Stories about: Neil Schechter

Racial disparities in analgesia: Who gets pain relief?

teddy bear hospital bed pain management
(upixa/Shutterstock)

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

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Where do opioids fit in pediatric pain management?

opioids pain control pediatrics

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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