Canadian Emergency Medicine Residents’ Perspectives on Pediatric Pain Management

Ali, Huma; Kircher, Janeva; Meyers, Christine; Maclellan, J; Ali, Samina

doi:10.1017/cem.2015.2

Cited by 8 publications

(3 citation statements)

References 37 publications

(40 reference statements)

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“…There is also evidence that when youth look online for information on their health and well-being, they encounter a great deal of misinformation or information that is not evidence based. 40 This suggests that when patients/caregivers/family members are looking for their preferred evidence-based resources, identified earlier as social media or websites, they may struggle to identify or access high-quality information. Though each individual stakeholder group may differ in the degree to which they find resources accessible, the present findings shed light on a larger issue of accessibility of evidence for all stakeholders, where evidence may not be available where stakeholders traditionally seek information or the information available is not evidence based.…”

Section: Discussionmentioning

confidence: 99%

Bridging the gap: Identifying diverse stakeholder needs and barriers to accessing evidence and resources for children’s pain

MacKenzie

Chambers

Parker

et al. 2022

Canadian Journal of Pain

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Background Stakeholder engagement in knowledge mobilization (KMb) activities can bridge the knowledge to action gap within children’s pain but may be influenced by how well stakeholder needs and barriers to evidence-based resources are addressed. The needs of different Canadian stakeholder groups related to children’s pain have not been examined, limiting the degree to which KMb efforts can be tailored to each group. Aims The study aim was to identify shared and unique needs, barriers, and accessibility of evidence for children’s pain across three stakeholder groups: knowledge users (i.e., health professionals, administrators, policymakers, educators), researchers (including trainees), and patients, caregivers, and family members. Methods This study comprised an online needs assessment survey. Analyses included descriptive statistics, one-way analyses of variances, and chi-square tests to examine differences between stakeholder groups. Open-ended responses were analyzed using conventional content analysis. Results A total of 711 stakeholders completed the survey. Educational materials were the most utilized evidence-based resources among all stakeholders. Researchers and patients/caregivers/family members found resources significantly less accessible than knowledge users ( P = 0.008). Knowledge of evidence was the primary barrier across all stakeholder groups (69.2%, n = 492); however, each group reported a need for stakeholder-specific resources. Finally, stakeholders desired opportunities to engage in the KMb process through partnerships and an increased awareness of children’s pain. Conclusions Though stakeholders experience common barriers to evidence-based resources for children’s pain, their needs to address these barriers are diverse. Evidence-based resources should be tailored for stakeholders’ contexts, with diverse audiences in mind.

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Section: Discussionmentioning

confidence: 99%

Bridging the gap: Identifying diverse stakeholder needs and barriers to accessing evidence and resources for children’s pain

MacKenzie

Chambers

Parker

et al. 2022

Canadian Journal of Pain

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“…Currently recommended first-line therapy for moderate pain in children is to combine acetaminophen with ibuprofen; if this is inadequate, oral opioids, including oxycodone, can be added 16. Still, up to 41% of trainees and 25% of practitioners indicate that they consider opioids a top choice for moderate pain treatment 17 18. Considering both this and the fact that ibuprofen and opioids are reported as similarly efficacious for childhood fracture pain management,19 20 AE profiles are an important consideration when making clinical prescribing decisions.…”

Section: Discussionmentioning

confidence: 99%

Quantifying the intensity of adverse events with ibuprofen and oxycodone: an observational cohort study

Ali

Gourlay

Yukseloglu

et al. 2022

bmjpo

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ObjectiveTo quantify the frequency and intensity of adverse events (AEs), commonly known as side effects, experienced by children receiving either ibuprofen or oxycodone for pain management following an acute fracture. Secondary objectives were to quantify functional outcome impairment and describe demographic and clinical characteristics associated with AEs.DesignObservational cohort study.SettingPaediatric emergency department.PatientsPatients (n=240) aged 4–16 years diagnosed with an acute fracture.InterventionPrescribed either ibuprofen (n=179) or oxycodone (n=61) for pain.Main outcome measuresFamilies were called for the first 3 days after discharge to report the presence and intensity of AEs and their child’s functional outcomes (ability to eat, sleep, play or attend school).ResultsOn day 1, children using oxycodone were more likely to report any AE (χ21=13.5, p<0.001), nausea (χ21=17.0, p<0.001), vomiting (χ21=11.2, p<0.001), drowsiness (χ21=13.7,p<0.001), constipation (χ21=8.9, p=0.003) and dizziness (χ21=19.1, p<0.001), compared with those using ibuprofen. Children receiving oxycodone reported greater severity of abdominal pain (oxycodone: mean 5.4 SD 3.1; ibuprofen mean 2.5 SD 1.4, F113=6.5, p=0.02) on day 1 and worse intensity of constipation (oxycodone: mean 4.9 SD 2.1; ibuprofen mean 3.2 SD 2.2, F133=4.5, p=0.04) over all 3 days. Use of oxycodone was associated with an increased odds of experiencing an AE on day 1 (OR=1.31 (95% CI 1.13 to 1.52)). Higher pain scores (OR=1.50 (95% CI 1.12 to 2.01)), lower extremity fracture (OR=1.25 (95% CI 1.07 to 1.47)) and undergoing ED sedation (OR=1.16 (95% CI 1.01 to 1.34)) were associated with missing school. Higher pain scores (OR=1.50 (95% CI 1.14 to 1.97)) and lower extremity fractures (OR=1.23 (95% CI 1.07 to 1.43)) were also associated with less play.ConclusionsOxycodone is associated with more frequent AEs overall, higher intensity gastrointestinal AEs and greater functional limitations compared with ibuprofen. Lower extremity fractures cause more functional limitations than upper extremity fractures. Clinicians should consider these differences when providing fracture pain care for children.

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“…While opioids are generally safe and effective short-term treatment for children with severe acute pain, caregivers (i.e., parents and legal guardians) are increasingly hesitant to administer them to their child, in the wake of the current opioid crisis (1,2). Studies show that caregivers refuse opioids more frequently than nonopioid analgesics (3,4), and will often not request a stronger pain medication even with ongoing pain (5)(6)(7)(8).…”

mentioning

confidence: 99%

102 A two-centre survey of caregiver perspectives on opioid use for children’s acute pain management

Jun¹,

Ali²,

Poonai³

et al. 2019

Paediatrics &Amp; Child Health

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Background: Given the current opioid crisis, caregivers have mounting fears regarding the use of opioid medication in their children. We aimed to determine caregivers' a) willingness to accept, b) reasons for refusing, and c) past experiences with opioids. Methods: A novel electronic survey of caregivers of children aged 4 to 16 years who had an acute musculoskeletal injury and presented to two Canadian paediatric emergency departments (ED) (March to November 2017). Primary outcome was caregiver willingness to accept opioids for moderate pain for their children. Results: Five hundred and seventeen caregivers participated; mean age was 40.9 (SD 7.1) years with 70.0% (362/517) mothers. Children included 62.2% (321/516) males with a mean age of 10.0 (SD 3.6) years. 49.6% of caregivers (254/512) reported willingness to accept opioids for ongoing moderate pain in the ED, while 37.1% (190/512) were 'unsure'; 33.2% (170/512) of caregivers would accept opioids for at-home use, but 45.5% (233/512) were 'unsure'. Caregivers' primary concerns were side effects, overdose, addiction, and masking of diagnosis. Caregiver fear of addiction (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.01 to 1.25) and side effects (OR 1.25, 95% CI 1.11 to 1.42) affected willingness to accept opioids in the emergency department; fears of addiction (OR 1.19, 95% CI 1.07 to 1.32), and overdose (OR 1.15, 95% CI 1.04 to 1.27) affected willingness to accept opioids for at-home use. Conclusions: Only half of the caregivers would accept opioids for moderate pain, despite ongoing pain following nonopioid analgesics. Caregivers' fears of addiction, side effects, overdose, and masking diagnosis may have influenced their responses. These findings are a first step in understanding caregiver analgesic decision making.

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Canadian Emergency Medicine Residents’ Perspectives on Pediatric Pain Management

Cited by 8 publications

References 37 publications

Bridging the gap: Identifying diverse stakeholder needs and barriers to accessing evidence and resources for children’s pain

Bridging the gap: Identifying diverse stakeholder needs and barriers to accessing evidence and resources for children’s pain

Quantifying the intensity of adverse events with ibuprofen and oxycodone: an observational cohort study

102 A two-centre survey of caregiver perspectives on opioid use for children’s acute pain management

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