General Resources

Overview

When a child or youth has pain, their pain should be managed using a multimodal, biopsychosocial approach employing physical, psychological, and pharmacologic modalities.

Pharmacologic therapies should begin with nonopioid analgesia whenever possible. For various types of pain adding opioids may sometimes be necessary – this includes moderate to severe short-term pain, or long-term pain.

This toolkit section includes general resources about managing children’s and youths’ pain, and general information about opioid safety.

When opioids are prescribed and administered for pain, there are several considerations to ensure safer therapeutic use:

• Treat pain in a multimodal fashion, combining physical, psychological, and pharmacologic interventions to create the best pain-relief plan for each child/youth
• Physical (e.g., heat, ice, splinting) and psychological (e.g., distraction) treatments should be used for most children and youth with acute pain
• Chronic pain is best managed using combined treatment modalities (e.g., physiotherapy, occupational therapy), non-opioid medications, and counselling, and infrequently requires opioid use
• Non-opioid pharmacologic treatments (e.g., acetaminophen, ibuprofen, other NSAIDs) should be used before or at the same time as opioid options are prescribed
• When needed, opioid analgesia should be combined with non-opioid pharmacologic medications to ensure that only the lowest dose of opioids is used
• Opioid analgesia should be used for as short of a time as possible. As soon as a child or youth’s pain is better managed, they should be transitioned to an alternative non-opioid treatment
• Children, youth and their families should always be counselled about the potential side effects of opioid medications when prescribing or administering opioid analgesia
• Potential for higher-risk opioid use should be assessed using a validated risk assessment tool before prescribing or administering opioid analgesia
• Children and youth who are prescribed opioids for a longer term should be educated about the risks of physical and psychological dependence, as well as withdrawal

However, even when these risks are present, children with severe pain have the right to adequate pain management, which may include the use of opioids. Children and their families should share the decision making about whether opioid analgesia is appropriate for them with their healthcare provider.

“Children’s pain deserves attention and respect. Ignoring and under-treating their pain has important short and long-term effects for both the child’s well-being as well as their ability to get proper healthcare. Dispelling myths and sharing facts through easy-to-use toolkits like this can help make providing better pain care simpler for care providers.”

~ Dr. Samina Ali, Physician

Implicit bias and stigma in healthcare are significant contributors to health inequalities, poor treatment outcomes and avoidance of care.

To ensure equitable access to quality pain management, it is essential to be self-reflective and consider the conscious and unconscious perceptions and attitudes that drive effective and safe opioid prescribing for pain in youth.

There is a need for additional research and resources to address pain- and opioid-related stigma in youth with acute and chronic pain. The following resources contain general information on the role of stigma in the health system. The resources also include recommended ways of communicating about opioid use in compassionate, safe, and non-stigmatizing ways.

Stigma harms patients and considerations are needed for designing and delivering safe and equitable care.

Production of this document has been made possible through a financial contribution from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada.