Addressing Children's Pain in the Midst of an Opioid Epidemic

For many children, breaking a bone is part of growing up. And while opioids historically are prescribed, the current crisis is causing doctors to reexamine how to manage young patients' pain.

That's why doctors with the Pediatric Orthopaedic Society of North America (POSNA) recently published a review article examining the current state of the opioid epidemic as it relates to pediatric orthopedics. The authors present strategies for pain management, education, research and advocacy.

Co-author Dr. Joshua Abzug is a University of Maryland School of Medicine associate professor of orthopedics and pediatrics, and a University of Maryland Children's Hospital pediatric orthopedic surgeon.

Research shows that nearly 1 in 4 high school seniors in the United States have been exposed to prescription opioids through either medical or non-medical use. In addition, legitimate opioid prescriptions significantly increases a child’s risk of future opioid misuse.

Orthopedic surgeons are top opioid prescribers because the conditions they treat are frequently associated with severe pain. In light of this, they have a responsibility to know how to properly manage pain in treating conditions from fractures to sports injuries.

But a survey of POSNA members showed that some physicians are prescribing opioids to children without fully understanding the research or best practices. Even more concerning is that the current protocols for treating acute pain in children are insufficient.

Children experiencing pain from orthopedic injuries don't necessarily require opioid medication for a prolonged period. Some parents, not wanting their child to be in pain, want them to receive narcotics even for minor injuries. Other parents don't want their child prescribed any opioid narcotics – no matter how severe the pain – for fear they will become addicted.

When prescribing opioids, it can be a challenge to know the right dose for the individual child, and physicians must strike a balance. Children's thresholds for pain can be very different. A parent may perceive that the child needs more than he or she actually does. No one wants a child to be in extreme pain, nor does anyone want a child to become addicted, or for leftover narcotics to get into the hands of someone who might misuse them.

Armed with a renewed understanding of the roots and current state of this overwhelming problem, the next immediate steps are to create:

• Better education for providers, patients and families;
• Better narcotic prescribing practices; and
• Better plans for disposing unused narcotics.

Longer-term issues to tackle include changing patient and family expectations around pain management, legislation and more resources.