Advertisement

Evidence-Based Guidelines for Opioid Therapy in Pediatrics

  • See Wan ThamEmail author
  • Cornelius B. Groenewald
  • Gary A. Walco
Chapter

Abstract

Ongoing national efforts to curb the opioid overdose epidemic have resulted in the development and implementation of national guidelines (e.g., Center for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain). This has had a downstream effect onto pediatric practice. However, the scope of problematic opioid prescribing and etiology of misuse/abuse in children and adolescents remain unclear. This raises concerns regarding the application of guidelines intended for the adult population onto pediatric practice. In this chapter, we examine the epidemiologic data of pediatric opioid prescribing patterns to understand the scope of the problem and present available practice guidelines for treatment of chronic non-malignant pain as applied to children and adolescents. Finally, we review the efforts in the State of Washington, which has been on the forefront of legislation to address opioid-related deaths to exemplify the concerns regarding federal and state regulatory interventions.

Keywords

Opioids Children Adolescents Evidence-based guidelines 

References

  1. 1.
    Jones CM, Paulozzi LJ, Mack KA. Sources of prescription opioid pain relievers by frequency of past-year nonmedical use United States, 2008-2011. JAMA Intern Med. 2014;174(5):802–3.  https://doi.org/10.1001/jamainternmed.2013.12809.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain--United States, 2016. JAMA. 2016;315(15):1624–45.  https://doi.org/10.1001/jama.2016.1464.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Busse JW, Juurlink D, Guyatt GH. Addressing the limitations of the CDC guideline for prescribing opioids for chronic noncancer pain. CMAJ. 2016;188(17–18):1210–1.  https://doi.org/10.1503/cmaj.161023.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Juurlink DN. Critiquing the CDC opioid guideline: some light from the heat. Clin Pharmacol Ther. 2018;103(6):966–8.  https://doi.org/10.1002/cpt.1061.CrossRefPubMedGoogle Scholar
  5. 5.
    Hedegaard HMA, Warner M. NCHS Data Brief, no 329. (2018). Drug overdose deaths in the United States, 1999–2017. (NCHS Data Brief, no 329). Hyattsville: National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db329.htm.
  6. 6.
    Burke A. (2018). Assembymember Autumn Burke fights to protect children from opioid addiction. Retrieved from https://www.prnewswire.com/news-releases/assemblymember-autumn-burke-fights-to-protect-children-from-opioid-addiction-300602329.html.
  7. 7.
    Carr DB. NPS versus CDC: Scylla, Charybdis and the “Number Needed to [Under-] Treat”. Pain Med. 2016;  https://doi.org/10.1093/pm/pnw104.
  8. 8.
    Howard RF. Current status of pain management in children. JAMA. 2003;290(18):2464–9.  https://doi.org/10.1001/jama.290.18.2464.CrossRefPubMedGoogle Scholar
  9. 9.
    Palermo TM, Valrie CR, Karlson CW. Family and parent influences on pediatric chronic pain: a developmental perspective. Am Psychol. 2014;69(2):142–52.  https://doi.org/10.1037/a0035216.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Rabbitts JA, Zhou C, Groenewald CB, Durkin L, Palermo TM. Trajectories of postsurgical pain in children: risk factors and impact of late pain recovery on long-term health outcomes after major surgery. Pain. 2015;156(11):2383–9.  https://doi.org/10.1097/j.pain.0000000000000281.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Schwaller F, Fitzgerald M. The consequences of pain in early life: injury-induced plasticity in developing pain pathways. Eur J Neurosci. 2014;39(3):344–52.  https://doi.org/10.1111/ejn.12414.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Cummings EA, Reid GJ, Finley GA, McGrath PJ, Ritchie JA. Prevalence and source of pain in pediatric inpatients. Pain. 1996;68(1):25–31.CrossRefGoogle Scholar
  13. 13.
    Groenewald CB, Rabbitts JA, Schroeder DR, Harrison TE. Prevalence of moderate-severe pain in hospitalized children. Paediatr Anaesth. 2012;22(7):661–8.  https://doi.org/10.1111/j.1460-9592.2012.03807.x.CrossRefPubMedGoogle Scholar
  14. 14.
    Taylor EM, Boyer K, Campbell FA. Pain in hospitalized children: a prospective cross-sectional survey of pain prevalence, intensity, assessment and management in a Canadian pediatric teaching hospital. Pain Res Manag. 2008;13(1):25–32.CrossRefGoogle Scholar
  15. 15.
    Committee on Psychosocial Aspects of Child and Family Health, American Academy of Pediatrics; Task Force on Pain in Infants, Children, and Adolescents, American Pain Society. The assessment and management of acute pain in infants, children, and adolescents. (2001). In (Vol. 108, pp. 793–797): Pediatrics.Google Scholar
  16. 16.
    Fortuna RJ, Robbins BW, Caiola E, Joynt M, Halterman JS. Prescribing of controlled medications to adolescents and young adults in the United States. Pediatrics. 2010;126(6):1108–16.  https://doi.org/10.1542/peds.2010-0791.CrossRefPubMedGoogle Scholar
  17. 17.
    Richardson LP, Fan MY, McCarty CA, Katon W, Edlund M, DeVries A, et al. Trends in the prescription of opioids for adolescents with non-cancer pain. Gen Hosp Psychiatry. 2011;33(5):423–8.  https://doi.org/10.1016/j.genhosppsych.2011.04.009.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Groenewald CB, Rabbitts JA, Gebert JT, Palermo TM. Trends in opioid prescriptions among children and adolescents in the United States: a nationally representative study from 1996 to 2012. Pain. 2016;157(5):1021–7.  https://doi.org/10.1097/j.pain.0000000000000475.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kaiser SV, Asteria-Penaloza R, Vittinghoff E, Rosenbluth G, Cabana MD, Bardach NS. National patterns of codeine prescriptions for children in the emergency department. Pediatrics. 2014;133(5):e1139–47.  https://doi.org/10.1542/peds.2013-3171.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Sites BD, Beach ML, Davis MA. Increases in the use of prescription opioid analgesics and the lack of improvement in disability metrics among users. Reg Anesth Pain Med. 2014;39(1):6–12.  https://doi.org/10.1097/AAP.0000000000000022.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Gaither JR, Shabanova V, Leventhal JM. US National Trends in pediatric deaths from prescription and illicit opioids, 1999-2016. JAMA Netw Open. 2018;1(8):e186558.  https://doi.org/10.1001/jamanetworkopen.2018.6558.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Martins SS, Segura LE, Santaella-Tenorio J, Perlmutter A, Fenton MC, Cerda M, et al. Prescription opioid use disorder and heroin use among 12-34 year-olds in the United States from 2002 to 2014. Addict Behav. 2017;65:236–41.  https://doi.org/10.1016/j.addbeh.2016.08.033.CrossRefPubMedGoogle Scholar
  23. 23.
    Chumpitazi CE, Rees CA, Camp EA, Bernhardt MB. Decreased opioid prescribing in a pediatric emergency department after the rescheduling of hydrocodone. J Emerg Med. 2017;52(4):547–53.  https://doi.org/10.1016/j.jemermed.2016.08.026.CrossRefPubMedGoogle Scholar
  24. 24.
    Chung CP, Callahan ST, Cooper WO, Dupont WD, Murray KT, Franklin AD, et al. Outpatient opioid prescriptions for children and opioid-related adverse events. Pediatrics. 2018;142(2):e20172156.  https://doi.org/10.1542/peds.2017-2156.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Gagne JJ, He M, Bateman BT. Trends in opioid prescription in children and adolescents in a commercially insured population in the United States, 2004-2017. JAMA Pediatr. 2018;173:98.  https://doi.org/10.1001/jamapediatrics.2018.3668.CrossRefPubMedCentralGoogle Scholar
  26. 26.
    Guy GP Jr, Zhang K, Bohm MK, Losby J, Lewis B, Young R, et al. Vital signs: changes in opioid prescribing in the United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66(26):697–704.  https://doi.org/10.15585/mmwr.mm6626a4.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    McCabe SE, West BT, Veliz P, McCabe VV, Stoddard SA, Boyd CJ. Trends in medical and nonmedical use of prescription opioids among US adolescents: 1976-2015. Pediatrics. 2017;139(4):e20162387.  https://doi.org/10.1542/peds.2016-2387.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Pezalla EJ, Rosen D, Erensen JG, Haddox JD, Mayne TJ. Secular trends in opioid prescribing in the USA. J Pain Res. 2017;10:383–7.  https://doi.org/10.2147/JPR.S129553.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Chai G, Governale L, McMahon AW, Trinidad JP, Staffa J, Murphy D. Trends of outpatient prescription drug utilization in US children, 2002-2010. Pediatrics. 2012;130(1):23–31.  https://doi.org/10.1542/peds.2011-2879.CrossRefPubMedGoogle Scholar
  30. 30.
    McCabe SE, Boyd CJ, Young A. Medical and nonmedical use of prescription drugs among secondary school students. J Adolesc Health. 2007;40(1):76–83.  https://doi.org/10.1016/j.jadohealth.2006.07.016.CrossRefPubMedGoogle Scholar
  31. 31.
    Levy S. Youth and the opioid epidemic. Pediatrics. 2019;143(2):e20182752.  https://doi.org/10.1542/peds.2018-2752.CrossRefPubMedGoogle Scholar
  32. 32.
    Hingson RW, Heeren T, Winter MR. Age at drinking onset and alcohol dependence: age at onset, duration, and severity. Arch Pediatr Adolesc Med. 2006;160(7):739–46.  https://doi.org/10.1001/archpedi.160.7.739.CrossRefPubMedGoogle Scholar
  33. 33.
    Le Strat Y, Dubertret C, Le Foll B. Impact of age at onset of cannabis use on cannabis dependence and driving under the influence in the United States. Accid Anal Prev. 2015;76:1–5.  https://doi.org/10.1016/j.aap.2014.12.015.CrossRefPubMedGoogle Scholar
  34. 34.
    Partnership for Drug-Free Kids (formerly known as The partnership at DrugFree.org). (2013). 2012 Partnership Attitude Tracking Study. Teens and Parents. (2013). Retrieved from https://drugfree.org/wp-content/uploads/2013/04/PATS-2012-FULL-REPORT2.pdf.
  35. 35.
    Voepel-Lewis T, Wagner D, Tait AR. Leftover prescription opioids after minor procedures: an unwitting source for accidental overdose in children. JAMA Pediatr. 2015;169(5):497–8.  https://doi.org/10.1001/jamapediatrics.2014.3583.CrossRefPubMedGoogle Scholar
  36. 36.
    Garbutt JM, Kulka K, Dodd S, Sterkel R, Plax K. Opioids in adolescents’ homes: prevalence, caregiver attitudes, and risk reduction opportunities. Acad Pediatr. 2018;19:103.  https://doi.org/10.1016/j.acap.2018.06.012.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    McDonald R, Campbell ND, Strang J. Twenty years of take-home naloxone for the prevention of overdose deaths from heroin and other opioids-conception and maturation. Drug Alcohol Depend. 2017;178:176–87.  https://doi.org/10.1016/j.drugalcdep.2017.05.001.CrossRefPubMedGoogle Scholar
  38. 38.
    Lankenau SE, Teti M, Silva K, Jackson Bloom J, Harocopos A, Treese M. Initiation into prescription opioid misuse amongst young injection drug users. Int J Drug Policy. 2012;23(1):37–44.  https://doi.org/10.1016/j.drugpo.2011.05.014.CrossRefPubMedGoogle Scholar
  39. 39.
    Schepis TS, Krishnan-Sarin S. Sources of prescriptions for misuse by adolescents: differences in sex, ethnicity, and severity of misuse in a population-based study. J Am Acad Child Adolesc Psychiatry. 2009;48(8):828–36.  https://doi.org/10.1097/CHI.0b013e3181a8130d.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Johnston LD, O’Malley PM, Miech RA, Bachman JG, Schulenberg JE. Monitoring the Future national survey results on drug use,1975–2015: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research.The University of Michigan; 2016.Google Scholar
  41. 41.
    Miech R, Johnston L, O’Malley PM, Keyes KM, Heard K. Prescription opioids in adolescence and future opioid misuse. Pediatrics. 2015;136(5):e1169–77.  https://doi.org/10.1542/peds.2015-1364.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    McCabe SE, Veliz P, Schulenberg JE. Adolescent context of exposure to prescription opioids and substance use disorder symptoms at age 35: a national longitudinal study. Pain. 2016;157(10):2173–8.  https://doi.org/10.1097/j.pain.0000000000000624.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Hooten WM, Brummett CM, Sullivan MD, Goesling J, Tilburt JC, Merlin JS, et al. A conceptual framework for understanding unintended prolonged opioid use. Mayo Clin Proc. 2017;92(12):1822–30.  https://doi.org/10.1016/j.mayocp.2017.10.010.CrossRefPubMedGoogle Scholar
  44. 44.
    Hooten WM, St Sauver JL, McGree ME, Jacobson DJ, Warner DO. Incidence and risk factors for progression from short-term to episodic or long-term opioid prescribing: a population-based study. Mayo Clin Proc. 2015;90(7):850–6.  https://doi.org/10.1016/j.mayocp.2015.04.012.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Whiteside LK, Russo J, Wang J, Ranney ML, Neam V, Zatzick DF. Predictors of sustained prescription opioid use after admission for trauma in adolescents. J Adolesc Health. 2016;58(1):92–7.  https://doi.org/10.1016/j.jadohealth.2015.08.011.CrossRefPubMedGoogle Scholar
  46. 46.
    Harbaugh CM, Lee JS, Hu HM, McCabe SE, Voepel-Lewis T, Englesbe MJ, et al. Persistent opioid use among pediatric patients after surgery. Pediatrics. 2018;141(1):e20172439.  https://doi.org/10.1542/peds.2017-2439.CrossRefPubMedGoogle Scholar
  47. 47.
    Quinn PD, Hur K, Chang Z, Scott EL, Krebs EE, Bair MJ, et al. Association of mental health conditions and treatments with long-term opioid analgesic receipt among adolescents. JAMA Pediatr. 2018;172(5):423–30.  https://doi.org/10.1001/jamapediatrics.2017.5641.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Krane EJ, Weisman SJ, Walco GA. The national opioid epidemic and the risk of outpatient opioids in children. Pediatrics. 2018;142(2):e20181623.  https://doi.org/10.1542/peds.2018-1623.CrossRefPubMedGoogle Scholar
  49. 49.
    Groenewald CB, Law EF, Fisher E, Beals-Erickson SE, Palermo TM. Associations between adolescent chronic pain and prescription opioid misuse in adulthood. J Pain. 2019;20(1):28–37.  https://doi.org/10.1016/j.jpain.2018.07.007.CrossRefPubMedGoogle Scholar
  50. 50.
    Chou R. 2009 clinical guidelines from the American Pain Society and the American Academy of Pain Medicine on the use of chronic opioid therapy in chronic noncancer pain: what are the key messages for clinical practice? Pol Arch Med Wewn. 2009;119(7–8):469–77.PubMedGoogle Scholar
  51. 51.
    Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113–30.  https://doi.org/10.1016/j.jpain.2008.10.008.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Mu A, Weinberg E, Moulin DE, Clarke H. Pharmacologic management of chronic neuropathic pain: review of the Canadian Pain Society consensus statement. Can Fam Physician. 2017;63(11):844–52.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Nuckols TK, Anderson L, Popescu I, Diamant AL, Doyle B, Di Capua P, Chou R. Opioid prescribing: a systematic review and critical appraisal of guidelines for chronic pain. Ann Intern Med. 2014;160(1):38–47.  https://doi.org/10.7326/0003-4819-160-1-201401070-00732.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Anand KJ, International Evidence-Based Group for Neonatal, P. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med. 2001;155(2):173–80.CrossRefGoogle Scholar
  55. 55.
    World Health Organization. WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses. Geneva: World Health Organization; 2012.Google Scholar
  56. 56.
    Parniczky A, Abu-El-Haija M, Husain S, Lowe M, Oracz G, Sahin-Toth M, et al. EPC/HPSG evidence-based guidelines for the management of pediatric pancreatitis. Pancreatology. 2018;18(2):146–60.  https://doi.org/10.1016/j.pan.2018.01.001.CrossRefPubMedGoogle Scholar
  57. 57.
    Fletcher ND, Glotzbecker MP, Marks M, Newton PO, Harms Study G. Development of consensus-based best practice guidelines for postoperative care following posterior spinal fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2017;42(9):E547–54.  https://doi.org/10.1097/BRS.0000000000001865.CrossRefGoogle Scholar
  58. 58.
    Ericsson E, Brattwall M, Lundeberg S. Swedish guidelines for the treatment of pain in tonsil surgery in pediatric patients up to 18 years. Int J Pediatr Otorhinolaryngol. 2015;79(4):443–50.  https://doi.org/10.1016/j.ijporl.2015.01.016.CrossRefPubMedGoogle Scholar
  59. 59.
    Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131–57.  https://doi.org/10.1016/j.jpain.2015.12.008.CrossRefGoogle Scholar
  60. 60.
    Herndon CM, Arnstein P, Darnall B, Hartrick C, Hecht K, Lyons M, Maleki J, Manworren R, Miaskowski C, Sehgal N. American Pain Society’s Principles of Analgesic Use, 7th ed. 2016.Google Scholar
  61. 61.
    Bohnert ASB, Guy GP Jr, Losby JL. Opioid prescribing in the United States before and after the centers for disease control and prevention’s 2016 opioid guideline. Ann Intern Med. 2018;169(6):367–75.  https://doi.org/10.7326/M18-1243.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Monitto CL, Hsu A, Gao S, Vozzo PT, Park PS, Roter D, et al. Opioid prescribing for the treatment of acute pain in children on hospital discharge. Anesth Analg. 2017;125(6):2113–22.  https://doi.org/10.1213/ANE.0000000000002586.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Parikh JM, Amolenda P, Rutledge J, Szabova A, Chidambaran V. An update on the safety of prescribing opioids in pediatrics. Expert Opin Drug Saf. 2019;18:1–17.  https://doi.org/10.1080/14740338.2019.1571037.CrossRefGoogle Scholar
  64. 64.
    Franklin G, Sabel J, Jones CM, Mai J, Baumgartner C, Banta-Green CJ, et al. A comprehensive approach to address the prescription opioid epidemic in Washington State: milestones and lessons learned. Am J Public Health. 2015;105(3):463–9.  https://doi.org/10.2105/AJPH.2014.302367.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Walco G. Managing chronic non-cancer pain in children and adolescents. In: W. S. A. M. D. Group, editor. Interagency guideline on prescribing opioids for pain. 3rd ed. Olympia: State of Washington; 2015. p. 45–7.Google Scholar
  66. 66.
    Collaborative B. (2017). Dental guideline on prescribing opioids for acute pain management. Retrieved from http://www.breecollaborative.org/wp-content/uploads/Dental-Opioid-Recommendations-Final-2017.pdf.
  67. 67.
    Denisco RC, Kenna GA, O’Neil MG, Kulich RJ, Moore PA, Kane WT, et al. Prevention of prescription opioid abuse: the role of the dentist. J Am Dent Assoc. 2011;142(7):800–10.CrossRefGoogle Scholar
  68. 68.
    Harbaugh CM, Nalliah RP, Hu HM, Englesbe MJ, Waljee JF, Brummett CM. Persistent opioid use after wisdom tooth extraction. JAMA. 2018;320(5):504–6.  https://doi.org/10.1001/jama.2018.9023.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Collaborative B. (2018). Prescribing opioids for postoperative pain. Retrieved from http://www.breecollaborative.org/wp-content/uploads/Supplemental-Bree-AMDG-Postop-pain-Draft-Final.pdf.

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • See Wan Tham
    • 1
    Email author
  • Cornelius B. Groenewald
    • 1
  • Gary A. Walco
    • 1
  1. 1.Anesthesiology and Pain MedicineSeattle Children’s HospitalSeattleUSA

Personalised recommendations