Opioids for Acute Pain Management in Children and Adolescents

• This patient summary is specifically for children and adolescents in outpatient settings (i.e. those not currently in the hospital), and only for the use of opioids in the management of acute pain.
  • Acute pain is short-lived and usually goes away once the underlying cause is treated. Examples of conditions that may result in acute pain include: broken bones, burns or cuts, some dental work, and pain after surgery.
  • Chronic pain is ongoing and can last for months or years. Examples of conditions that may result in chronic pain include: arthritis, fibromyalgia, and certain types of cancers and the medications that treat them.
• When treating acute pain, any use of opioids should be as one component of a multimodal approach that may also include one or more of the following:
  • Non-pharmacological treatment: these are treatments that do not involve medications or drugs
    • Examples include: physical therapy, ice and heat treatments, mind-body practices (e.g., yoga, tai chi), and massage
  • Non-opioid treatment: these are treatments that may involve medications that are not opioids
    • Examples include: topical or oral nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen
  • Lifestyle changes: these are things that can be done in daily life
    • Example include: diet, stress relief and relaxation, and exercise
• Opioids come in many different strengths and formulations, with the most common administration route being oral, as either tablets, capsules, or liquids. These can be further categorized as either extended release or immediate release.
  • Extended release medications are generally only taken once or twice a day. They are specially designed to provide a pre-designated amount of medication throughout the day.
  • As the name suggests, the benefit of immediate release medications is that they work quickly to start relieving pain. The disadvantage is the relief does not last longer than a few hours, so they may need to be taken more frequently.
• The decision to use opioids, and the specific opioids that may be used, often depends on one or more of the following:
  • The age of the patient
  • Whether the pain is chronic, acute, or both
  • The presence of any other pre-existing conditions, such as sleep apnea or severe lung diseases
  • Other medications being taken, especially sedating medications, such as benzodiazepines
  • And more

• Naloxone is used to treat an opioid overdose (it works only for overdoses from opioids). It is available as a nasal spray and in an injectable form.
• Having naloxone available can help to save a person who has taken so much opioid that they stop or have trouble breathing.
• If an overdose is suspected, call 911 immediately and give naloxone as soon as possible.
• More than one dose of naloxone may be needed to reverse an overdose of high potency opioids such as fentanyl. Naloxone may need to be given multiple times since its effects may wear off before the opioid does.
• To ensure patient safety, patients, their family members, significant others, and friends should keep naloxone on hand and should be trained in its use in case of overdose.
• The clinician should provide naloxone, or a prescription for naloxone, for both the patient and family members. Naloxone is also available without a prescription through the pharmacy.

AN OPIOID OVERDOSE NEEDS IMMEDIATE MEDICAL ATTENTION

• DO Call for Help (Dial 911)
• DO support the person’s breathing by administering oxygen or performing rescue breathing.
• DO administer naloxone (a drug that reverses the effect of opioids) as an injection or a nasal spray.
• ALL FRIENDS/FAMILY SHOULD HAVE NALOXONE AND KNOW HOW TO USE IT.
• DO put persons on their side if they are breathing independently.
• DO stay with the person and keep them warm.
• DON’T slap or try to forcefully stimulate the person—it will only cause further injury. If shouting, rubbing knuckles on the sternum (center of the chest or rib cage), or light pinching will not awaken the person, he or she may be unconscious.
• DON’T put the person into a cold bath or shower. This increases the risk of falling, drowning or going into shock.
• DON’T inject the person with any substance (salt water, milk, “speed,” heroin, etc.). The only safe and appropriate treatment is naloxone.
• DON’T try to make the person vomit drugs that he or she may have swallowed. Choking or inhaling vomit into the lungs can cause death.