Drugs are typically the first resort for treating pain, and it’s easy to find lots of evidence for what works and what doesn’t in adults. Not all painkillers work for all adults, and there are certainly no silver bullets, but we have hundreds of high-quality clinical trials on which to build research.
It’s not just adults who experience pain, though. For one in four children, pain is more than bumps and scrapes; it lasts longer than three months and is often disabling. It’s hard not to be moved by the thought of a child in constant pain, so you might think that in 2019 we would have a similar evidence base for treating chronic pain in children. But you’d be very wrong.
We recently conducted an overview of systematic reviews (the highest form of evidence) that looked at pain in children. We found just 23 systematic reviews. Between them, they examined six trials involving 393 children; just six trials across all drugs and all chronic pain conditions, except headache. Ever. Not one treated children with cancer-related pain.
We know very little about which drugs might work, for whom they might work, or what benefits and harms may result. We know more about which talk therapies work for children (three Cochrane reviews, that looked at more than 3500 children) than we do about pain relief.
There are some silver linings. Enough trial work exists for the UK’s National Institute for Health and Care Excellence (NICE) to recommend the use of anti-TNF drugs (drugs that stop inflammation) for juvenile idiopathic arthritis, and the danger of using codeine in children has been recognised – although not widely enough.