The American Academy of Pediatrics (AAP) has recently published a clinical practice guideline (CPG) on Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings. This marks a significant milestone for the AAP, as it is their inaugural CPG on opioid prescribing. The release of this guideline is particularly noteworthy given the intense scrutiny surrounding this topic in the United States, stemming from past challenges and controversies.
Pain is a prevalent symptom that often leads children, teens and their families to seek medical attention. Opioids have traditionally played a major role in managing severe pain in pediatric patients. However, the recent trend of decreased opioid prescriptions for children may result in both appropriate and inappropriate use being reduced. This shift in prescribing practices raises concerns about the potential undertreatment of severe pain in pediatric patients. It is essential to ensure that children receive adequate pain management, especially when other interventions have proven ineffective. By addressing the challenge of providing this CPG to healthcare providers, AAP demonstrates their dedication and commitment to enhancing care for children and families. This is achieved by integrating the most effective clinical recommendations with the human elements of past experiences.
In this discussion, we will delve into the key takeaways and insights surrounding the guideline’s recommendations for Opioid Prescribing in Children and Adolescents in an Outpatient Setting. Please note that this list does not encompass all major points. For a complete list of recommendations, refer to the full text guideline located here.
Key Takeaways and Recommendations:
This CPG is designed for pediatric healthcare providers (PHCPs) who are responsible for prescribing opioids to children and adolescents under the age of 21 in outpatient settings. The focus of this guideline is on managing acute pain (pain lasting less than one month), as opposed to subacute (1-3 months), chronic pain (more than 3 months), or palliative and end-of-life pain. The goal is to strike a balance between effectively managing pain with opioids, when necessary, while also considering the potential risks associated with this class of medication.
Within this CPG are 12 key action statements (KASs) that provide guidance on best practices for prescribing opioids to pediatric patients.
Let’s briefly explore a few of the KASs:
- A Multimodal Approach:
- This approach includes the appropriate use of nonpharmacologic therapies, nonopioid medications, and, when needed, opioid medications. Opioids should not be prescribed as monotherapy for children or adolescents.
- Dosing Guidance:
- Follow age-appropriate dosing guidelines when prescribing opioids. Ensure dosages are carefully calculated based on weight and severity of pain. For acute pain in children and adolescents, PHCPs should opt for immediate-release opioid formulations, initiate treatment with the lowest age- and weight-appropriate doses and limit the initial supply to 5 days or less, unless the pain is associated with trauma or surgery expected to last longer than 5 days.
- Educating Families and Caregivers:
- Equip families with naloxone and educate them on the signs of an overdose and on how to use naloxone in case of an opioid overdose. Educate caregivers about safe storage as well as safe disposal of unused medications, help caregivers develop a plan to safely dispose of unused medications.
There you have some key points from this important CPG. Hopefully, this CPG will guide clinicians in providing optimal treatment for acute pain in children and adolescents, while also helping them to minimize and manage any risks associated with opioid use. We strongly recommend reading the CPG in its entirety.
Thank you for reading our Guidelines Spotlight on Opioid Prescribing in Children and Adolescents in an Outpatient Setting. We value your thoughts and feedback as we endeavor to provide you with valuable insights in our future spotlights.
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