Adolescents, Acute Pain and The Risk of Opioid Addiction
It is important to understand that this information does NOT apply for individuals with chronic pain. Chronic (long-term) pain needs to and should be managed by a dedicated specialist who is trained in safely and effectively managing pain in pediatric patients. Sometimes narcotics are indicated, but many times these specialists can effectively manage pain with other approaches.
The risk we are discussing relates to ACUTE (short-term) pain; ailments you might take your adolescent to an outpatient surgery center or urgent care to address. Examples include minor surgeries, tooth extractions, sports injuries (ex. sprains and fractures), and lacerations.
In order to manage pain for these conditions it is important to understand the following:
1. Adolescents and Pain Adolescents usually don’t have the context to understand pain on a pain scale. So, it is usually not helpful to ask them to rate pain on a scale of 1 to 10. When assessing their pain, it’s more important to assess how easily they are able to rest, sleep and hydrate. If their pain is severe enough that they cannot get any rest, then it might be necessary to manage their pain more aggressively. If narcotics are indicated, it is important to use the lowest therapeutic dose for the shortest possible duration, switching to another form of pain management (ex. pediatrician-guided therapeutic doses of Tylenol and Ibuprofen) as soon as possible.
2. The Expectation of Pain Eradication vs. Pain Management When it comes to acute (short-term) pain, it is important to understand that it is not a realistic expectation to eradicate ALL pain. This expectation is what leads to the over-prescription of addictive, unnecessary substances. Our goal is to reduce pain to a level where your adolescent can sleep, rest and hydrate so they can heal safely and effectively. Their bodies are going to need to experience discomfort in this process. That is normal, temporary, and to be expected.
3. Appreciate the Value of Pain as an Informant Pain can be a great informant that can be used to help guide appropriate activities for healing. When pain is induced by certain actions, it can be used to guide which activities are safe to resume. Narcotics will only mask pain and risk further injury. Never underestimate the value of supportive measures like icepacks, elevating the injury and rest. These are far more therapeutic in the healing process than masking the symptom of pain.
As we endeavor to reduce the risk of addiction by educating and empowering our families, we want to make sure we are offering an accurate and balanced approach.
I DO want to acknowledge that narcotics definitely have a very important place in medicine. I will never forget a particular night shift in the Pediatric ER where I admitted a teen who had broken his femur so badly that it was shifted a full 30 degrees. My patient was in such excruciating pain, that I was SO grateful to have opioids at my disposal to be able to offer him some relief until we could get him into surgery. That one dose certainly didn’t expose him to a risk of addiction, and it offered him a humane level of pain relief that sometimes only narcotics can offer.
When used APPROPRIATELY and RESPONSIBLY, opioids DO have value. Since we cannot yet trust our healthcare system to responsibly manage their use, it is our greatest hope that we have helped our parents understand enough to advocate for our teens in a humane, appropriate and responsible way. Remember – if you are confused or have any questions, you can ALWAYS call us! We are here to lay a safe and healthy foundation for our families!