Roselien Pas1, Kelly Ickmans1, Kelly Van der Cruyssen1, Laurence Leysen1, Jo Nijs1, Mira Meeus1
1) Belgium
Sensitization of the central nervous system plays an important role in the development and maintenance of chronic pain in the adult population. It remains unclear whether this process is also present in children with chronic pain. A systematic review was performed according to the PRISMA guidelines to screen and evaluate the existing evidence for the presence of central sensitization (CS) in children with chronic pain.
The literature search was performed using the electronic databases PubMed and Web of Science. An article was considered eligible if it met the following inclusion criteria: included participants had to be children (aged 2-12 years), diagnosed with chronic, intractable or idiopathic pain; articles had to report on outcomes related to CS and a comparison with a healthy control group was necessary; articles had to be full text reports of original research.
A total of twelve case-control studies was included. In total 1180 children were included in this review, of which 510 children presenting chronic pain and 670 healthy controls. Signs of CS were investigated by direct quantifiable pain instruments. Evidence for secondary hyperalgesia was found in children with recurrent abdominal pain, juvenile fibromyalgia and juvenile idiopathic arthritis. Different cortical nociceptive processing was seen in children with migraine and recurrent abdominal pain.
The majority of the literature is indicative for the presence of CS in children with recurrent abdominal pain, juvenile idiopathic arthritis, juvenile fibromyalgia and migraine. A general conclusion regarding chronic pediatric pain cannot be made given the heterogeneity amongst the studies in terms of study sample and measurement protocol. Further research is required to provide firm evidence in support of various aspects of CS in children with chronic pain.
This work is funded by the Berekuyl Academy/ European College for Decongestive Lymphatic Therapy, the Netherlands.
