Opioids in the Management of Acute Pediatric Pain: An Update in a Time of Crisis

Management of acute pain in children is fundamental to our practice. Its myriad benefits include reduced suffering, improved patient satisfaction, more rapid recovery, and a reduced risk of developing postsurgical chronic pain. Although a multimodal analgesic approach is now routinely used, informed and judicious use of opioid receptor agonists remains crucial in this treatment paradigm, as long as the benefits and risks are fully understood. Further, an ongoing public health response to the current opioid crisis is required to help prevent new cases of opioid addiction, identify opioid-addicted individuals, and ensure access to effective opioid addiction treatment, while at the same time continuing to safely meet the needs of patients experiencing pain.
Source: The Clinical Journal of Pain - Category: Anesthesiology Tags: Special Topic Series on Opioid Therapeutics and Concerns in Pediatrics Source Type: research

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Over the past two decades, the federal and state governments, industry, and professionals have taken significant actions to address opioid abuse, addiction, and overdose, including efforts to determine the appropriateness of prescribing opioid analgesics to patients with acute and chronic pain (Greene, et  al., 2018; Jones, et al., 2018). Without a doubt, many of these efforts have been necessary. Some measures, however, have focused sharply on reducing the supply of prescription opioids, which has contributed toward confusion and fear among prescribers and restricted access to controlled prescript ion medication...
Source: Pain Management Nursing - Category: Nursing Authors: Tags: Editorial Source Type: research
AbstractThe primary objective of this article is to assist oncologists and advanced practice prescribers to safely and effectively minimize risk when providing opioids for cancer pain relief. The majority of people with cancer are unlikely to misuse or divert opioid medications, yet the prescriber is often unaware of those who are at risk for these behaviors. To provide skillful pain management to each patient in the oncology setting, while limiting harm to the community, all prescribers must consider the potential for risk of misuse, addiction, or diversion. To minimize this risk to the greatest degree possible, it is imp...
Source: The Oncologist - Category: Cancer & Oncology Authors: Tags: Symptom Management and Supportive Care Cancer Care and the Opioid Crisis Source Type: research
Conclusions: Indian medical practitioners felt the need for formal pain management training. There is a lack of consensus on how to manage the pain using opioid analgesics. Tough regulations on medical and scientific use of opioids are the most commonly reported barrier to prescribing them.
Source: Indian Journal of Palliative Care - Category: Palliative Care Authors: Source Type: research
Addiction is a chronic, relapsing brain disease.  It is not the same as physical dependence (i.e., withdrawal) and tolerance, but is characterized by loss of control over the use of the substance, continued use despite consequences, compulsive use, and cravings. Addiction involves functional changes to brain pathways involved in reward, stress a nd learning, and these changes can last a long time after the addictive substance is no longer used. Repeated interruption of normal brain function from repetitive use of addictive substances can hijack normal reward mechanisms resulting in fundamental alterations in brai...
Source: Pain Management Nursing - Category: Nursing Authors: Tags: Original Article Source Type: research
Publication date: Available online 5 October 2019Source: Neuroscience LettersAuthor(s): Patrick CarrollAbstractSickle cell disease is a uniquely complex painful disease, with lifelong episodes of unpredictable acute pain and superimposed chronic pain in adulthood. Both painful crises and chronic pain in sickle cell disease lack strong objective pathological correlates and their mechanisms are poorly understood. Opioids have emerged as the standard of care for severe acute pain in sickle cell disease and many patients with chronic pain are maintained on chronic opioid therapy. The strong association between recurrent acute ...
Source: Neuroscience Letters - Category: Neuroscience Source Type: research
In this study of 462 patients with SLE from the population-based Michigan Lupus Epidemiology and Surveillance (MILES) Cohort and 192 frequency-matched persons without SLE, nearly one third (31%) of SLE patients were using prescription opioids during the study period (2014-2015), compared with 8% of persons without SLE (p1 year, and 31 (22%) were concomitantly on two or more opioid medications. Among SLE patients, those using the emergency department (ED) were approximately twice as likely to use prescription opioids (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.3-3.6; p = 0.004). In SLE, the ...
Source: MMWR Morb Mortal Wkl... - Category: Epidemiology Authors: Tags: MMWR Morb Mortal Wkly Rep Source Type: research
Jeffrey A. SingerThe Drug Enforcement Administration, having virtually eliminated the diversion of prescription pain relievers into the underground market for nonmedical users, appears to be setting its sights on regulating the medical management of pain, a mission not suited for law enforcement. Acting under the authority of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act), the DEA  announced a proposal to reduce, once again, the national production quotas for fentanyl, morphine, hydromorphone (Dilaudid), oxycodone, and oxymorphone, ...
Source: Cato-at-liberty - Category: American Health Authors: Source Type: blogs
AbstractGlobally, chronic pain is a major therapeutic challenge and affects more than 15% of the population. As patients with painful terminal diseases may face unbearable pain, there is a need for more potent analgesics. Although opioid-based therapeutic agents received attention to manage severe pain, their adverse drug effects and mortality rate associated with opioids overdose are the major concerns. Evidences from clinical trials showed therapeutic benefits of cannabis, especially delta-9-tetrahydrocannabinol and cannabinoids reduced neuropathic pain intensity in various conditions. Also, there are reports on using co...
Source: Journal of Anesthesia - Category: Anesthesiology Source Type: research
Abstract BACKGROUND: As opioid abuse and addiction have developed into a major national health crisis, prescription of opioids for pain management has become more controversial. However, opioids do help some patients by providing pain relief and improving the quality of life. To better understand the addictive properties of opioids under chronic pain conditions, we used a conditioned place preference (CPP) paradigm to examine the rewarding properties of morphine in rats with persistent nociception. METHODS: Spared nerve injury (SNI) model was used to induce persistent nociception in rats. Nociceptive behavior...
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
Authors: Koller G, Schwarzer A, Halfter K, Soyka M Abstract Introduction: Opioid addiction is a worldwide disease with a significant impact. A multitude of physical and mental comorbidities are associated with opioid addiction, pain being one of the most relevant. Insufficient pain management may lead to a disruption in medical treatment, self-medication, and subsequent harm to patients. Areas covered: In this review, the authors provide a general overview of opioid addiction. A literature search for pain management and opioid maintenance treatment was conducted. Different settings of acute or chronic pain and situ...
Source: Expert Opinion on Pharmacotherapy - Category: Drugs & Pharmacology Tags: Expert Opin Pharmacother Source Type: research
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