A systematic review and meta-analysis indicated that psychotropic medications may be effective in the management of chronic pain in children and adolescents, according to findings published in Journal of Pain Research.

Publication databases were searched through June 2020 for studies of psychotropic medications for the treatment of chronic pain among pediatric patients. A total of 5 studies met the inclusion criteria, and 4 studies were finally included.

The studies included 395 individuals aged between 6 and 18 years with the percentage of girls ranging from 59.8% to 75.0%. All studies randomly assigned the participants to receive active treatment (n=197) or placebo (n=198); follow-up was from 4 to 13 weeks.


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The active therapies and indications were amitriptyline for irritable bowel syndrome and functional gastrointestinal disorders, citalopram or buspirone for functional abdominal pain, and duloxetine for juvenile fibromyalgia.

After 12 to 13 weeks of therapy, the psychotropic drug recipients had greater pain reduction (standardized mean difference [SMD], -0.77; 95% CI, -1.54 to 0.0001; P =.05). This comparison had no publication bias (P =.18) but significant heterogeneity (I2=91%; P <.001).

Compared with placebo, the use of psychotropic drugs for 12 to 13 weeks increased the likelihood of pain reduction (odds ratio [OR], 1.66; 95% CI, 1.08-2.54; P =.02). This test did not include publication bias (P =.68) or heterogeneity (I2=27.0%; P =.25).

The subgroup analysis of antidepressants found a greater efficacy for pain (SMD, -1.15; 95% CI, -2.21 to -0.09; P =.03) and higher likelihood of pain reduction (OR, 2.03; P =.005).

A meta-regression analysis detected a significant effect of time (b, 0.23; P <.001) in which newer studies tended to report lower reductions in pain. No significant effect of baseline pain score (P =.85), age (P =.24), or duration of therapy (P =.20) on pain reduction were reported.

The results of this study were likely limited by the study heterogeneity and the differing active therapies and indications that were combined in this analysis.

These data indicated that psychotropic medications have the potential to reduce chronic pain among pediatric patient populations.

Disclosure: One author declared affiliations with biomedical, pharmaceutical, and/or device manufacturers. Please see the original reference for a full list of disclosures.

Reference

Jolly T, Mansuri Z, Trivedi C, Adnan M, Cohen SP, Vu T-N. Are psychotropic medications effective in chronic pain management in children and adolescents? A meta-analysis of randomized control trials. J Pain Res. 2021;14:1915-1924. doi:10.2147/JPR.S310381