Mechanism-Based Pharmacological Treatment for Chronic Non-cancer Pain in Adolescents: Current Approaches and Future Directions

Bruneau, Alice; Carrié, Sabrina; Moscaritolo, Lorenzo; Ingelmo, Pablo

doi:10.1007/s40272-022-00534-x

Cited by 5 publications

(4 citation statements)

References 102 publications

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“…The results of the QST were available during the first evaluation and were used to personalize the treatment program of each patient. 13 , 14 …”

Section: Methodsmentioning

confidence: 99%

The Psychosocial Characteristics and Somatosensory Function of Children and Adolescents Who Meet the Criteria for Chronic Nociplastic Pain

Ocay¹,

Ross²,

Moscaritolo³

et al. 2023

JPR

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Purpose Nociplastic pain distinguishes individuals with pain and hypersensitivity in body regions with apparently normal tissues, without any signs of neuropathy, but with contribution of central and/or peripheral sensitization. There is a lack of literature describing nociplastic pain in the pediatric population. The objective of this study was to investigate the differences between pediatric patients with nociplastic pain compared with patients with non-nociplastic pain. Patients and Methods This study included 414 pediatric patients followed at an interdisciplinary centre for complex pain. All patients underwent an exhaustive pain assessment consisting of face-to-face interviews, validated self-report questionnaires and quantitative sensory testing. Recently established criteria for chronic nociplastic pain, and quantitative sensory testing was used to describe and stratify our cohort. Results One hundred and sixty-five patients (40%) were stratified as having possible nociplastic pain and two hundred and forty-nine (60%) patients, as non-nociplastic pain. Patients with nociplastic pain displayed pain hypersensitivity in the region of pain, more symptoms of panic and social phobia, and worse sleep quality than patients with non-nociplastic pain. The proportion of patients achieving a meaningful clinical outcome after completion of their treatment (medications, physiotherapy, psychology, nursing, social worker, and/or interventional procedures) was lower in patients with nociplastic pain (62%) than those without nociplastic pain (86%). Conclusion Our results suggest that patients who meet the criteria for nociplastic pain can be identified in a population of children and adolescents being treated in a center for complex pain. Combining screening with validated questionnaires and quantitative sensory testing facilitates the phenotyping and graded severity of patients with nociplastic pain in daily clinical practice.

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“…The results of the QST were available during the first evaluation and were used to personalize the treatment program of each patient. 13 , 14 …”

Section: Methodsmentioning

confidence: 99%

The Psychosocial Characteristics and Somatosensory Function of Children and Adolescents Who Meet the Criteria for Chronic Nociplastic Pain

Ocay¹,

Ross²,

Moscaritolo³

et al. 2023

JPR

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“…107 Recent studies suggested that personalized treatment approaches to various pediatric chronic pain conditions in general, and in pediatric neuropathic pain in particular, can be developed based on the individual nociceptive phenotypes as determined by the use of Quantitative Sensory Testing and conditioned pain modulation evaluation (QST/CPM). [108][109][110] QST/CPM testing appears to provide more targeted therapeutic options, resulting in less polypharmacotherapy and the use of interventional treatments, while still being at least as effective as standard treatment protocols. However, further studies are needed to examine the potential benefits of pain phenotyping and to confirm these hypotheses.…”

Section: Brief Summary Of Pharmacologic and Non-pharmacologic Treatme...mentioning

confidence: 99%

Chronic Postsurgical Pain in Children and Adolescents: A Call for Action

Einhorn,

Krishnan,

Poirier

et al. 2024

JPR

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Chronic postsurgical pain (CPSP) affects a significant proportion of children and adolescents after major surgery and is a detriment to both short-and long-term recovery outcomes. While clinical characteristics and psychosocial risk factors for developing CPSP in children and adults are well established in the literature, there has been little progress on the prevention and management of CPSP after pediatric surgery. Limited evidence to support current pharmacologic approaches suggests a fundamentally new paradigm must be considered by clinicians to both conceptualize and address this adverse complication. This narrative review provides a comprehensive evaluation of both the known and emerging mechanisms that support our current understanding of CPSP. Additionally, we discuss the importance of optimizing perioperative analgesic strategies to mitigate CPSP based on individual patient risks. We highlight the importance of postoperative pain trajectories to identify those most at risk for developing CPSP, the early referral to multi-disciplinary pain clinics for comprehensive evaluation and treatment of CPSP, and additional work needed to differentiate CPSP characteristics from other chronic pain syndromes in children. Finally, we recognize ongoing challenges associated with the universal implementation of available knowledge about pediatric CPSP into practically useful care plans for clinicians.

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“…Future studies with risk stratification and longer-term follow-up for multimodal pain protocols are warranted. In the case of children, family-centered care approaches are needed as impaired parental responses may also reinforce the child’s pain response when parents have been involved with the NICU experience, indicating the need for parental education as well [ 216 ]. Importantly, we need policies supporting biomarker development and implementation, improved reimbursement for evidence-backed pain management practices, improved leverage of electronic media for education, assessments and management, and most importantly the support within the electronic medical record infrastructure to enable automated clinical decision support tools based on risk stratification.…”

Section: Future Directions For Clinical Practicementioning

confidence: 99%

“…It is likely that mechanistic trials of treatment paradigms stratified by genetic, psychophysical, and psychological risk assessments may improve the ability to discern responders. Table 1 lists the several mechanism-based available and potential pharmacologic and non-pharmacologic therapies in pain chronification [ 216 ]. However, early identification, prevention, and management are of utmost importance.…”

Section: Future Directions For Clinical Practicementioning

confidence: 99%

Current Evidence for Biological Biomarkers and Mechanisms Underlying Acute to Chronic Pain Transition across the Pediatric Age Spectrum

Duff

Krolick

Mahmoud

et al. 2023

JCM

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Chronic pain is highly prevalent in the pediatric population. Many factors are involved in the transition from acute to chronic pain. Currently, there are conceptual models proposed, but they lack a mechanistically sound integrated theory considering the stages of child development. Objective biomarkers are critically needed for the diagnosis, risk stratification, and prognosis of the pathological stages of pain chronification. In this article, we summarize the current evidence on mechanisms and biomarkers of acute to chronic pain transitions in infants and children through the developmental lens. The goal is to identify gaps and outline future directions for basic and clinical research toward a developmentally informed theory of pain chronification in the pediatric population. At the outset, the importance of objective biomarkers for chronification of pain in children is outlined, followed by a summary of the current evidence on the mechanisms of acute to chronic pain transition in adults, in order to contrast with the developmental mechanisms of pain chronification in the pediatric population. Evidence is presented to show that chronic pain may have its origin from insults early in life, which prime the child for the development of chronic pain in later life. Furthermore, available genetic, epigenetic, psychophysical, electrophysiological, neuroimaging, neuroimmune, and sex mechanisms are described in infants and older children. In conclusion, future directions are discussed with a focus on research gaps, translational and clinical implications. Utilization of developmental mechanisms framework to inform clinical decision-making and strategies for prevention and management of acute to chronic pain transitions in children, is highlighted.

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Mechanism-Based Pharmacological Treatment for Chronic Non-cancer Pain in Adolescents: Current Approaches and Future Directions

Cited by 5 publications

References 102 publications

The Psychosocial Characteristics and Somatosensory Function of Children and Adolescents Who Meet the Criteria for Chronic Nociplastic Pain

The Psychosocial Characteristics and Somatosensory Function of Children and Adolescents Who Meet the Criteria for Chronic Nociplastic Pain

Chronic Postsurgical Pain in Children and Adolescents: A Call for Action

Current Evidence for Biological Biomarkers and Mechanisms Underlying Acute to Chronic Pain Transition across the Pediatric Age Spectrum

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