NSAIDs Provided Most Benefits, Least Harm in Treating Pediatric Acute Pain
In a network meta-analysis, researchers compared the safety and efficacy of available analgesic treatment for treating acute pain in children.
Nonsteroidal anti-inflammatory drugs (NSAIDs), mid- to high-potency opioids, and ketamine were effective in treating pediatric acute pain, with NSAIDs providing the most benefits and least harm. While researchers suggested NSAIDs as the first line treatment for children with acute pain, they also noted instances of notably effective treatments showing only modest pain relief, according to data published in JAMA Pediatric.1
“Acute pain is prevalent in children, reported in almost 60% of all pediatric emergency department (ED) encounters. Pediatric guidelines emphasize multimodal therapy for pain care (ie, psychological, physical, pharmacologic), including several analgesic medications as potential options,” wrote authors of the study.
Approximately 30% of children reported acute pain during childhood. | image credit: HENADZY / stock.adobe.com
Pain is a significantly prominent health issue in the US for adults and children. According to Children’s Hospital Colorado, around 30% of all children experience acute pain at some point in adolescence.2 Furthermore, it’s estimated that up to 80 million adults receive medication for acute pain every year, leading to constant research for the best pharmacologic treatment option.3
For all populations, a series of trials, reviews, and expert opinions have intended to guide the pharmaceutical standards for treating acute pain. However, a lack of up-to-date and comprehensive evidence has allowed the search for a front-line pain treatment to persist. This has led to unprecedented events such as the opioid epidemic as health care experts intend to steer straight the country’s sentiments regarding pain.
READ MORE: Gestational Age Associated with Pain Among Very Preterm Infants
“The clinical management of acute pain remains variable, and opioids are often administered despite minimal and sometimes contradictory evidence regarding their efficacy,” continued the authors.1 “In response, we conducted a systematic review and network meta-analysis (NMA) of randomized clinical trials (RCTs) to compare the effectiveness and safety of pharmacologic treatments. Our goal was to provide a comprehensive comparison of the safety and efficacy of the available analgesics to inform clinical guidelines and practice.”
In their NMA, researchers searched for RCTs that focused on children under 18 who reported acute pain and were randomized to receive a pharmacologic analgesic treatment, compared with either placebo or an alternative analgesic. Their main outcomes when reviewing trials were pain severity, need for rescue medication, symptom relief, and adverse drug events.
Upon completing their review, researchers included 41 RCTs featuring a total of 4935 adolescent participants (median age, 9.7). A majority of the trials (61%) explored musculoskeletal pain, while 85% were conducted during ED encounters. Finally, interventions to treat acute pain included in the review were grouped as follows: placebo, acetaminophen, NSAIDs, tramadol, codeine, mid- to high-potency opioids, ketamine, and a combination of pain interventions.1
“In this NMA of analgesic trials for children with acute pain, we found high to moderate certainty evidence that NSAIDs, mid- to high-potency opioids, and ketamine provide effective pain relief compared with placebo,” they wrote. “We found moderate certainty evidence that compared with placebo, NSAIDs probably reduce the need for rescue medication, whereas mid- to high-potency opioids and ketamine probably do not.”
NSAIDs are the most commonly prescribed analgesic for the management of pain among pediatric populations in EDs. With a majority of trials conducted in hospital EDs and NSAIDs having the safest and best outcomes, researchers’ results confirmed previous recommendations for treating children with pain.
“Our findings align with a recent NMA examining oral analgesics for acute musculoskeletal pain in children, which found that ibuprofen with or without opioids, acetaminophen, and opioids were similarly effective for pain relief at 1-hour follow-up,” they continued.
Ultimately, trials and reviews like these highlight the fact that every patient encounter is unique. With multiple treatment options showing continued efficacy for treating acute pain in children, as well as adults, it’s up to providers to use previous data to guide their decisions for choosing the safest and most effective medications.
“NSAIDs should be considered as first-line analgesic therapy for children with acute pain. Notably, even the most effective pharmacologic treatments provide only modest pain relief. Further pediatric studies are needed on alternative analgesic routes, such as topical NSAIDs and combination opioid/nonopioid therapies,” concluded the authors.1
READ MORE: Pain Management Resource Center
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