When a young athlete visits their pediatrician or primary care provider (PCP) with hip pain, the proper course of treatment isn’t always clear. The damage caused by acute and traumatic hip injuries can often be determined in imaging, while overuse injuries may be more difficult to diagnose.
For significant injuries requiring surgical intervention, it’s always in the best interest of a young athlete to be immediately referred to a pediatric orthopedic surgeon. But for nagging hip pain that doesn’t have a discernible cause, the best course of action may not be evident.
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.
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