Interventions to treat pain in paediatric CFS/ME: a systematic review, by Caitlin Ascough, Hayley Kin, Teona Serafimova, Lucy Beasant, Sophie Jackson, Luke Baldock, Anthony Edward Pickering, Jonathan Brooks, Esther Crawley in BMJ Paediatrics Open Vol 4, #1, March 2020

What is known about the subject?

• Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is prevalent (1%–2%) in adolescents and nearly two-thirds of patients report moderate or severe pain
• Pain is associated with worse fatigue and poorer physical function in adolescents with CFS/ME.

What this study adds?

• Despite the prevalence and impact of pain in children with CFS/ME few treatment studies have measured pain as an outcome and no interventions targeted pain.
• There is insufficient evidence to suggest that the treatment of fatigue also improves pain in paediatric CFS/ME.
• Patients who recover from CFS/ME appear to have less pain at follow-up than those who do not recover.

Research abstract:

Background
Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is common (prevalence 1%-2%). Two-thirds of children experience moderate or severe pain, which is associated with increased fatigue and poorer physical function. However, we do not know if treatment for CFS/ME improves pain.

Objective
Identify whether specialist treatment of paediatric CFS/ME improves pain.

Methods
We conducted a detailed search in MEDLINE, EMBASE, PsycINFO and the Cochrane Library. Two researchers independently screened texts published between 1994 and 24 January 2019 with no language restrictions. Inclusion criteria were (1) randomised controlled trials and observational studies; (2) participants aged <19 years with CFS/ME; and (3) measure of pain before and after an intervention.

Results
Of 1898 papers screened, 26 studies investigated treatment for paediatric CFS/ME, 19 of which did not measure pain at any time point. Only five treatment studies measured pain at baseline and follow-up and were included in this review. None of the interventions were
specifically targeted at treating pain. Of the included studies, two showed no improvement in pain scores, one suggested an improvement in one subgroup and two studies identified improvements in pain measures in ‘recovered’ patients compared with ‘non-recovered’ patients.

Conclusions
Despite the prevalence and impact of pain in children with CFS/ME surprisingly few treatment studies measured pain. In those that did measure pain, the treatments used focused on overall management of CFS/ME and we identified no treatments that were targeted specifically at managing pain. There is limited evidence that treatment helps improve pain scores. However, patients who recover appear to have less pain than those who do not recover. More studies are needed to determine if pain in paediatric CFS/ME requires a specific treatment approach, with a particular focus on patients who do not recover following initial treatment.

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