• Article
  • April 16, 2019

5 Considerations for Children's Hospitals' Pain Management Practices

One pain expert says there are things providers should consider when prescribing opioids so children don't have to endure unnecessary pain.

Perspectives in pain management

In this series, Children's Hospitals Today explores balancing the use of opioids to ensure children's hospitals can adequately treat pain in children.

When it comes to opioid prescribing in pediatrics, Gary Walco, Ph.D., ABPP, director of pain medicine at Seattle Children's Hospital, says there are five things children's hospitals should consider when examining pain management practices.

Create a family educational package about the safe use of opioids

A prescription for an opioid should come with extensive education to proactively alleviate caregiver concerns. This includes what the indications are, when the parent should or shouldn't give the drug, how to dispose of an unused prescription and how to make sure the drug is safe in the household so it's not accessible to others. Parents should have concrete care instructions, so they aren't left to guess if they're doing the right thing.

Continue increasing awareness and support for physicians

According to a 2016 New England Journal of Medicine article, use of opioid medications in children with severe and chronic pain conditions requires special consideration, and physicians need information that helps them prescribe such medications safety and effectively, while protecting minors who lack mature decision-making capabilities.

"Education is necessary, but not sufficient on its own," Walco says. "We have to make it easy for patients to do the right thing with practice changes like standard order sets." Walco, in partnership with the opioid safety committee leader at Seattle Children's Hospital, sent personal emails to help providers understand why new practices are being put in place.

Understand that chronic and acute pain as separate issues

Walco says there's stigma around how people endure pain. "When pain is chronic, you're dealing with a whole different set of issues," he says. "But most of what children's hospitals are talking about is acute pain treatment in kids. That doesn't mean we're talking about the opioid epidemic automatically."

Recognize the age difference related to opioid use

Currently, data for pediatrics are clustered using broad age bands. Most often, pediatrics is defined as ages 0 to 21, with risk at its greatest in the 15- to 25-year-old band. Walco says the developmental difference between these ages is significant. "Who we are at 15 and 25 isn't in the same category," he says. "But that's how the data we have now looks. It's clumped together."

Fund studies on children

Children have never been well-studied with respect to medications, according to Walco. And while there's more work being done on understanding the safety and efficacy of drugs in children of different ages, Walco says people generalize from adult opioids data, which is more readily available. "The data we need isn't easy to get," he says. "But we know we can't keep extrapolating from adult data. If we can get the data we need on children, then we can make rational, sound decisions on pediatric opioid management rather those based on speculation."

Walco hopes the increasing focus on opioids brings the opportunity to do more research on children, as well as dispel misconceptions that surround the issue of opioids for pain management. "It's important to understand that we don't have an opioid issue as much as we have a substance misuse issue," Walco says. "It's not limited to opioids. Social and mental health issues contribute to people seeking an array of medications that are being misused."

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