What They Don't Know Can Hurt Them: Risky Analgesic Use in Children.

Abstract

FOR SEVERAL DECADES, most of us have practiced under the impression that children have been undertreated for their pain both in the hospital and at home. Studies and commentaries alike have echoed this notion based on data showing that children receive less than the prescribed amounts of their pain medicines even when pain remains at an intensity level considered to be “clinically significant.” 1 Fortier M.A. MacLaren J.E. Martin S.R. Perret-Karimi D. Kain Z.N. Pediatric pain after ambulatory surgery: Where's the medication?. Pediatrics. 2009; 124: e588-e595 Crossref PubMed Scopus (162) Google Scholar , 2 Rony R.Y. Fortier M.A. Chorney J.M. Perret D. Kain Z.N. Parental postoperative pain management: Attitudes, assessment, and management. Pediatrics. 2010; 125: e1372-e1378 Crossref PubMed Scopus (106) Google Scholar , 3 Wilson M.E. Helgadottir H.L. Patterns of pain and analgesic use in 3- to 7-year-old children after tonsillectomy. Pain Manag Nurs. 2006; 7: 159-166 Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar Much of this data has been derived from the postoperative setting or from other acute care visits. In these settings, it has been widely suggested that children need to be given regular or as-ordered doses of their prescribed analgesic to have good pain management. 4 Sutters K.A. Miaskowski C. Holdridge-Zeuner D. et al. A randomized clinical trial of the effectiveness of a scheduled oral analgesic dosing regimen for the management of postoperative pain in children following tonsillectomy. Pain. 2004; 110: 49-55 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar , 5 Sutters K.A. Miaskowski C. Holdridge-Zeuner D. et al. A randomized clinical trial of the efficacy of scheduled dosing of acetaminophen and hydrocodone for the management of postoperative pain in children after tonsillectomy. Clin J Pain. 2010; 26: 95-103 Crossref PubMed Scopus (86) Google Scholar Some experts have even suggested that not doing so constitutes poorly managed pain. 6 Twycross A.M. Maclaren Chorney J. McGrath P.J. Finley G.A. Boliver D.M. Mifflin K.A. A Delphi study to identify indicators of poorly managed pain for pediatric postoperative and procedural pain. Pain Res Manag. 2013; 18: e68-e74 PubMed Google Scholar These notions have led many—particularly in the perioperative field—to advise parents about the merits of potent analgesic use, to encourage their liberal use, even around the clock, 4 Sutters K.A. Miaskowski C. Holdridge-Zeuner D. et al. A randomized clinical trial of the effectiveness of a scheduled oral analgesic dosing regimen for the management of postoperative pain in children following tonsillectomy. Pain. 2004; 110: 49-55 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar , 5 Sutters K.A. Miaskowski C. Holdridge-Zeuner D. et al. A randomized clinical trial of the efficacy of scheduled dosing of acetaminophen and hydrocodone for the management of postoperative pain in children after tonsillectomy. Clin J Pain. 2010; 26: 95-103 Crossref PubMed Scopus (86) Google Scholar , 7 Sutters K.A. Holdridge-Zeuner D. Waite S. et al. A descriptive feasibility study to evaluate scheduled oral analgesic dosing at home for the management of postoperative pain in preschool children following tonsillectomy. Pain Med. 2012; 13: 472-483 Crossref PubMed Scopus (31) Google Scholar and to assure parents of their safety. 8 Kankkunen P. Vehvilainen-Julkunen K.M. Pietila A.-M.K. et al. A tale of two countries: Comparison of the perceptions of analgesics among Finnish and American parents. Pain Manag Nurs. 2008; 9: 113-119 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar Terri Voepel-Lewis, PhD, RN, Associate Research Scientist, University of Michigan Medical School, Department of Anesthesiology, Section of Pediatrics, Ann Arbor, MI