Children & Pain Relief

A study in journal for The American Academy of Pediatrics revealed that children may not be receiving enough pain medication after surgery. The study, Pediatric Pain After Ambulatory Surgery: Where's the Medication? found that while parents acknowledge their children's post-operative pain, many do not provide adequate pain relief.

A study in journal for The American Academy of Pediatrics revealed that children may not be receiving enough pain medication after surgery. The study, “Pediatric Pain After Ambulatory Surgery: Where’s the Medication?” found that while parents acknowledge their children’s post-operative pain, many do not provide adequate pain relief.

Researchers looked at  261 children ranging in age from 2 to 12 years of age who underwent a routine tonsillectomy. They found that 86 percent of parents rated their children as experiencing significant pain. However, 24 percent of those children received zero or one dose of pain medication throughout the day.

Why don’t parents administer appropriate pain medication? Three major reasons were cited:

  • Fear of medication dependence
  • Lack of knowledge about how children exhibit pain
  • Belief that pain medication should be used only as a last resort.

The authors suggest that providing parents with better education about round-the-clock management of pain and a better understanding as to how children express that they’re in pain could help increase the amount of post-operative medication children receive at home.

Another study looked at what was the best pain medication to give your child. The study looked at three commonly used medicines for kid’s pain and found which one works best. Even after decades of using Tylenol, ibuprofen, and codeine, we still do not have a definitive grasp on which is best for pain due to musculoskeletal injuries--things like bruises, and even fractures. But there hasn’t been a lot of research into this, which is why this new study sheds a lot of light on the issue.

An example is the story of  eight year old Lovie Taylor. She is dealing with a lot of pain. Her grandmother Rhonda reports,  "Lovie is here today because she had surgery, very intense surgery. A lot of pain, we came into the emergency room, she was in an awful lot of pain. Morphine is Lovie’s drug du jour.

But for most kids who come to the E.R., or even are just treated at home, the pain can be managed with less intense medicine… But which one is best? Tylenol? Ibuprofen? What about a narcotic like codeine? Dr. Ting An Lee, a pediatrician at Children’s Hospital at Montefiore, says, “You face a decision on which one do I choose. There haven’t been a lot of studies to necessarily compare, so this is the study is unique in that way.”

The research, in an issue of Pediatrics, compared acetaminophen, which is what Tylenol is, ibuprofen, which is what Motrin is, and codeine. The study looked at how well the medications worked for musculoskeletal injuries to the neck, back, arms or legs in kids who came to the emergency room.

The findings clearly show a pain relief advantage to ibuprofen, which acts both centrally in the brain pain centers and at the site of injury. We are talking about one dose. After one hour, more patients got adequate pain relief than those taking Tylenol or codeine. In fact, there’s no difference between tylenol and codeine in terms of pain relief

“Tylenol acts more centrally and the ibuprofen also is acting centrally but also has peripheral effects. That is the major difference between the two. Often times we will use ibuprofen because of what I mentioned before the peripheral effects and helping to reduce the swelling and the inflammation that comes along with these muscular-skeletal injuries,” says Dr. Lee.

But what about using more than one together? “I would not recommended using acetaminophen and Ibuprofen together to treat muscular skeletal pain because there haven’t been studies to show that it has been helpful and if you can stick with one medication its always a safer way,”

Dr. Lee advises. We should make a strong point that if the child doesn’t get relief, certainly within 24 hours, or worsening symptoms, like more swelling or pain, you should bring your child to the doctor. Using ibuprofen repeatedly can cause side effects like stomach irritation and bleeding. Codeine, though, which is a narcotic, is associated with more side effects than ibuprofen, so it appears there’s little reason to use it.

 


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