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. 2018 Nov;38(11):2015-2025.
doi: 10.1007/s00296-018-4136-8. Epub 2018 Aug 23.

Non-pharmacological options for managing chronic musculoskeletal pain in children with pediatric rheumatic disease: a systematic review

Linde N Nijhof  1 , Merel M Nap-van der Vlist  2 , Elise M van de Putte  2 , Annet van Royen-Kerkhof  3 , Sanne L Nijhof  2
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Non-pharmacological options for managing chronic musculoskeletal pain in children with pediatric rheumatic disease: a systematic review

Linde N Nijhof et al. Rheumatol Int. 2018 Nov.

Abstract

In patients with a pediatric rheumatic disease (PRD), chronic musculoskeletal pain (CMP) can have a major impact on functioning and social participation. Because CMP is not always alleviated solely by the use of pharmacological approaches, the aim was to systematically review the available evidence regarding non-pharmacological treatment options for reducing CMP in patients with PRD. PubMed, Embase, PsycINFO, and the Cochrane Library were systematically searched for (non-)randomized trials investigating non-pharmacological treatments for CMP in PRD published through October 25, 2017. The GRADE approach was used to assess the quality of evidence. The search yielded 11 studies involving 420 children 5-18 years of age. All studies were relatively small and short-term, and the quality of evidence ranged from very low to moderate. The main modalities within non-pharmacology therapy were psychological interventions and exercise-based interventions. Some studies show modest positive short-term results for psychological and exercise-based interventions. Psychological and exercise-based interventions can have a modest positive result in PRD, with no evidence of side effects. Non-pharmacological therapies are a promising option to alleviate pain in PRD and improve functioning, which can be used as an alternative for or in addition to pharmacological therapies. Because chronic pain can differ etiologically from acute pain in PRD, non-pharmacological therapies might have different effects in patients with or without active inflammation. To best determine the effect of non-pharmacological therapies, future studies should take this difference into account.

Keywords: Autoimmune diseases; Chronic pain; Juvenile idiopathic arthritis; Musculoskeletal pain; Pediatrics; Rheumatic diseases.

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Conflict of interest statement

Conflict of interest

Author Linde N. Nijhof declares that she has no conflict of interest. Author Merel M. Nap-van der Vlist declares that she has no conflict of interest. Author Elise M. van de Putte declares that she has no conflict of interest. Author Annet van Royen-Kerkhof declares that she has no conflict of interest. Author Sanne L. Nijhof declares that she has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Figures

Fig. 1
Fig. 1
Flow-chart depicting the search strategy, inclusion and exclusion criteria, and studies included in the final analysis
See this image and copyright information in PMC

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