3C Pediatric Chronic Pain and Opioids

Abstract

Chronic non-malignant pain (often defined as persistent and recurrent pain) in children and adolescents is a significant problem worldwide with prevalence rates reported as high as 35%. Untreated persistent pain may lead to significant pain-related disability, emotional disturbance, and poor school performance. These patients frequently have seen many specialists and have been placed on a multitude of medications, opioids included, without relief. However, use of opioids for non-malignant chronic pain is not supported in the pediatric literature except in limited circumstances or as part of a structured treatment plan. There is growing consensus that treatment should be focused on a multidisciplinary, multi-modal approach and some centers are reporting success while attempting to maximize the likelihood of improved outcomes. The most common chronic conditions seen are musculoskeletal pain, headaches, back pain and abdominal pain. Management of pain in this population does require an appreciation of ongoing assessment identifying the presence and severity of pain in the individual while having skills with a utilization of a multi-modal approach. Left untreated, these young people will often go on to have issues as adults that may lead to chronic disability, suboptimal functionality, and an overall decreased quality of life. The presentation will present some of common problems managed at The Children's Medical Center of Dallas Center for Pain Management, discuss the multi-modal approach currently utilized in practice, and attempt to answer the following questions: 1) should opiates be prescribed for children with chronic non-malignant pain, 2) if yes, what screening is required in this age group, and 3) will the opioid epidemic have any impact on prescription practices moving forward on patients who have chronic non-malignant pain?