156(8): p. 1511-8.

21. Clinch, J. and C. Eccleston, Chronic musculoskeletal pain in children: assessment and management. Rheumatology (Oxford), 2009. 48(5): p. 466-74.

22. Palermo, T.M., C.R. Valrie, and C.W. Karlson, Family and Parent Influences on Pediatric Chronic Pain: A Developmental Perspective. The American psychologist, 2014. 69(2): p. 142-152.

23. NHS England, E02/S/b, NHS Standard Contract For Paediatric Surgery: Chronic Pain. NHS Commissioning Board, 2013.

24. Hechler, T., et al., Systematic Review on Intensive Interdisciplinary Pain Treatment of Children With Chronic Pain. Pediatrics, 2015. 136(1): p. 115-27.

25. Velleman, S., P. Stallard, and T. Richardson, A review and meta-analysis of computerized cognitive behaviour therapy for the treatment of pain in children and adolescents. Child Care Health Dev, 2010. 36(4): p. 465-72.

26. Van Der Veek, S.M., et al., Do parents maintain or exacerbate pediatric functional abdominal pain? A systematic review and meta-analysis. J Health Psychol, 2012. 17(2): p. 258-72.

27. von Baeyer, C.L. and L.J. Spagrud, Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Pain, 2007. 127(1-2): p. 140-50.

28. Hunt, A., et al., Clinical validation of the Paediatric Pain Profile. Developmental Medicine & Child Neurology, 2004. 46(1): p. 9-18.

29. Gregoire, M.C. and G.A. Finley, Drugs for chronic pain in children: a commentary on clinical practice and the absence of evidence. Pain Res Manag, 2013. 18(1): p. 47-50.

30. British Medical Association and Royal Pharmaceutical Society of Great Britain, Guidance on Prescribing in The British National Formulary No. 61, . 2012.

31. General Medical Council, General Medical Council (2008) Good practice in prescribing medicines. Available from: 2008.

32. Paediatric Formulary Committee, BNF for Children (online). BMJ Group, Pharmaceutical Press, and RCPCH Publications 2016

33. Karen M. Starko, M., et al,, Reye's syndrome and salicylate use. Pediatrics, 1998. 102(1): p. 259-262.

34. Waldman, R.J., et al., Aspirin as a risk factor in Reye's syndrome. Jama, 1982. 247(22): p. 3089-94.

35. Halpin, T.J., et al., Reyes syndrome and medication use. JAMA, 1982. 248(6): p. 687-691.

36. Heintjes, E., et al., Pharmacotherapy for patellofemoral pain syndrome. Cochrane Database Syst Rev, 2004(3): p. CD003470.

37. Kavanagh, P.L., et al., Management of children with sickle cell disease: a comprehensive review of the literature. Pediatrics, 2011. 128(6): p. e1552-74.

38. Pierce, C.A. and B. Voss, Efficacy and safety of ibuprofen and acetaminophen in children and adults: a meta-analysis and qualitative review. Ann Pharmacother, 2010. 44(3): p. 489-506.

39. Frost, S.G., Treatment of complex regional pain syndrome type 1 in a pediatric patient using the lidocaine patch 5%: a case report(). Current Therapeutic Research, Clinical and Experimental, 2003. 64(8): p. 626-629.

40. Nayak, S. and M. Cunliffe, Lidocaine 5% patch for localized chronic neuropathic pain in adolescents: report of five cases. Paediatr Anaesth, 2008. 18(6): p. 554-8.

41. Orellana Silva, M., et al., 5% lidocaine medicated plaster use in children with neuropathic pain from burn sequelae. Pain Med, 2013. 14(3): p. 422-9.

42. McElhiney L, F., Case report: The use of topical concentrated capsaicin cream to treat erythromelalgia in a pediatric patient. . International Journal of Pharmaceutical Compounding 2011. 15 (3): p. 194-199.

43. Brown, S.C., et al., A randomized controlled trial of amitriptyline versus gabapentin for complex regional pain syndrome type I and neuropathic pain in children. Canadian Journal of Pain, 2014( 61:S1–S165).

44. Ching, C.B., et al., Interdisciplinary pain management is beneficial for refractory orchialgia in children. Journal of pediatric urology, 2015. 11(3): p. 123. e1-123. e6.

45. Hauer, J.M. and J.C. Solodiuk, Gabapentin for Management of Recurrent Pain in 22 Nonverbal Children with Severe Neurological Impairment: A Retrospective Analysis. Journal of palliative medicine, 2015. 18(5): p. 453-456.

46. Low, A.K., K. Ward, and A.P. Wines, Pediatric complex regional pain syndrome. J Pediatr Orthop, 2007. 27(5): p. 567-72.

47. Low, A.K., K. Ward, and A.P. Wines, Pediatric complex regional pain syndrome. Journal of Pediatric Orthopaedics, 2007. 27(5): p. 567-572.

48. Pedemonte Stalla, V., et al., Complex regional pain syndrome type I. An analysis of 7 cases in children. Neurología (English Edition), 2015. 30(6): p. 347-351.

49. Tan, H.J., et al., Comparison of antiepileptic drugs, no treatment, or placebo for children with benign epilepsy with centro temporal spikes. Cochrane Database of Systematic Reviews, 2014(9).

50. Eddy, C.M., H.E. Rickards, and A.E. Cavanna, The cognitive impact of antiepileptic drugs. Therapeutic Advances in Neurological Disorders, 2011. 4(6): p. 385-407.

51. Rutten, J.M.T.M., et al., Nonpharmacologic Treatment of Functional Abdominal Pain Disorders: A Systematic Review. Pediatrics, 2015.

52. Kaminski, A., et al., Antidepressants for the treatment of abdominal pain-related functional gastrointestinal disorders in children and adolescents. Cochrane Database Syst Rev, 2011(7): p. CD008013.

53. Beecham, E., et al., Pharmacological interventions for pain in children and adolescents with life-limiting conditions. Cochrane Database Syst Rev, 2015(3): p. CD010750.

54. Korterink, J.J., et al., Pharmacologic treatment in pediatric functional abdominal pain disorders: a systematic review. J Pediatr, 2015. 166(2): p. 424-31 e6.

55. Weydert, J.A., T.M. Ball, and M.F. Davis, Systematic review of treatments for recurrent abdominal pain. Pediatrics, 2003. 111(1): p. e1-11.

56. Chou, R., et al., The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med, 2015. 162(4): p. 276-86.

57. Chaparro, L.E., et al., Opioids compared to placebo or other treatments for chronic low-back pain. Cochrane Database Syst Rev, 2013(8): p. CD004959.

58. Moore, R.A., et al., Estimate at your peril: imputation methods for patient withdrawal can bias efficacy outcomes in chronic pain trials using responder analyses. Pain, 2012. 153(2): p. 265-8.

59. Manchikanti, L., et al., A systematic review of randomized trials of long-term opioid management for chronic non-cancer pain. Pain Physician, 2011. 14(2): p. 91-121.

60. Jain, G., et al., Long-term neuropsychological effects of opioid use in children: a descriptive literature review. Pain Physician, 2014. 17(2): p. 109-18.

61. Niesters, M., et al., Opioid-induced respiratory depression in paediatrics: a review of case reports. Br J Anaesth, 2013. 110(2): p. 175-82.

62. Quigley, C., Opioid switching to improve pain relief and drug tolerability. Cochrane Database Syst Rev, 2004(3): p. CD004847.

63. Yawn, B.P., et al., Management of sickle cell disease: summary of the 2014 evidence-based report by expert panel members. JAMA, 2014. 312(10): p. 1033-48.

64. Bialocerkowski, A.E. and A. Daly, Is Physiotherapy Effective for Children With Complex Regional Pain Syndrome Type 1? Clinical Journal of Pain, 2012. 28(1): p. 81-91.

65. van der Heijden, R.A., et al., Exercise for treating patellofemoral pain syndrome. Cochrane Database Syst Rev, 2015. 1: p. CD010387.

66. Tan, S.S., et al., Cost-utility of exercise therapy in adolescents and young adults suffering from the patellofemoral pain syndrome. Scand J Med Sci Sports, 2010. 20(4): p. 568-79.

67. Lee, B.H., et al., Physical therapy and cognitive-behavioral treatment for complex regional pain syndromes. J Pediatr, 2002. 141(1): p. 135-40.

68. Smith, T.O., How effective is physiotherapy in the treatment of complex regional pain syndrome type I? A review of the literature. Musculoskeletal Care, 2005. 3(4): p. 181-200.

69. Swart, N.M., et al., The additional effect of orthotic devices on exercise therapy for patients with patellofemoral pain syndrome: a systematic review. Br J Sports Med, 2012. 46(8): p. 570-7.

70. Skinner, B.F., The operant side of behavior therapy. Journal of behavior therapy and experimental psychiatry, 1988. 19(3): p. 171-179.

71. Hollon, S.D. and A.T. Beck, Cognitive and cognitive-behavioral therapies. 1994.

72. Hayes, S.C., Acceptance and Commitment Therapy and the New Behavior Therapies: Mindfulness, Acceptance, and Relationship. 2004.

73. Kabat‐Zinn, J., Mindfulnessbased interventions in context: past, present, and future. Clinical psychology: Science and practice, 2003. 10(2): p. 144-156.

74. Fisher, E., et al., Systematic review and meta-analysis of psychological therapies for children with chronic pain. J Pediatr Psychol, 2014. 39(8): p. 763-82.

75. The Matrix, A Guide to Delivering Evidence-Based Psychological Therapies in Scotland. 2015.

76. Palermo, T.M., et al., Randomized controlled trials of psychological therapies for management of chronic pain in children and adolescents: an updated meta-analytic review. Pain, 2010. 148(3): p. 387-397.

77. Sprenger, L., F. Gerhards, and L. Goldbeck, Effects of psychological treatment on recurrent abdominal pain in children—A meta-analysis. Clinical psychology review, 2011. 31(7): p. 1192-1197.

78. Eccleston, C., et al., Psychological therapies for the management of chronic and recurrent pain in children and adolescents. The Cochrane Library, 2014.

79. Velleman, S., P. Stallard, and T. Richardson, A review and metaanalysis of computerized cognitive behaviour therapy for the treatment of pain in children and adolescents. Child: care, health and development, 2010. 36(4): p. 465-472.

80. Wicksell, R.K., et al., Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain–a randomized controlled trial. Pain, 2009. 141(3): p. 248-257.

81. Palermo, T.M., et al., Randomized controlled trial of an Internet-delivered family cognitive-behavioral therapy intervention for children and adolescents with chronic pain. Pain, 2009. 146(1-2): p. 205-13.

82. Gerber, W.-D., et al., MIPAS-Family—evaluation of a new multi-modal behavioral training program for pediatric headaches: clinical effects and the impact on quality of life. The Journal of Headache and Pain, 2010. 11(3): p. 215-225.

83. Eccleston, C., et al., Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev, 2012. 12: p. CD003968.

84. Stanton, T.R., et al., Local anaesthetic sympathetic blockade for complex regional pain syndrome. Cochrane Database Syst Rev, 2013(8): p. CD004598.

85. Cepeda, M.S., D.B. Carr, and J. Lau, Local anesthetic sympathetic blockade for complex regional pain syndrome. Cochrane Database Syst Rev, 2005(4): p. CD004598.

86. Horvath, A., P. Dziechciarz, and H. Szajewska, Systematic review of randomized controlled trials: fiber supplements for abdominal pain-related functional gastrointestinal disorders in childhood. Ann Nutr Metab, 2012. 61(2): p. 95-101.

87. Jindal, V., A. Ge, and P.J. Mansky, Safety and efficacy of acupuncture in children: a review of the evidence. J Pediatr Hematol Oncol, 2008. 30(6): p. 431-42.

88. Chan, C.L.W., et al., QigongExercise for the Treatment of Fibromyalgia: A Systematic Review of Randomized Controlled Trials. The Journal of Alternative and Complementary Medicine, 2012. 18(7): p. 641-646.

89. Stephens, S., et al., Feasibility and effectiveness of an aerobic exercise program in children with fibromyalgia: results of a randomized controlled pilot trial. Arthritis Rheum, 2008. 59(10): p. 1399-406.

90. Treurnicht Naylor, K., et al., The effectiveness of music in pediatric healthcare: a systematic review of randomized controlled trials. Evid Based Complement Alternat Med, 2011. 2011: p. 464759.

91. Oelkers-Ax, R., et al., Butterbur root extract and music therapy in the prevention of childhood migraine: an explorative study. Eur J Pain, 2008. 12(3): p. 301-13.


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