These are challenging times for clinicians who care for children and adults in pain. The general philosophy regarding the level of attention that should be paid to pain as well as its treatment has changed dramatically during the past 30 years, swinging wildly between extremes, and remains a moving target.
The first published recognition of pain undertreatment in adults occurred in the 1970s, with identification of similar and more dramatic concerns for children emerging a few years later. Research documenting the short- and long-term negative consequences of poorly-treated pain—coupled with the development and marketing of new opioid compounds—led to a dramatic increase in analgesia prescribing for essentially all painful conditions.
Unfortunately, although most patients who were prescribed opioids benefited, it became clear that these agents were not as benign as had been assumed, and that addiction, diversion, opioid hyperalgesia and other adverse effects were legitimate concerns. Although one would assume that these concerns would only limit the indiscriminate use of these drugs for inappropriate situations, in fact, the pendulum swung to the other extreme, with a wave of negative publicity leading to the scrutiny of essentially any use of narcotic analgesics.
As a result, at this time, we run the genuine risk of returning to a state of opiophobia and denying individuals in severe pain the mercy of access to these incredibly valuable drugs.
It is with these societal currents in mind that we read a recent article in JAMA Pediatrics that identified significant undertreatment of children with severe pain associated with appendicitis while in the emergency department (ED). …Read More