Jolly T, Mansuri Z, Trivedi C, et al. Are Psychotropic Medications Effective in Chronic Pain Management in Children and Adolescents? A Meta-Analysis of Randomized Control Trials. J Pain Res. 2021 Jun 24;14:1915-1924. doi: 10.2147/JPR.S310381. eCollection 2021. (Systematic review)

Objective: Data defining and subsequently guiding the use of psychotropic medications in children and adolescents is sparse. We conducted a meta-analysis of randomized control trials to examine the effectiveness of psychotropic medications in children and adolescents with chronic pain.

Methods: We conducted a comprehensive literature search from published studies, and annual scientific sessions of psychiatry conferences. We identified double-blind, randomized control trials (RCTs) in which psychotropic medications were compared to placebo. Data was collected for the total number of patients, baseline characteristics, and changes in pain score. Meta-analysis was performed using a random effect model evaluating average change in pain score and the number of patients with a reduction in pain score for both groups. Pooled data are expressed as standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals (CI).

Results: We found 5 studies that included amitriptyline (n=2), citalopram (n=1), buspirone (n=1) and duloxetine (n=1). In the pooled analysis for the difference in the average change in pain score, 4 RCTs with 395 patients were included. After 12-13 weeks of therapy, reductions in pain score were significantly greater in the psychotropic drug group as compared to placebo (SMD: -0.77, 95% CI -1.54, 0.0001, p= 0.05). For the analysis on the number of patients with a reduction in pain, data were available for 445 patients (224-medication group, 221-placebo group). More patients in the psychotropic drug group experienced a meaningful reduction in pain score at 12-13 weeks of therapy compared to placebo (OR 1.66, 95% CI 1.08-2.54, p= 0.02).

Conclusion: The results of this meta-analysis demonstrate significant analgesic efficacy of psychotropic medications in the management of children with chronic pain. This review is limited by the small number of studies included for analysis. There is a pressing need for more robust clinical trials to further investigate these promising findings.

Discipline Area Score
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Comments from MORE raters

Physician rater

This review and meta-analysis of RCTs for treating children and adolescents for chronic pain with psychotropic medications found 5 studies. In general, there is support for medications we also use in adults, such as amitryptiline. So the findings are not surprising. There are challenges to combining the 5 studies: different diagnoses, medications, and outcome measures. Plus, there was clearly an effect related to publication year, perhaps because of trends in diagnosis and treatment.
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