Antidepressants for chronic non-cancer pain in children and adolescents

Abstract

Antidepressants for chronic non-cancer pain in children and adolescents (Review)

Cognitive Biases in Children and Adolescents With Chronic Pain: A Review of Findings and a Call for Developmental Research

“…One study of participants aged 9-16 years who experienced headache at least weekly found a tendency to over-report pain intensity and duration in retrospective compared to daily ratings of the experience [68]. Two other studies recruiting patients of similar age range (8)(9)(10)(11)(12)(13)(14)(15)(16)(17) year olds [8] and 9-18 year olds [64]) but different diagnoses (chronic abdominal pain [8] and juvenile idiopathic arthritis [64]) found an under-reporting of pain using similar designs.…”

Placebos Are Part of the Solution, Not the Problem. An Exemplification of the Case of Antidepressants in Pediatric Chronic Pain Conditions

“…Interventions for chronic pediatric pain comprise a range of treatment approaches, among them antidepressants (ADs). Pharmacological treatment indications for pediatric populations are usually based on data extrapolated from adults where ADs are described to be effective and frequently used for the treatment of chronic pain (4)(5)(6). Furthermore, chronic pain is multi-faced, therefore the use of ADs may be utilized not only to address pain but also underlying or comorbid psychiatric symptoms such as depression, anxiety, or different sleep disorders (4,7).…”

“…Pharmacological treatment indications for pediatric populations are usually based on data extrapolated from adults where ADs are described to be effective and frequently used for the treatment of chronic pain (4)(5)(6). Furthermore, chronic pain is multi-faced, therefore the use of ADs may be utilized not only to address pain but also underlying or comorbid psychiatric symptoms such as depression, anxiety, or different sleep disorders (4,7). However, although ADs are frequently used in clinical practice, a recent Cochrane review could only include four studies that examined the use of ADs in pediatric chronic non-cancer pain and was therefore not able to report effect sizes (4).…”

“…Furthermore, chronic pain is multi-faced, therefore the use of ADs may be utilized not only to address pain but also underlying or comorbid psychiatric symptoms such as depression, anxiety, or different sleep disorders (4,7). However, although ADs are frequently used in clinical practice, a recent Cochrane review could only include four studies that examined the use of ADs in pediatric chronic non-cancer pain and was therefore not able to report effect sizes (4). In addition, the small to moderate effect sizes reported in many pediatric AD trials in the common psychiatric disorders are potentially due to large placebo effects, with effect sizes as high as high as 1.57 (Hedges g) (8).…”

El cuarto número del 2017 en NeuroGastroLATAM Reviews

“…En cuanto a los antidepresivos, los resultados de los únicos dos estudios controlados con tríciclicos (amitriptilina) no permiten establecer una recomendación para su uso. En forma similar, existen dos estudios con citalopram cuyos resultados son contradictorios 20 . Con relación a la ciproheptadina, un antihistamínico con propiedades anticolinérgicas y antiserotoninérgicas, ha sido analizada de manera retrospectiva en dispepsia funcional en un estudio prospectivo y dos retrospectivos, también con resultados mixtos, pero un estudio controlado en dolor abdominal funcional mostró su eficacia frente al placebo en la mejoría del dolor abdominal 21 .…”