Stories about: Anesthesia Perioperative and Pain Medicine

Matching children in chronic pain with the right treatment

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(Giovanni Cancemi/Shutterstock)

Chronic pain ranks with ADHD and asthma among the most costly chronic pediatric conditions in the United States. To some extent, the cost—roughly $19.5 billion annually—stems from the large number of children—an estimated 1.9 million—seen for pain every year.

However, in large part the problem may also be one of matching children and adolescents in pain to the appropriate treatments. As psychologist and pain specialist Laura Simons, PhD, and collaborators recently noted in PAIN, pediatrician surveys reveal a lack of consensus when it comes to diagnosing pain, making treatment planning a challenge and potentially putting children at risk for chronic pain problems as adults.

“We’re not catching pain problems early enough,” says Simons, who works in Boston Children’s Hospital’s Department of Anesthesia, Perioperative and Pain Medicine. “Patients may undergo multiple medical procedures, or see several specialists before a diagnosis is given or an appropriate treatment plan is put into place.”

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Where do opioids fit in pediatric pain management?

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The approach the field of pediatrics has taken toward pain management in children has shifted dramatically over the last half century. Pediatric pain was woefully under-managed even up to the 1970s and 80s, with infants sometimes undergoing complex surgeries without perioperative or postoperative pain control.

Over the following two decades, as physicians and scientists learned more about the acute and long-term effects of pediatric pain, the pendulum swung in favor not only of pain management, but of the use of opioid medications for controlling both chronic and acute pain in both children and adults, regardless of the pain’s origin.

“With the recognition that pain had short- and long-term potential consequences, and the lack of data at the time suggesting downsides to opioids, there was a very dramatic shift,” says Neil Schechter, MD, of the Pain Treatment Service in Boston Children’s Hospital’s Department of Anesthesia, Perioperative and Pain Medicine. “We started asking, ‘If there’s no significant downside, why should children suffer unnecessarily?'”

But has the pendulum swung too far in favor of opioids? …Read More

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