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Cochrane Database of Systematic Reviews

Antidepresant untuk sakit bukan cancer kronik dalam kanak‐kanak dan dewasa

Information

DOI:
https://doi.org/10.1002/14651858.CD012535.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 05 August 2017see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Pain, Palliative and Supportive Care Group

Copyright:
  1. Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Tess E Cooper

    Correspondence to: Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia

    [email protected]

  • Lauren C Heathcote

    Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, USA

  • Jacqui Clinch

    Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK

    Child/Adolescent Pain, Bath Centre for Pain Services, Bath, UK

  • Jeffrey I. Gold

    Anesthesiology, Pediatrics, and Psychiatry & Behavioral Sciences, Keck School of Medicine, University of Southern California / Children’s Hospital Los Angeles, Los Angeles, USA

  • Richard Howard

    Anaesthesia and Pain Management, Great Ormond Street Hospital, London, UK

  • Susan M Lord

    Children’s Complex Pain Service, John Hunter Children’s Hospital, Newcastle, Australia

  • Neil Schechter

    Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, USA

  • Chantal Wood

    Rheumatology, University Hospital Dupuytren, Limoges, France

  • Philip J Wiffen

    Thame, UK

Contributions of authors

TC and PW registered the title.

TC, PW, and Christopher Eccleston wrote the template protocol for the suite of children's reviews of which this review is a part.

All authors contributed to writing the protocol, and all authors agreed on the final version.

All authors were responsible for data extraction, analysis, and writing of the Discussion for the full review.

All authors will be responsible for the completion of updates.

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • National Institute for Health Research (NIHR), UK.

    NIHR Programme Grant, Award Reference Number: 13/89/29 (Addressing the unmet need of chronic pain: providing the evidence for treatments of pain)

Declarations of interest

PW: none known.

TC: none known.

LH: none known.

JC: none known; JC is a specialist paediatric pain physician and treats patients with complex pain.

JG: none known; JG is a paediatric psychologist specialising in the assessment/evaluation and treatment of children and adolescents with chronic pain.

RH: none known; RH is a specialist paediatric pain clinician and treats patients with chronic pain.

SL: none known; SL is a specialist paediatric pain clinician and treats patients with chronic pain.

NS: none known; NS is a developmental paediatrician and treats children and adolescents with pain; NS directs the Chronic Pain Clinic at Boston Children’s Hospital and is on the faculty at Harvard Medical School.

CW: none known; CW is a paediatrician and anaesthesiologist; CW specialises in pain and treats children and adults presenting chronic pain; CW also treats patients in palliative care.

Acknowledgements

We acknowledge the contribution of Christopher Eccleston to the template protocol.

We thank Nanna Brix Finnerup, Andrew Gray, Sebastian Straube, and Andrew Moore for peer reviewing.

Cochrane Review Group funding acknowledgement: the National Institute for Health Research (NIHR) is the largest single funder of the Cochrane Pain, Palliative and Supportive Care Review Group. Disclaimer: the views and opinions expressed herein are those of the authors and do not necessarily reflect those of the NIHR, National Health Service (NHS), or the Department of Health.

Version history

Published

Title

Stage

Authors

Version

2017 Aug 05

Antidepressants for chronic non‐cancer pain in children and adolescents

Review

Tess E Cooper, Lauren C Heathcote, Jacqui Clinch, Jeffrey I. Gold, Richard Howard, Susan M Lord, Neil Schechter, Chantal Wood, Philip J Wiffen

https://doi.org/10.1002/14651858.CD012535.pub2

2017 Feb 14

Antidepressants for chronic non‐cancer pain in children and adolescents

Protocol

Tess E Cooper, Lauren C Heathcote, Jacqui Clinch, Jeffrey I. Gold, Richard Howard, Susan M Lord, Neil Schechter, Chantal Wood, Philip J Wiffen

https://doi.org/10.1002/14651858.CD012535

Differences between protocol and review

We did not consider studies with fewer than 10 participants per treatment arm for inclusion in this review, as is standard practice for this group.

In the protocol we stated the age inclusion criterion as birth to 17 years old. Three trials reported participants as being between 6 and 18 years of age. We decided to include the studies rather than miss data on participants who were under 18 years of age.

Notes

A restricted search in March 2019 did not identify any potentially relevant studies likely to change the conclusions. Therefore, this review has now been stabilised following discussion with the authors and editors. The review will be re‐assessed for updating in five years. If appropriate, we will update the review before this date if new evidence likely to change the conclusions is published, or if standards change substantially which necessitates major revisions.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Summary of findings for the main comparison. Amitriptyline compared with gabapentin for chronic non‐cancer pain

Amitriptyline compared with gabapentin for chronic non‐cancer pain

Patient or population: children and adolescents (birth to 17 years) with chronic non‐cancer pain

Settings: single‐centre, chronic pain clinic, Canada

Intervention: amitriptyline

Comparison: gabapentin

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Gabapentin

Amitriptyline

Participant‐reported pain relief of 30% or greater

No data

No data

No data

No data

No evidence to support or refuteb

Participant‐reported pain relief of 50% or greater

No data

No data

No data

No data

No evidence to support or refuteb

Patient Global Impression of Change: much improved or very much improved

No data

No data

No data

No data

No evidence to support or refuteb

Adverse events

1/17

2/17

N/A

34 participants

(1 study)

⊕⊝⊝⊝
very lowa

Serious adverse events

0/17

0/17

N/A

34 participants

(1 study)

⊕⊝⊝⊝
very lowa

Withdrawals due to adverse events

2/17

1/17

N/A

34 participants

(1 study)

⊕⊝⊝⊝
very lowa

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; N/A: not applicable; RR: risk ratio

GRADE Working Group grades of evidence

High quality: We are very confident that the true effect lies close to that of the estimate of the effect.

Moderate quality: We are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different.

Low quality: Our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.

Very low quality: We have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

aDowngraded three levels due to too few data and number of events were too small to be meaningful.

bNo data available for this outcome, and therefore no GRADE rating has been applied and there is no evidence to support or refute.

Figures and Tables -
Summary of findings for the main comparison. Amitriptyline compared with gabapentin for chronic non‐cancer pain
Summary of findings 2. Amitriptyline compared with placebo for chronic non‐cancer pain

Amitriptyline compared with placebo for chronic non‐cancer pain

Patient or population: children and adolescents (birth to 17 years) with chronic non‐cancer pain

Settings: single‐ and multicentre; (1) private outpatient practice paediatric gastroenterology clinic, California, USA; (2) paediatric gastroenterology clinics, (6) tertiary care centres, USA

Intervention: amitriptyline

Comparison: placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Placebo

Amitriptyline

Participant‐reported pain relief of 30% or greater

No data

No data

No data

No data

No evidence to support or refuteb

Participant‐reported pain relief of 50% or greater

No data

No data

No data

No data

No evidence to support or refuteb

Patient Global Impression of Change: much improved or very much improved

No data

No data

No data

No data

No evidence to support or refuteb

Adverse events

1/61

2/62

N/A

123 participants

(2 studies)

⊕⊝⊝⊝
very lowa

Serious adverse events

0/61

0/62

N/A

123 participants

(2 studies)

⊕⊝⊝⊝
very lowa

Withdrawals due to adverse events

1/61

2/62

N/A

123 participants

(2 studies)

⊕⊝⊝⊝
very lowa

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; N/A: not applicable; RR: risk ratio

GRADE Working Group grades of evidence

High quality: We are very confident that the true effect lies close to that of the estimate of the effect.

Moderate quality: We are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different.

Low quality: Our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.

Very low quality: We have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

aDowngraded three levels due to too few data and number of events were too small to be meaningful.

bNo data available for this outcome, and therefore no GRADE rating has been applied and there is no evidence to support or refute.

Figures and Tables -
Summary of findings 2. Amitriptyline compared with placebo for chronic non‐cancer pain
Summary of findings 3. Citalopram compared with placebo for chronic non‐cancer pain

Citalopram compared with placebo for chronic non‐cancer pain

Patient or population: children and adolescents with functional abdominal pain

Settings: single‐centre, tertiary outpatient clinic of paediatric gastroenterology, Iran

Intervention: citalopram

Comparison: placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Placebo

Citalopram

Participant‐reported pain relief of 30% or greater

No data

No data

No data

No data

No evidence to support or refuteb

Participant‐reported pain relief of 50% or greater

No data

No data

No data

No data

No evidence to support or refuteb

Patient Global Impression of Change: much improved or very much improved

No data

No data

No data

No data

No evidence to support or refuteb

Adverse events

0/56

5/59

N/A

115 participants

(1 study)

⊕⊝⊝⊝
very lowa

Serious adverse events

0/56

0/59

N/A

115 participants

(1 study)

⊕⊝⊝⊝
very lowa

Withdrawals due to adverse events

0/56

5/59

N/A

115 participants

(1 study)

⊕⊝⊝⊝
very lowa

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; N/A: not applicable; RR: risk ratio

GRADE Working Group grades of evidence

High quality: We are very confident that the true effect lies close to that of the estimate of the effect.

Moderate quality: We are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different.

Low quality: Our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.

Very low quality: We have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

aDowngraded three levels due to too few data and number of events are too small to be meaningful.

bNo data available for this outcome, and therefore no GRADE rating has been applied and there is no evidence to support or refute.

Figures and Tables -
Summary of findings 3. Citalopram compared with placebo for chronic non‐cancer pain