Nav: Home

More research on addiction potential needed for use of opioids to treat children's pain

March 25, 2020

A pair of new studies led by University of Alberta pediatricians indicate that parents are more reluctant to have opioids prescribed for their children than doctors are to prescribe them.

In a newly published study, the researchers asked 136 pediatric emergency room doctors across Canada whether concerns about potential addiction or the opioid crisis hold them back from prescribing opioids such as fentanyl and morphine to children with moderate to severe pain.

The doctors reported minimal concern, although they did say that parental reluctance, a lack of guidelines for opioid use in children and concern about side-effects play a role in their approach to prescribing opioids to children. Both the World Health Organization and the American Academy of Pediatrics recommend prescribing opioids for children with moderate to severe pain that does not respond to non-opioid medication, such as acetaminophen or ibuprofen.

In a separate study published recently, U of A researchers asked more than 500 parents and caregivers about their willingness to accept an opioid prescription for their child.

Only half said they would accept opioids for moderate pain and only 33 per cent would accept them for at-home use. The parents cited fears of addiction, side-effects and overdose.

"Right now we don't have a lot of strong evidence to say how worried we should be about addiction risk of opioids for children," said lead author Megan Fowler, an emergency physician at Edmonton's Stollery Children's Hospital and clinical lecturer in pediatrics at the U of A.

"We do know that treating children's pain is very important, so physicians do have to prescribe opioids responsibly," Fowler said. "More research and guidelines are going to be needed."

Samina Ali, a U of A professor of pediatrics and adjunct professor of emergency medicine, as well as a pediatric emergency physician at the Stollery, said one in five children in North America are prescribed opioids by the time they are in their teens, usually to treat short-term pain from injuries or acute illnesses such as appendicitis.

She said parental fears are likely shaped by media reports about the opioid crisis, which point to inappropriate emergency room prescriptions as part of the problem. At the same time, physicians must follow their training, which directs them to do what they can to treat children's pain.

"We know for a fact that not treating children's pain has consequences," Ali said. "Short term, it makes investigation, diagnosis and getting kids home more difficult. Long term, there is a subset of children who develop true phobias of medical procedures, or they develop chronic pain disorders because their acute pain was not treated adequately."

Ali said doctors must balance the unknown risks of opioid treatment with the known risks of untreated pain.

"That's why they will still offer opioids in small amounts when pain is severe, and only as needed," she said.

Her message to doctors is, "Don't stop prescribing. Prescribe in the most responsible of ways based on the evidence. And where evidence is lacking, our research teams will try to address that."

Ali said a number of steps need to be taken to gather more information for both parents and physicians about the impact of opioids on children.

Her team is working with the Alberta Research Centre for Health Evidence on a systematic review of research evidence to determine whether there is a link between short-term opioid use for medical reasons and the potential to develop addiction later in life.

"We know that being exposed to opioids as a child increases your risk of having an opioid use disorder, but there is very little research linking short-term use to long-term outcomes," she said. "We need to know more about that."

The U of A team is conducting in-depth interviews with some of the physicians surveyed to better understand their thought process when prescribing opioids to children.

They are also working with a federally funded initiative called Solutions for Kids in Pain to better disseminate evidence about how to treat children's pain.

"In response to the opioid crisis, the Government of Canada has published guidelines for prescribing opioids to adults, but there is nothing for children," said Fowler. "Pediatric physicians are kind of left empty-handed."

Ali said even without the concerns about addiction, half of patients who are prescribed opioids will get some combination of side-effects including sleepiness, dizziness, constipation, stomach pain and nausea.

"None of that is pleasant when you're already feeling sick or injured," Ali said.

The U of A team is exploring alternatives to opioids for treating pain in children, including the No-Ouch Study, which compares the effectiveness of ibuprofen on its own with a combination of ibuprofen and acetaminophen, and another combination of ibuprofen and hydromorphone, an opioid.

Ali encouraged health-care professionals and parents to always use non-medicinal comforts for children who are in pain.

"If I have a broken arm, it should be in a splint, which will probably take away a third or a half of the pain if I just stop moving it for a few days," Ali said. "And then I put ice on it and that takes down inflammation. And then some nice person makes me a cup of tea and puts on Netflix, and now I'm distracted and feel cared for, and so my perception of pain goes down.

"My arm is still broken, and I will likely still need pain medications, but likely a whole lot less than if these things were not provided," Ali explained. "Pain is so complicated."

The studies on pediatric physician and parental concerns about opioid use were funded by the Stollery Children's Hospital Foundation through the Women and Children's Health Research Institute.
-end-


University of Alberta Faculty of Medicine & Dentistry

Related Pain Articles:

It's not just a pain in the head -- facial pain can be a symptom of headaches too
A new study finds that up to 10% of people with headaches also have facial pain.
New opioid speeds up recovery without increasing pain sensitivity or risk of chronic pain
A new type of non-addictive opioid developed by researchers at Tulane University and the Southeast Louisiana Veterans Health Care System accelerates recovery time from pain compared to morphine without increasing pain sensitivity, according to a new study published in the Journal of Neuroinflammation.
The insular cortex processes pain and drives learning from pain
Neuroscientists at EPFL have discovered an area of the brain, the insular cortex, that processes painful experiences and thereby drives learning from aversive events.
Pain, pain go away: new tools improve students' experience of school-based vaccines
Researchers at the University of Toronto and The Hospital for Sick Children (SickKids) have teamed up with educators, public health practitioners and grade seven students in Ontario to develop and implement a new approach to delivering school-based vaccines that improves student experience.
Pain sensitization increases risk of persistent knee pain
Becoming more sensitive to pain, or pain sensitization, is an important risk factor for developing persistent knee pain in osteoarthritis (OA), according to a new study by researchers from the Université de Montréal (UdeM) School of Rehabilitation and Hôpital Maisonneuve Rosemont Research Centre (CRHMR) in collaboration with researchers at Boston University School of Medicine (BUSM).
Becoming more sensitive to pain increases the risk of knee pain not going away
A new study by researchers in Montreal and Boston looks at the role that pain plays in osteoarthritis, a disease that affects over 300 million adults worldwide.
Pain disruption therapy treats source of chronic back pain
People with treatment-resistant back pain may get significant and lasting relief with dorsal root ganglion (DRG) stimulation therapy, an innovative treatment that short-circuits pain, suggests a study presented at the ANESTHESIOLOGY® 2018 annual meeting.
Sugar pills relieve pain for chronic pain patients
Someday doctors may prescribe sugar pills for certain chronic pain patients based on their brain anatomy and psychology.
Peripheral nerve block provides some with long-lasting pain relief for severe facial pain
A new study has shown that use of peripheral nerve blocks in the treatment of Trigeminal Neuralgia (TGN) may produce long-term pain relief.
How do you assess pain in children who can't express themselves? New research identifies priorities in identifying pain in nonverbal children with medical complexity
Pain is a frequent problem for children with complex medical conditions -- but many of them are unable to communicate their pain verbally.
More Pain News and Pain Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Uncharted
There's so much we've yet to explore–from outer space to the deep ocean to our own brains. This hour, Manoush goes on a journey through those uncharted places, led by TED Science Curator David Biello.
Now Playing: Science for the People

#555 Coronavirus
It's everywhere, and it felt disingenuous for us here at Science for the People to avoid it, so here is our episode on Coronavirus. It's ok to give this one a skip if this isn't what you want to listen to right now. Check out the links below for other great podcasts mentioned in the intro. Host Rachelle Saunders gets us up to date on what the Coronavirus is, how it spreads, and what we know and don't know with Dr Jason Kindrachuk, Assistant Professor in the Department of Medical Microbiology and infectious diseases at the University of Manitoba. And...
Now Playing: Radiolab

Dispatch 1: Numbers
In a recent Radiolab group huddle, with coronavirus unraveling around us, the team found themselves grappling with all the numbers connected to COVID-19. Our new found 6 foot bubbles of personal space. Three percent mortality rate (or 1, or 2, or 4). 7,000 cases (now, much much more). So in the wake of that meeting, we reflect on the onslaught of numbers - what they reveal, and what they hide.  Support Radiolab today at Radiolab.org/donate.