Interventions to treat pain in paediatric CFS/ME: a systematic review

Abstract

BackgroundPaediatric 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.ObjectiveIdentify whether specialist treatment of paediatric CFS/ME improves pain.MethodsWe 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.ResultsOf 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.ConclusionsDespite 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 numberCRD42019117540.

Effectiveness of an online multicomponent program (FATIGUEWALK) for chronic fatigue syndrome: A randomized controlled trial.

“…Although pain is a prevalent symptom in individuals with CFS/ME, previous studies have not often focused on assessment of pain symptoms and specific management treatment approaches in this patient population (Ascough et al, 2020). In this vein, the present results are remarkably important, as they support the effectiveness of our online multicomponent approach to help reduce pain intensity.…”

Experiences of pain in paediatric chronic fatigue syndrome/myalgic encephalomyelitis: a single-centre qualitative study

“…Only five treatment studies included pain as an outcome measure. 10 In these studies, treatments included (CBT (cognitive behaviour therapy), a ‘self-confrontation method’, the Lightning Process and low-dose clonidine). No intervention resulted in a significant reduction in pain although two studies suggested that pain may improve in those who are ‘recovered’ compared with ‘non-recovered’.…”

“…Pain in paediatric CFS/ME is poorly understood and there are no treatments specifically targeting pain in this population. Only five treatment studies included pain as an outcome measure 10. In these studies, treatments included (CBT (cognitive behaviour therapy), a ‘self-confrontation method’, the Lightning Process and low-dose clonidine).…”