Pain and Opiates
November 21, 2017
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Anyone following news even occasionally is likely aware of the terrible scourge of opiate addiction sweeping our nation.  Many consider Ocean county to be an epicenter of the problem.  Both the origins and the treating factors are multifactorial–economic, social, educational, legal, technologic, even religious.  And medical–certainly physician prescribing practices contribute.  I think we doctors simply must endeavor to be more cautious and aware when faced with the challenge of treating pain.

There are several studies published currently that look at the use of opiate vs. non-opiates for post-operative pain management for common uncomplicated surgical situations.  Recently the Canadian Medical Journal compared ibuprofen to morphine after simple orthopedic procedures like fracture reduction.  154 children were enrolled from 2013-16 for either medicine.  Pain control was similar for both drugs after the first dose and after multiple treatments.  Not surprisingly, side effects were more common with morphine compared to ibuprofen: nausea (30% vs. 13%), vomiting (12% vs. 3%), drowsiness (31% vs. 15%), dizziness (20% vs. 4%), constipation (9% vs 3%) or “any” (45% vs 26%).

The results of this study were similar to one from 2015 in Pediatrics comparing the same drugs post-tonsillectomy.  There 91 children were observed and the ibuprofen group actually reported better pain relief (68% vs 14%) with fewer incidents of respiratory depression and no difference in post operative bleeding.

So where does that leave us? In each analysis there is very good evidence that the simpler, milder, non-addictive agent is at least as good as the “stronger” opiate painkiller.  Now, while there currently aren’t studies for every clinical situation, I think it is not unreasonable to extrapolate to comparable common surgical/trauma/pain issues like dental procedures and oral surgery, suturing, moderate burns, or outpatient abscess drainage: likely at least as effective to use the milder OTC analgesics like ibuprofen or acetaminophen.  And certainly safer for the child and for the larger community to stay away from the addictive stuff.  Please keep this in mind should your child require such interventions.

For questions about pain management or any other conditions, please don’t hesitate to call, and thanks for following.