Last week Becca Abbott was invited to attend a meeting hosted by @CochranePAPAS on Paediatric Pain at the Wellcome Building in London. The meeting, ‘Chronic pain in childhood, time for change; Evidence, policy, and practice in paediatric pain’, brought together many of those eminent in the field of paediatric pain in the UK. The invite was a result of our reviews of #recurrentabdominalpain, which we published as three separate Cochrane reviews (#1, #2, #3) and a summary paper.
Before we talk about the meeting, it would be wrong not to mention the wonderful venue. The building hosts the @WellcomeCollection – a wonderful library and home to medical exhibits. On the advice of a good friend, Becca took herself up to the Reading Room – what a place to immerse yourself. We in the @evidsyntheam all love reading – probably part of why we love what we do! If only there had been more time – in her bag was a book which indulges many of her passions #crimefiction #london #evidence (#thetheseusparadox). Not enough time on this trip to sit on one of the cushions and read– maybe next time!
Back to the meeting….
The event, hosted by Professor Christopher Eccelston from the Centre for Pain Research, started with snapshot presentations around novel methodologies for identifying neonatal pain, evidence for pharmacological approaches to pain and paediatric pain more specifically, and finished with a summary of the evidence for psychosocial interventions for pain in children and adolescents. Small working groups then discussed what the key issues and priorities were for the paediatric pain agenda. Coming together at the end, there were five clear messages:
- Despite a wealth of research – we still do not have a robust evidence base for what is effective in paediatric pain (trials too small, outcomes too diverse or of questionable validity, etc)
- More simple RCTs are not the answer. Future paediatric pain research needs to evaluate more ‘real-life’ complex interventions, which might involve a number of treatment approaches
- We need to share the evidence we already have and not work in silos. There is a lot of good pain research happening, but we need to share these data
- We need better outcome measures for paediatric pain. Many of our current measures are adapted from adult outcomes. We need children to help us understand pain from their perspective
And which leads to the final point
- We need to include children (and their parents) in the development of the research agenda.
We also talked about the need for people to understand the size and nature of paediatric pain, and this might be highlighted in a forthcoming prominent journal (#cansaynomoreathistime). And we heard about the excellent Pain Roadmap, launched recently by Arthritis UK which outlines the most pressing and vital areas for future pain research, and discussed whether something similar for paediatric pain could be initiated.
So whilst in one sense we have an abundance of evidence, we do not as yet have sufficient or robust enough evidence on which to guide practice.
Before finishing, it would be amiss not to mention the TEETH exhibition. If you love medical history, take a visit….a walk through the dental centuries….and in some places, not for the squeamish. But what about the public health messages – did they have the evidence at the time they were written that looking after your teeth has many health benefits. Who’s to say – though there is a rather nice summary here 🙂 :
Abbott, R.A., Martin, A.E., Newlove-Delgado, T.V., Bethel, A., Thompson-Coon, J., Whear, R., Logan, S. Psychosocial interventions for recurrent abdominal pain in childhood. Cochrane Database of Systematic Reviews. 2017 Jan 10;1:CD010971. doi: 10.1002/14651858.CD010971.pub2
Newlove-Delgado, T.V., Martin, A.E., Abbott, R.A., Bethel, A., Thompson-Coon, J., Whear, R., Logan, S. Dietary interventions for recurrent abdominal pain in childhood. Cochrane Database of Systematic Reviews. 2017; Issue 3. Art. No.: CD010972. DOI: 10.1002/14651858.CD010972.pub2
Martin, A.E., Newlove-Delgado, T.V., Abbott, R.A., Bethel, A., Thompson-Coon, J., Whear, R., Logan, S. Pharmacological interventions for recurrent abdominal pain in childhood. Cochrane Database of Systematic Reviews.2017; Issue 3. Art. No.: CD010973. DOI: 10.1002/14651858.CD010973.pub2
Abbott, R.A., Martin, A.E., Newlove-Delgado, T.V., Bethel, A., Thompson-Coon, J., Whear, R., Logan, S. Recurrent Abdominal Pain in Children: Summary Evidence From 3 Systematic Reviews of Treatment Effectiveness. Journal of Paediatric Gastroenterology & Nutrition. 2018; 67 (1): 23-33. doi: 10.1097/MPG.0000000000001922