Background: Paediatric chronic pain is a significant problem that can have devastating impacts on quality of life. Multimodal interdisciplinary interventions are the mainstay of paediatric treatment. The aim of this article is to provide a comprehensive review of the effectiveness of interdisciplinary interventions in the management of paediatric chronic pain. Methods: Studies were identified via a search of nine databases. The search strategy included concept blocks pertaining to type of pain, study population, and type of intervention. Eligible studies reported the effects of an intervention coordinated by two or more healthcare professionals of different disciplines, and recruited a sample aged 22 yr or below with chronic pain. Twenty-eight studies were included, and 21 provided data for inclusion in between-and withingroups meta-analyses. Results: Patients randomised to interdisciplinary interventions reported significantly lower pain intensity 0e1 month post-intervention compared with patients randomised to the control groups. Within-groups analysis of patients receiving interdisciplinary interventions showed significant improvements pre-to post-intervention in pain intensity, functional disability, anxiety, depression, catastrophising, school attendance, school functioning, and pain acceptance. Few differences were found between interventions delivered in inpatient vs outpatient settings. Significant heterogeneity due mainly to differing outcome variables and intervention content was found in most analyses. Conclusions: Overall, interdisciplinary interventions show promise in providing a range of clinical benefits for children with chronic pain. Methodologically robust randomised controlled trials using standardised outcome measures are needed, however, to guide clinical care.

Background: Adolescent chronic pain is prevalent, and interdisciplinary treatment is recommended. Although it is well known that technology is a key part of adolescents’ daily lives, there have not been any online, interdisciplinary interventions developed for adolescents with chronic pain in a UK healthcare context. Little is known about how adolescents currently use online resources to manage chronic pain, or what guidance they seek. Methods: Ninety-five participants from the community answered this mixed-methods, online survey (adolescent n = 54, parent n = 41), which assessed the needs of UK-based adolescents for a new online chronic pain management resource. Results: Findings indicated that, at the time of the survey, adolescents frequently used social media platforms, such as Instagram, for chronic pain management. Desired techniques for a new interdisciplinary resource for adolescents included ‘advice on explaining chronic pain to others’ (86.7% of adolescents) and sleep hygiene (82.2% of adolescents), though access to a range of pain management techniques was desired. Qualitative results indicated endorsement of a new programme by adolescents and parents. Conclusions: Adolescents and parents had a positive outlook towards the development of a UK-specific online resource to help manage chronic pain. Such an intervention should aim to be made accessible via the National Health Service. Adolescent use of social media platforms to seek support for chronic pain requires further exploration in future research.

Background: Chemotherapy-induced oral mucositis can result in severe pain.Intravenous (IV) opioids are recommended, but management protocols vary. We systematically reviewed studies reporting IV opioid use for pain related to chemotherapyinduced severe oral mucositis in children and conducted a large single-center case series.Methods: Ovid MEDLINE, PubMed, and Cochrane databases were searched for studies reporting IV opioid duration and/or dose requirements for severe mucositis.Secondly, our pain service database was interrogated to describe episodes of opioid administration by patient-or nurse-controlled analgesia (PCA/NCA) for children with mucositis and cancer treatment-related pain.Results: Seventeen studies (six randomized trials, two prospective observational, three retrospective cohort, six retrospective case series) included IV opioid in 618 patients (age 0.3-22.3 years), but reported parameters varied. Mucositis severity and chemotherapy indication influenced IV opioid requirements, with duration ranging from 3 to 68 days and variable dose trajectories (hourly morphine or equivalent 0-97 mcg/kg/h). Our 7-year series included PCA/NCA for 364 episodes of severe mucositis (302 patients; age 0.12-17.2 years). Duration ranged from 1 to 107 days and dose requirements in the first 3 days from 1 to 110 mcg/kg/h morphine. Longer PCA/ NCA duration was associated with: higher initial morphine requirements (ρ = 0.46 [95% CI 0.35, 0.57]); subsequent increased pain and need for ketamine co-analgesia (118/364 episodes with opioid/ketamine 13.9 [9.8-22.2] days vs opioid alone 6.0 [3.9-10.8] days; median [IQR]); but not with age or sex.Conclusions: Management of severe mucositis pain can require prolonged IV opioid therapy. Individual and treatment-related variability in analgesic requirements highlight the need for regular review, titration, and management by specialist services.

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BackgroundPain education is effective in increasing understanding and reducing disability when implemented early in adult pain management (British Pain Society, 2013). However, less research has been undertaken into the benefits of this for young people. Great Ormond Street Hospital Pain Control Service observed that Pain education provided in clinic settings were often poorly retained by young people and their families. Therefore, Pain Education Sessions were developed and implemented to target this.MethodsStand-alone sessions were run with 4–8 young people aged between 9–18 years old. Each young person attended with at least one parent/carer. The sessions lasted 3 hours and covered topics including pain mechanisms, medication management, pacing, relaxation, distraction techniques and healthy thinking. A multi-professional approach to planning and delivery was utilised, including psychology, physiotherapy, nursing and medical input. Feedback was collected via anonymous forms from young people and carers who attended.ResultsThe feedback suggested that 93% of young people and 97% of parents felt the sessions were helpful or very helpful. Participants indicated that they benefited greatly from meeting others with chronic pain. The feedback highlighted that many participants found the pain mechanisms and medication management topics most helpful.ConclusionFeedback from young people and parents who participated indicates that Pain Education Sessions were helpful to aid understanding of chronic pain and management strategies available. Sessions were evaluated favourably by all who attended and suggested they would recommend this to other people with chronic pain. Further research into the impact of pain education sessions on the long term outcomes of young people with chronic pain is required.