The Clinical journal of pain
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The increase in opioid-related deaths in the United States (and other countries) has prompted a national debate in medicine about the appropriateness of opioids for the treatment of acute and chronic pain, and specifically in children, if medical opioid use causes or increases the risk of opioid use disorder (OUD) later in life. Some in the medical community and in government advocate withholding opioids from children after an arbitrary number of days of treatment, regardless of diagnosis. Here, I argue that opioid experimentation and misuse is no more common in children and adolescents today than 2 or 3 decades ago, that there is no compelling evidence that appropriate medical use of opioids leads to OUD, and that the epidemic of inadequately treated pain in children remains the more compelling issue.
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Meta Analysis
Efficacy of the Buzzy Device for Pain Management during Needle-Related Procedures: A Systematic Review and Meta-analysis.
This systematic review and meta-analysis examined the effectiveness of the Buzzy device combining cold and vibration for needle-related procedural pain in children. ⋯ The Buzzy device seems to be a promising intervention for procedural pain management in children. However, the comparative effect is uncertain due to the presence of significant heterogeneity and very low-quality evidence. There is a need to improve the methodological quality and rigor in the design of future trials to conclude to the efficacy of the Buzzy device.
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Understanding the molecular biology of opioid analgesia is essential for its proper implementation and mechanistic approach to its modulation in order to maximize analgesia and minimize undesired effects. By appreciating the molecular mechanisms intrinsic to opioid analgesia, one can manipulate a molecular target to augment or diminish a specific effect using adjuvant drugs, select an appropriate opioid for opioid rotation or define a molecular target for new opioid drug development. In this review, we present the cellular and molecular mechanisms of opioid analgesia and that of the associated phenomena of tolerance, dependence, and hyperalgesia. The specific mechanisms highlighted are those that presently can be clinically addressed.
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Children represent a patient demographic composed of multiple, unique subpopulations differentiated by rapidly changing age-related physiology, which includes the means of metabolizing opioids. Opioids are an important part of the pharmacological treatment of both acute and chronic pain. In both clinical medicine and clinical research, it is necessary to understand the differences in drug handling by age cohort in order to appropriately dose children to effect, and to avoid exacerbating deleterious adverse events with potentially grave sequelae. ⋯ Understanding how these variables change the pharmacokinetics and pharmacodynamics of each opioid is critical to the successful and safe management of pain in children.
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The entire field of medicine, not just anesthesiology, has grown comfortable with the risks posed by opioids; but these risks are unacceptably high. It is time for a dramatic paradigm shift. ⋯ Furthermore, there are a myriad of alternative analgesic strategies that provide superior analgesia, decrease recovery time, and have fewer side effects and risks associated with their use. In this article the negative consequences of opioid use for pain, appropriate alternatives to opioids for analgesia, and the available evidence in pediatric populations for both are described.