对脑瘫患儿或脑瘫高危患儿慢性疼痛的评估和干预措施的系统评价。
A Systematic Review of Assessments and Interventions for Chronic Pain in Young Children With or at High Risk for Cerebral Palsy.
机构信息
Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, 2358University of Virginia School of Medicine, UVA Children's, Charlottesville, VA, USA.
Department of Pediatrics, 37205Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Ontario, Canada.
出版信息
J Child Neurol. 2021 Aug;36(9):697-710. doi: 10.1177/0883073821996916. Epub 2021 Mar 9.
BACKGROUND
Pain is common in children with cerebral palsy. The purpose of this systematic review was to evaluate the evidence regarding assessments and interventions for chronic pain in children aged ≤2 years with or at high risk for cerebral palsy.
METHODS
A comprehensive literature search was performed. Included articles were screened using PRISMA guidelines and quality of evidence was reviewed using best-evidence tools by independent reviewers. Using social media channels, an online survey was conducted to elicit parent preferences.
RESULTS
Six articles met criteria. Parent perception was an assessment option. Three pharmacologic interventions (gabapentin, medical cannabis, botulinum toxin type A) and 1 nonpharmacologic intervention were identified. Parent survey report parent-comfort and other nonpharmacologic interventions ranked as most preferable.
CONCLUSION
A conditional GRADE recommendation was in favor of parent report for pain assessment. Clinical trials are sorely needed because of the lack of evidence for safety and efficacy of pharmacologic interventions.
背景
脑瘫儿童常伴有疼痛。本系统评价旨在评估≤2 岁且患有或有脑瘫高风险的儿童慢性疼痛的评估和干预措施的证据。
方法
进行了全面的文献检索。使用 PRISMA 指南筛选纳入的文章，并由独立评审员使用最佳证据工具对证据质量进行评估。通过社交媒体渠道进行在线调查，以了解家长的偏好。
结果
有 6 篇文章符合标准。家长感知是一种评估选择。确定了 3 种药物干预（加巴喷丁、医用大麻、A型肉毒毒素）和 1 种非药物干预。家长调查报告表明，家长的舒适度和其他非药物干预措施是最受欢迎的。
结论
基于家长报告的疼痛评估方法具有条件性 GRADE 推荐。由于缺乏药物干预的安全性和有效性证据，非常需要进行临床试验。
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