Fran Lowry

October 01, 2013

ORLANDO, Florida — Conditions associated with pain in children are common, yet pharmacologic treatments for pain are prescribed in less than half of patients, according to new research.

In a study that included data on 25.5 million pediatric patients from the United States with a variety of painful conditions, up to 76% did not receive any prescription analgesics, according to lead author Laura Wallace, MPH, from Purdue Pharma, LP, Stamford, Connecticut, which also funded the study.

"Basically, these kids are not getting treated," Wallace said here at American Academy of Pain Management (AAPM) 24th Annual Clinical Meeting.

"Thankfully, the prevalence of pain in kids is very low, although it does increase with age. For example, you see a lot more painful conditions in the older adolescents, in the 12- to 16-year-olds," she told Medscape Medical News.

"But the real take-home is that a lot of the conditions that we know are associated with pain and that are being treated with analgesics in adults are not being treated in kids," she said.

Wallace and her team used Market Scan Commercial and Medicaid databases to better understand the prevalence of conditions associated with acute and chronic pain in pediatric patients, and also to characterize pediatric pain treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 inhibitors, and immediate-release or extended-release opioids.

Laura Wallace

Conditions associated with pain included orthopedic conditions, malignancies, surgeries, trauma, genetic conditions, arthritis, and migraine.

Of the millions of children in the databases, the most common condition associated with pain was trauma, in 3.5% of the population, followed by malignancies in 1.8%, orthopedic conditions in 1%, genetic conditions in 0.7%, and surgeries in 0.3%.

In addition, 8.7% of children other pain conditions, including arthritis (osteoarthritis and rheumatoid arthritis), abdominal pain, fibromyalgia, lupus, neuropathy, osteonecrosis, trigeminal neuralgia, and avascular necrosis.

The majority of children, regardless of their condition, went without pharmacologic treatment.

Table. Proportion of Untreated Patients by Pain Condition

Condition Untreated Patients (%)
Orthopedic 66
Malignancies 75
Surgeries 75
Trauma 73
Genetic 76
Other 70


"Some of these children may be receiving over-the-counter NSAIDs; that seems pretty likely," Wallace said.

"But for surgeries, only about 20% are getting some kind of immediate-release opioid, 5% were getting a prescription NSAID, 0.3% were getting an extended-release opioid, but 75% are not being prescribed anything. They may be receiving treatment while they are in hospital, but once they are out of hospital and recovering, they are not receiving those prescriptions."

An Underserved Population

"This study alerts us to the fact that only a minority of children are getting any type of pain medication," Thomas Watson, DPT, a physical therapist in Bend, Oregon, told Medscape Medical News.

"This is an underserved population because we don't know all the effects of these medications on kids," Dr. Watson said.

Thomas Watson

As a physical therapist, Dr. Watson said he uses nonpharmacologic methods to help alleviate pain in his pediatric patients.

"I get my 2- and 3-year-olds who have had brain surgeries, or my kids with severe juvenile rheumatoid arthritis, on a very gentle movement program, if it is indicated. I use a lot of transcranial electrical stimulation, which is considered to be safe with these kids, and it works," he said.

He also uses cold laser. "I tell them it's Buzz Lightyear's communication device. Many of these pediatric patients are in so much pain, even the softest touch is too painful for them, but I can use the laser beam or a light beam on them and it works," he said.

This study was sponsored by Purdue Pharma L.P. Ms. Wallace is an employee of Purdue Pharma. Dr. Watson has disclosed no relevant financial relationships.

American Academy of Pain Management (AAPM) 24th Annual Clinical Meeting. Abstract # 12. Presented September 27, 2013.


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