Top Anke P C, de Leeuw Thomas G, Bramer Wichor M, de Mol Bernadette C M, Huygen Frank J P M, Dirckx Maaike
Department of Anesthesiology, Amsterdam UMC, University Hospital Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, Netherlands.
Department of Anesthesiology, Erasmus MC-Sophia Children's Hospital, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, Netherlands.
Pain Res Manag. 2024 Jan 29;2024:6813025. doi: 10.1155/2024/6813025. eCollection 2024.
Evidence-based guidelines for managing anterior cutaneous nerve entrapment syndrome (ACNES) in children are absent. The primary aim of this review was to scrutinize the evidence supporting currently used treatment interventions. In accordance with the World Health Organization (WHO) guidelines for managing chronic pain in children, these patients and their families and caregivers should be treated within the context of the biopsychosocial model; pain should not be treated purely as a biomedical problem. Therefore, our second aim was to evaluate whether these interventions are applied within the context of the biopsychosocial model, utilizing an inter- or multidisciplinary approach.
A scoping review of the literature was conducted to explore treatment strategies for ACNES in children. To ensure a comprehensive overview of published literature on this topic, the search was not restricted based on study type. Two reviewers independently assessed titles and abstracts. After excluding records unrelated to children, full texts were screened for inclusion. Any discrepancies in judgement were resolved through discussion with a third reviewer.
Out of 35 relevant titles, 22 were included in this review. Only 4 articles provided information on long-term outcomes. The overall quality of the review was deemed low. The majority of reports did not address treatment or education within the psychological and social domains. A structural qualitative analysis was not feasible due to the substantial heterogeneity of the data.
The evidence supporting current treatment strategies in children with ACNES is of low quality. More research is needed to establish an evidence-based treatment algorithm for patients with this challenging pain problem. In line with the WHO recommendation, greater emphasis should be placed on a biopsychosocial approach. The ultimate goal should be the development of a generic treatment algorithm outlining an approach to ACNES applicable to all professionals involved.
目前尚无针对儿童前皮神经卡压综合征（ACNES）管理的循证指南。本综述的主要目的是审视支持当前所用治疗干预措施的证据。根据世界卫生组织（WHO）关于儿童慢性疼痛管理的指南，这些患者及其家庭和照料者应在生物心理社会模型的背景下接受治疗；疼痛不应单纯作为一个生物医学问题来处理。因此，我们的第二个目的是评估这些干预措施是否采用跨学科或多学科方法在生物心理社会模型的背景下实施。
对文献进行范围综述，以探索儿童ACNES的治疗策略。为确保全面概述关于该主题的已发表文献，搜索不受研究类型限制。两名评审员独立评估标题和摘要。在排除与儿童无关的记录后，对全文进行筛选以确定是否纳入。判断上的任何差异通过与第三位评审员讨论解决。
在35篇相关标题中，本综述纳入了22篇。只有4篇文章提供了关于长期结局的信息。综述的整体质量被认为较低。大多数报告未涉及心理和社会领域的治疗或教育。由于数据存在实质性异质性，无法进行结构性定性分析。
支持当前儿童ACNES治疗策略的证据质量较低。需要更多研究来建立针对这一具有挑战性疼痛问题患者的循证治疗算法。根据WHO的建议，应更加强调生物心理社会方法。最终目标应是制定一种通用治疗算法，概述适用于所有相关专业人员的ACNES治疗方法。
