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Pain
Original research
Interventions to treat pain in paediatric CFS/ME: a systematic review
  1. Caitlin Ascough1,
  2. Hayley King1,
  3. Teona Serafimova1,
  4. Lucy Beasant1,
  5. Sophie Jackson1,
  6. Luke Baldock1,
  7. Anthony Edward Pickering2,3,
  8. Jonathan Brooks4,
  9. Esther Crawley1
  1. 1 Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
  2. 2 School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
  3. 3 Bristol Anaesthesia, Pain & Critical Care Sciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  4. 4 School of Psychological Science, University of Bristol, Bristol, UK
  1. Correspondence to Dr Caitlin Ascough; caitlin.ascough{at}bristol.ac.uk

Abstract

Background Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is common (prevalence 1%–2%). Two-thirds of children experience moderate or severe pain, which is associated with increased fatigue and poorer physical function. However, we do not know if treatment for CFS/ME improves pain.

Objective Identify whether specialist treatment of paediatric CFS/ME improves pain.

Methods We conducted a detailed search in MEDLINE, EMBASE, PsycINFO and the Cochrane Library. Two researchers independently screened texts published between 1994 and 24 January 2019 with no language restrictions. Inclusion criteria were (1) randomised controlled trials and observational studies; (2) participants aged <19 years with CFS/ME; and (3) measure of pain before and after an intervention.

Results Of 1898 papers screened, 26 studies investigated treatment for paediatric CFS/ME, 19 of which did not measure pain at any time point. Only five treatment studies measured pain at baseline and follow-up and were included in this review. None of the interventions were specifically targeted at treating pain. Of the included studies, two showed no improvement in pain scores, one suggested an improvement in one subgroup and two studies identified improvements in pain measures in ‘recovered’ patients compared with ‘non-recovered’ patients.

Conclusions Despite the prevalence and impact of pain in children with CFS/ME surprisingly few treatment studies measured pain. In those that did measure pain, the treatments used focused on overall management of CFS/ME and we identified no treatments that were targeted specifically at managing pain. There is limited evidence that treatment helps improve pain scores. However, patients who recover appear to have less pain than those who do not recover. More studies are needed to determine if pain in paediatric CFS/ME requires a specific treatment approach, with a particular focus on patients who do not recover following initial treatment.

PROSPERO registration number CRD42019117540.

  • chronic fatigue syndrome
  • pain
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjpo-2019-000617

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    Footnotes

    • Contributors CA conducted the review and wrote the first draft of the paper. CA, HK, LB and SJ reviewed the titles and abstracts and extracted the data. TS and LB completed the risk of bias assessments. AP and JB advised on the interpretation of pain scores. The idea for the study was EC's. All the authors reviewed the drafts of the paper and all approved the final submitted version.

    • Funding This work was supported by the UKFPO Academic Foundation Programme.

    • Competing interests One of the authors of this systematic review (EC) was also an author of one of the included papers. However, to avoid a conflict of interest, EC was not involved in the study selection, data extraction or assessment of risk of bias.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data generated or analysed during this study are included in this published article (and its supplementary information files).