Ascough Caitlin, King Hayley, Serafimova Teona, Beasant Lucy, Jackson Sophie, Baldock Luke, Pickering Anthony Edward, Brooks Jonathan, Crawley Esther
Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK.
School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
BMJ Paediatr Open. 2020 Mar 5;4(1):e000617. doi: 10.1136/bmjpo-2019-000617. eCollection 2020.
Paediatric 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.
Identify whether specialist treatment of paediatric CFS/ME improves pain.
We 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.
Of 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.
Despite 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.
CRD42019117540.
儿童慢性疲劳综合征/肌痛性脑脊髓炎（CFS/ME）很常见（患病率为1%-2%）。三分之二的儿童经历中度或重度疼痛，这与疲劳加剧和身体功能较差有关。然而，我们不知道CFS/ME的治疗是否能改善疼痛。
确定儿童CFS/ME的专科治疗是否能改善疼痛。
我们在MEDLINE、EMBASE、PsycINFO和Cochrane图书馆进行了详细检索。两名研究人员独立筛选1994年至2019年1月24日期间发表的无语言限制的文献。纳入标准为：（1）随机对照试验和观察性研究；（2）年龄<19岁的CFS/ME患者；（3）干预前后的疼痛测量。
在筛选的1898篇论文中，26项研究调查了儿童CFS/ME的治疗，其中19项在任何时间点都未测量疼痛。只有5项治疗研究在基线和随访时测量了疼痛，并纳入本综述。没有一种干预措施专门针对疼痛治疗。在所纳入的研究中，两项研究显示疼痛评分无改善，一项研究表明一个亚组有改善，两项研究发现“康复”患者与“未康复”患者相比，疼痛测量有改善。
尽管CFS/ME儿童中疼痛的患病率和影响较大，但令人惊讶的是，很少有治疗研究测量疼痛。在那些测量了疼痛的研究中，所使用的治疗方法侧重于CFS/ME的整体管理，我们未发现专门针对疼痛管理的治疗方法。仅有有限的证据表明治疗有助于改善疼痛评分。然而，康复的患者似乎比未康复的患者疼痛更少。需要更多研究来确定儿童CFS/ME的疼痛是否需要特定的治疗方法，尤其要关注初始治疗后未康复的患者。
PROSPERO注册号：CRD42019117540。
