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Pain management in the paediatric population: the regulatory situation in Europe
  1. F Fortinguerra,
  2. S Maschi,
  3. A Clavenna,
  4. M Bonati
  1. Department of Public Health, Mario Negri Institute for Pharmacological Research, Milan, Italy
  1. Correspondence to Dr Filomena Fortinguerra, Laboratory for Mother and Child Health, Department of Public Health, Mario Negri Institute for Pharmacological Research, Via Giuseppe La Masa 19, 20156 Milan, Italy; filomena.fortinguerra{at}


This study compared the availability and the licensing status of analgesic drugs marketed in three European countries (Italy, France and the UK) and evaluated the evidence on safety and efficacy in the paediatric population of the drugs reported in the European Medicines Evaluation (EMA) document “Assessment of Pediatric Needs: Pain” (2005). Ten of 17 drugs reported in the EMA document were marketed with a paediatric licence in all three countries but with wide differences concerning age groups. In all, 594 randomised controlled trials (RCTs) concerning the 17 drugs in the EMA list were found through biomedical literature databases. Bupivacaine was the drug with the most trials retrieved (171 RCTs, 29%); 32 (5%) RCTs concerned clonidine not licensed for pain control, and 51 (9%) concerned ketamine licensed for paediatric use only in the UK. Access to, and the rational use, of drugs to prevent or control pain and its functional consequences pose a considerable challenge. There is a pressing need for further research and clinical development in the assessment and management of pain in children.

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  • Funding FF holds an educational fellowship granted by Boerhinger Ingelheim Italia.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.