Researchers aimed to determine whether or not opioids were appropriate for treating adolescents experiencing chronic pain.
When treating adolescents with chronic pain, researchers found that the best approach is multimodal, using nonpharmacologic interventions and opioids only when appropriate to avoid risks of opioid use disorder (OUD), poisoning, and overdose. They also discovered disproportionate inequities when treating communities of color for chronic pain, suggesting that pediatric health care providers (PHCPs) consider all social disparities before treating adolescents with chronic pain.
“It is critical for clinicians to understand when opioids may be indicated and how to safely prescribe them in a manner that minimizes the risk for OUD, poisoning, and overdose,” wrote authors of a study published in Pediatrics.1
Chronic pain is significantly relevant amongst children and adolescents worldwide. According to a study published in PAIN, about 20% of adolescents experience chronic pain, with a higher prevalence for girls compared with boys.2
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With a relatively high demand for PHCPs to facilitate pain management interventions for children, researchers’ goal to address the most appropriate interventions for treating chronic pain was aimed at PHCPs amidst conflicting views toward medications to treat chronic pain. The researchers’ study is known as a clinical practice guideline (CPG), advising PHCPs on what the safest mode of treating, in this case, adolescent patients with chronic pain.
“As a medication class, opioids have long had a beneficial role in the management of some pediatric patients’ pain, particularly when that pain is severe. Since the turn of the century, however, rates of OUD, poisoning, and overdose have increased dramatically among children and adolescents in the US,” continued the authors.1
About 20% of adolescents experience chronic pain worldwide. | image credit: New Africa / stock.adobe.com
Rates of opioid prescribing for both children and adults have been staggered for the past few decades. While opioids were prevalent upon their inception within the pain management space, prescribing rates have decreased dramatically, especially since the peak of prescribing for adolescents in the early 2010s.1 As OUDs, poisonings, and overdoses began to rise, PHCPs started to scale back the prescription of opioids for children with chronic pain, which has led to the issue of undertreatment.
READ MORE: Problematic Opioid Prescribing Among Patients with Chronic Pain
“One potential repercussion of clinicians prescribing fewer opioids is the undertreatment of pain,” they wrote. “Because pain can adversely impact physical and psychosocial functioning, withholding opioids in situations in which they might be needed could lead to broader negative consequences for some children and adolescents.”
This CPG featured the work of 2 health librarians to search PubMed and Embase databases twice in 2022 and again in the summer of 2023. “All studies were required to include children up to 18 years of age. Studies could also include young adults up to 21 years of age, if this population was stratified from older adult participants, as long as children younger than 18 years were also included in the study.”1
All studies included focused on children experiencing acute pain who were prescribed opioids for use in an at-home setting.
Researchers found that approximately 6.7% of children under 18 were prescribed opioids by a medical care provider and 1.2% were prescribed opioids after a dental visit. Most children observed in the study did not develop OUD, but as prescribing followed them into adulthood, OUD risk increased.
They then delved into the safe prescribing of opioids and how PHCPs, and the families of the children they are prescribing, can utilize nonpharmacologic approaches.
“The optimal approach starts with educating patients and their families on nonpharmacologic strategies. It is important that this education describes realistic expectations for patients and their families; this includes not promising the absence of pain but, rather, the goal of keeping pain at a tolerable level,” they wrote.1
They also discovered that a significant number of children who were prescribed opioids did not use their entire prescription. This led to their suggestion of prescribing opioids at their lowest effective dose and to consider that opioid prescribing is heavily reliant on the weight of the adolescent receiving the medication. Finally, when discussing risk minimization, the CPG suggested that PHCPs consider all risk factors and patient characteristics to understand which patient population may be at greater risk of developing OUD, poisoning, or overdose.
“PHCPs are experts at treating medical conditions with social and behavioral considerations. Because of this, PHCPs are exceptionally well-positioned to balance the benefits of effective pain management with the potential risks of prescribing opioids when they are indicated. This subcommittee strongly believes that it is time for the pediatric workforce to promote rational and equitable pain management,” concluded the authors.1
READ MORE: Chronic Pain Linked to Higher Anxiety, Depression in Youth
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