Managing chronic pain in children and adolescents: Effective responses are possible with non-evidence based clinical practice

doi:10.1136/bmj.327.7416.681-b

BMJ 2003;327:681 (20 September), doi:10.1136/bmj.327.7416.681-b

Letter

Managing chronic pain in children and adolescents

Effective responses are possible with non-evidence based clinical practice

The first 150 words of the full text of this article appear below.

EDITOR—Eccleston and Malleson highlighted the embarrassinglack of data on managing chronic pain in children but also theapparent ignorance and confusion surrounding the topic.¹ Families,I agree, can be unnecessarily offended by labels such as psychosomatic,wrongly perceiving this to mean all in the mind if labels aremisapplied, misunderstood, or not explained.

Owing to minimal evidence to guide clinical practice, considerableignorance remains about psychological treatment other than "management"of chronic pain and psychosomatic conditions. Resolution bypsychological means is a real possibility not accepted by many.Pain (and fear) must be investigated, managed, and treated appropriately—bothmedically and psychologically.

I agree that controlled trials with a focus on safety as wellas efficacy are urgently needed. However, treatments that lackevidence from controlled trials should not be avoided. Effectiveresponses are possible with non-evidence based clinical practice.Skilled clinical psychologists trained in research are precluded. . . [Full text of this article]

Philip Dutton, consultant clinical psychologist (maternal and child health)

Dollar, Central Scotland FK14 7ZA pdutton@synapse2000.co.uk