Opioid Analgesics Administered for Pain in the Inpatient Pediatric Setting

Walco, Gary A.; Gove, Nancy E.; Phillips, Jennifer; Weisman, Steven J.

doi:10.1016/j.jpain.2017.06.001

Cited by 12 publications

(5 citation statements)

References 13 publications

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“…Despite the lack of evidence, analgesics are regularly prescribed to children and adolescents with chronic pain and cancer pain. [87] There is a wealth of evidence in adults that is extrapolated to children, despite various warnings of the dangers of using such evidence to guide paediatric practice. [78] In this overview we were interested in pharmacological interventions for the management of chronic pain in children and adolescents, in which the primary outcome was pain relief.…”

Section: Introductionmentioning

confidence: 99%

Pharmacological interventions for chronic pain in children: an overview of systematic reviews

Eccleston

Fisher

Cooper

et al. 2019

Pain

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We know little about the safety or efficacy of pharmacological medicines for children and adolescents with chronic pain, despite their common use. Our aim was to conduct an overview review of systematic reviews of pharmacological interventions that purport to reduce pain in children with chronic non-cancer pain or chronic cancer-related pain. We searched the Cochrane Database of Systematic Reviews, Medline, EMBASE and DARE for systematic reviews from inception to March 2018. We conducted reference and citation searches of included reviews. We included children (0-18 years of age) with chronic noncancer pain or chronic cancer-related pain. We extracted the review characteristics and primary outcomes of ≥30% participant-reported pain relief and patient global impression of change. We sifted 704 abstracts and included 23 systematic reviews investigating children with chronic non-cancer pain or chronic cancer-related pain. Seven of those 23 reviews included six trials that involved children with chronic non-cancer pain. There were no RCTs in reviews relating to reducing pain in chronic cancer-related pain. We were unable to combine data in a meta-analysis. Overall, the quality of evidence was very low and we have very little confidence in the effect estimates. The state of evidence of randomized controlled trials in this field is poor; we have no evidence from randomised controlled trials for pharmacological interventions in children with cancer-related pain, yet cannot deny individual children access to potential pain relief. Prospero ID: CRD42017081205.

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Section: Introductionmentioning

confidence: 99%

Pharmacological interventions for chronic pain in children: an overview of systematic reviews

Eccleston

Fisher

Cooper

et al. 2019

Pain

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“…Previous studies investigating opioid use among hospitalized children for any diagnosis have demonstrated that .40% of children are prescribed an opioid while hospitalized. 18,19 In 1 small single-site study, researchers found that opioids were administered to treat migraine headaches in 26% of hospitalized children. 13 After adjusting for patient characteristics in our study, there was less interhospital variation in opioid administration; therefore, the difference in opioid administration between hospitals may be primarily driven by differences in patient characteristics as opposed to provider-or institutional-level factors.…”

Section: Discussionmentioning

confidence: 99%

“…There was a higher adjusted odds ratio (aOR) of administration of an opioid among older ages (18)(19)(20)(21) 3). There was no difference in adjusted rates of return ED visits within 7 days between hospitalizations with opioid administration and those without opioid administration (P 5 .126).…”

Section: Adjusted Characteristicsmentioning

confidence: 99%

Opioid Use to Treat Migraine Headaches in Hospitalized Children and Adolescents

Masonbrink

Richardson

Catley

et al. 2020

Hospital Pediatrics

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Prescription of opioids to treat pediatric migraine is explicitly discouraged by treatment guidelines but persists in some clinical settings. We sought to describe rates of opioid administration in pediatric migraine hospitalizations. METHODS:Using data from the Pediatric Health Information System, we performed a crosssectional study to investigate the prevalence and predictors of opioid administration for children aged 7 to 21 years who were hospitalized for migraine between January 1, 2016, and December 31, 2018.RESULTS: There were 6632 pediatric migraine hospitalizations at 50 hospitals during the study period, of which 448 (7%) had an opioid administered during the hospitalization. There were higher adjusted odds of opioid administration in hospitalizations for non-Hispanic black (adjusted odds ratio [aOR], 1.68; P , .001) and Hispanic (aOR, 1.54; P 5 .005) (reference white) race and ethnicity, among older age groups (18-21 years: aOR, 2.74; P , .001; reference, 7-10 years), and among patients with higher illness severity (aOR, 2.58; P , .001). Hospitalizations during which an opioid was administered had a longer length of stay (adjusted rate ratio, 1.48; P , .001) and higher 30-day readmission rate (aOR, 1.96; P , .001). By pediatric hospital, opioid administration ranged from 0% to 23.5% of migraine hospitalizations. Hospitals with higher opioid administration rates demonstrated higher adjusted readmission rates (P , .001) and higher adjusted rates of return emergency department visits (P 5 .026). CONCLUSIONS:Opioids continue to be used during pediatric migraine hospitalizations and are associated with longer lengths of stay and readmissions. These findings reveal important opportunities to improve adherence to migraine treatment guidelines and minimize unnecessary opioid exposure, with the potential to improve hospital discharge outcomes.

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“…Following these two studies, Kaiser 35 and Groenewald 33 38,39 . Of note, a recent study found that 40% of children receive opioid during hospitalization 40 . Despite decreasing rates of opioid prescribing to children in the USA, these rates continue to be greater than published reports from other developed countries.…”

Section: The Opioid Epidemic Facing Children and Adolescentsmentioning

confidence: 99%

Opioid-prescribing Patterns for Pediatric Patients in the United States

Groenewald

2019

The Clinical Journal of Pain

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The opioid crisis in America affects both adults and children. However, children are often excluded from health care policies and guidelines aimed at curbing the opioid crises. For example, recent guidelines on opioid prescribing authored by the Center for Disease Control and Prevention (CDC), has exclusively focused on adults. Stakeholders such as patients, providers, and public health agencies feel increased pressure to address the opioid crises and thus guidelines intended for adults may inadvertently be generalized to children. Indeed, some health agencies in the United States have advocated for more restrictive opioid prescribing to children as compared to adults. In order to better address the opioid crises we urgently need more evidence to guide decisions. Thus, this topical review aims to provide a brief overview of the opioid crises affecting children, followed by a synopsis of recent research on opioid prescribing patterns and data on the links between legitimate opioid use and risk for problematic opioid use behaviors.

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Opioid Analgesics Administered for Pain in the Inpatient Pediatric Setting

Cited by 12 publications

References 13 publications

Pharmacological interventions for chronic pain in children: an overview of systematic reviews

Pharmacological interventions for chronic pain in children: an overview of systematic reviews

Opioid Use to Treat Migraine Headaches in Hospitalized Children and Adolescents

Opioid-prescribing Patterns for Pediatric Patients in the United States

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