Non-steroidal anti-inflammatory drugs (NSAIDs) for chronic non-cancer pain in children and adolescents

Eccleston, Christopher; Cooper, Tess E; Fisher, Emma; Anderson, Brian J.; Wilkinson, Nick

doi:10.1002/14651858.cd012537

Cited by 54 publications

(38 citation statements)

References 39 publications

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“…NSAID-induced gastropathy and adverse effects on the cardiovascular system and the gastrointestinal tract pose a common serious problem in treatment of rheumatoid arthritis in adults, 3 being also typical in pediatric patients. 4,5 In some cases, long-term administration of NSAIDs requires prescription of adjuvant medications (gastroprotectors and cardioprotectors) to eliminate the adverse sequelae. This increases the total pill burden, which is especially important in medically compromised patients and among them children with JIA.…”

Section: Introductionmentioning

confidence: 99%

Dynamics of concomitant therapy in children with juvenile idiopathic arthritis treated with etanercept and methotrexate

Alexeeva

Dvoryakovskaya

Денисова

et al. 2019

Pediatrics & Neonatology

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Background: Both the steroid-and NSAID-sparing effects of biologics in juvenile idiopathic arthritis (JIA) treatment are key aspects of the dynamics of patient's condition. The proper selection of biologics enables maximum treatment effectiveness and reduction of the dosage of concomitant therapy. Our aim was to study the dynamics of concomitant therapy during etanercept (ETA) and methotrexate (MTX) treatment in patients with JIA. Methods: This analysis included 215 JIA patients (63.3% females) showing sufficient response to main therapy. One hundred patients received MTX as main therapy, 24 received ETA monotherapy, and 91 received ETA þ MTX combination therapy. The dynamics of concomitant therapy were analyzed after 1 month, every 3 months during the first year, and every 6 months during the long-term follow-up (up to 5 years). Results: At the baseline, 24 (11.2%) patients received concomitant oral glucocorticoids (orGCs) and NSAIDs; the remaining 191 (88.8%) patients were treated with concomitant NSAIDs only. Within 1-year treatment, NSAIDs were discontinued in 162 (75.3%) patients. There were no significant differences in the dynamics of withdrawal of NSAIDs in patients who received and did not receive concomitant MTX. However, the percentage of treatment discontinuation in the MTX group was significantly lower compared to the other two groups (p < 0.001). Oral GCs were discontinued completely in 4 children (16.7%), and the dose of Pediatrics and Neonatology (2019) 60, 549e555 oral GCs was reduced in another 4 patients (16.7%). By the end of the follow-up period, 44 of 115 patients (38.3%) treated with ETA in combination with any concomitant therapy could switch to ETA monotherapy. Conclusion: Therapy with ETA makes it possible to reduce the dosage or completely discontinue most concomitant medications (orGCs, NSAIDs, MTX) in a significant percentage of patients. This reduces the risk of development of NSAID-and GC-induced pathological conditions, while the effectiveness of therapy of the underlying condition remains high.

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Section: Introductionmentioning

confidence: 99%

Dynamics of concomitant therapy in children with juvenile idiopathic arthritis treated with etanercept and methotrexate

Alexeeva

Dvoryakovskaya

Денисова

et al. 2019

Pediatrics & Neonatology

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“…Only one Cochrane SR addressed chronic pain, and only for ibuprofen (Eccleston et al, ). The aim of the SR was to analyse benefits and harms of NSAIDs for chronic non‐cancer pain.…”

Section: Resultsmentioning

confidence: 99%

“…Cochrane authors concluded that they identified small number of studies with insufficient data for analyses and that there is no evidence from RCTs that NSAIDs were effective in treating chronic non‐cancer pain in children or adolescents. Data for safety were reported, but not addressed in the conclusions (Eccleston et al, ).…”

Section: Resultsmentioning

confidence: 99%

Revisiting established medicines: An overview of systematic reviews about ibuprofen and paracetamol for treating pain in children

Radman

Babić

Runjić

et al. 2019

European Journal of Pain

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Background and objective We explored how systematic reviews evaluated paracetamol and ibuprofen for treating pain in children, as these two non‐opioid analgesics are well‐established medicines included in most national essential medicines lists. Databases and data treatment We carried out an overview of systematic reviews (SRs) of randomized controlled trials (RCTs) of interventions (PROSPERO registration: 42016045367). We searched MEDLINE, EMBASE, Cochrane Database of Systematic Reviews (CDSR) and Database of Reviews of Effects (DARE) up to 23 August 2017. We used AMSTAR checklist to analyse methodological quality of included SRs. Results We found 17 SRs with 72 unique RCTs; the majority of those trials included under 100 children. Positive conclusive evidence was found in only one SR, regarding safety of paracetamol. Conclusions of other SRs for efficacy and safety of ibuprofen and paracetamol were inconclusive, unclear, or there was no opinion. Only one SR analysed efficacy of ibuprofen and other non‐steroidal anti‐inflammatory drugs (NSAIDs) in chronic pain and the conclusion was that there was no evidence from RCTs that NSAIDs were effective for chronic non‐cancer pain in children and adolescents. Most of the SRs addressed very narrow questions, included few trials, with few children and were of low or medium methodological quality. Conclusions Most SRs on two relevant medicines have inconsistent conclusions and doubt upon their effectiveness. Instead of focusing on very narrow questions, SRs should examine more comprehensive research topics to obtain a general sense of consistency, particularly when analysing established medicines. Significance Evidence behind two analgesics—ibuprofen and paracetamol—that are well‐established medicines for children in most countries appears limited, judging by the systematic reviews. The discrepancy between clinical use and the extensive evidence we reviewed may be a result of the selective criteria in the reviews examined. We need new, and better evidence syntheses supporting the use of these two medicines in wide indications regarding pain in children.

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“…Due to the lack of evidences, the pain management protocols were designed based on our previous experiences and currently available literature on chronic pain management [ 14 , 15 ]. There were three in-use protocols which were 200 mg celecoxib twice per day; buprenorphine transdermal patch at 5 μ g/h; 13 mg codeine plus 200 mg ibuprofen twice per day.…”

Section: Methodsmentioning

confidence: 99%

Pain Management during Rehabilitation after Distal Radius Fracture Stabilized with Volar Locking Plate: A Prospective Cohort Study

Luo

Lou

Yang

2018

BioMed Research International

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Introduction Internal fixation with volar locking plate (VLP) was widely adopted as a first-line choice in treatment of distal radius fracture (DRF). Methods Total 315 patients with distal radius fracture receiving VLP fixation were included for analysis in this study. The rehabilitation protocol was started immediately after surgery for all patients. During the initial two weeks after surgery, 149 patients received 200 mg celecoxib twice per day, 89 received buprenorphine transdermal patch at 5 μg/h, and 77 received 13 mg codeine plus 200 mg ibuprofen twice per day for pain management. Visual analog scale (VAS) scores of pain at rest, daily activity, and rehabilitative exercise were measured, respectively, every week according to the experiences of the past week in the initial six weeks after surgery. Functional outcomes including range of motion (ROM) for extension, flexion, pronation, supination, ulnar and radial abduction, the disabilities of arm, shoulder, and hand (DASH) score and the validated patient rated wrist evaluation (PRWE), and grip strength were collected at one, three, and six months after surgery. Results We showed that patients receiving transdermal buprenorphine and codeine/ibuprofen had decreased VAS scores during rehabilitative exercise, better compliance to the rehabilitation program, and thus faster functional recovery. Conclusions We recommend transdermal buprenorphine or codeine/ibuprofen for pain management during rehabilitation after distal radius fracture stabilized with VLP.

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Non-steroidal anti-inflammatory drugs (NSAIDs) for chronic non-cancer pain in children and adolescents

Abstract: Non-steroidal anti-inflammatory drugs (NSAIDs) for chronic non-cancer pain in children and adolescents.

Cited by 54 publications

References 39 publications

Dynamics of concomitant therapy in children with juvenile idiopathic arthritis treated with etanercept and methotrexate

Dynamics of concomitant therapy in children with juvenile idiopathic arthritis treated with etanercept and methotrexate

Revisiting established medicines: An overview of systematic reviews about ibuprofen and paracetamol for treating pain in children

Pain Management during Rehabilitation after Distal Radius Fracture Stabilized with Volar Locking Plate: A Prospective Cohort Study

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