Page 102 WHO - Guidelines on the pharmacological treatment of persisting pain in children with medical illness

Research agenda
Trials concerning the efficacy and safety of the systemic use of local anaesthetics as adjuvants in
persisting neuropathic pain in children are needed. A1

A2.2.15 Adjuvants for pain during muscle spasm or spasticity:
benzodiazepines and baclofen
Clinical question
In children with persisting pain due to medical illnesses, should benzodiazepines as compared to A2 A2
baclofen be used as adjuvant medicines in order to achieve and maintain effective and safe pain control
during muscle spasm and spasticity?

Recommendation
At present, it is not possible to make a recommendation for the use of benzodiazepines and/or baclofen
as an adjuvant in the management of pain in children with muscle spasm and spasticity.

Domains and considerations A3

Quality of evidence
A World Health Organization summary of evidence in palliative care identified that there was no
good evidence base for the use of these agents in that setting for pain associated with muscle spasm
(72). However, the panel noted that this is routine practice. There is no good evidence base for the
use of baclofen and benzodiazepines in the setting of pain associated with spasticity in adults (90,
91). No studies have been retrieved in children. A4
Uncertainty: yes.

Risks/benefits
Benefits
Unknown, although both baclofen and benzodiazepines have long been used in the management of
muscle spasm and spasticity. A5
Risks
The adverse effects associated with these medicines are well described.
Uncertainty: yes.

Research agenda
Trials concerning the efficacy and safety of baclofen and benzodiazepines as adjuvants in the
management of muscle spasm and spasticity in children are needed. A6

A2.3 non-pharmacological interventions

Only one systematic review was identified on non-pharmacological interventions (Annex 4. Evidence
retrieval and appraisal, GRADE Table 16). The one systematic review considered types of pain falling
both within and outside the scope of these guidelines. It was felt by the WHO Guidelines Development A7
Group that the scope had to be enlarged to comprise a wider spectrum of non-pharmacological
interventions beyond physical exercise, physiotherapy and cognitive behavioural therapy; and that
adequate expertise was needed to assess the evidence and formulate recommendations.

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