Opioids for acute pain in kids: Four things to know

According to the Centers for Disease Control and Prevention, an estimated 130 Americans die every day from an opioid overdose. Opioid use disorder can include addiction to heroin, as well as to fentanyl and other prescription opioid analgesics. In fact, research suggests that nearly 80 percent of heroin users report using prescription opioids first. It’s natural, then, for parents to have concerns about the role of opioids in managing their children’s post-operative pain.

“When we do use opioid drugs after surgery, it’s always as part of a comprehensive acute pain management approach,” says Dr. Christine Greco, director of the Inpatient Pain Service in the Department of Anesthesiology, Critical Care and Pain Medicine. Here, she offers more insight about opioids.

1. Opioids aren’t always necessary.

Studies show that opioid prescribing rates have started to decline. Yet pediatric providers still often prescribe more opioids than necessary for acute post-surgical pain. The pain specialists at Boston Children’s have long taken a more conservative approach to opioids, says Dr. Greco. “We use opioids very carefully and only when they are indicated,” she explains. “We don’t have to rely solely on traditional opioid-based pain management for kids to recover well after surgery.”

2. Parents and patients have options.

When possible, Dr. Greco and her colleagues prescribe non-opioid medications such as acetaminophen and ibuprofen, which can be effective and safer alternatives to opioids. “There’s very good evidence that these drugs can reduce pain and decrease the need for opioids,” she says. For eligible patients, the team also works with Boston Children’s Regional Anesthesia Program to provide regional nerve catheters. In this approach, a hollow tube called a catheter is left in place and allowed to infuse the affected area with local anesthetics. These can help make the surgical area numb, which can provide very good pain relief and reduce the need for opioids.  

3. Planning ahead can help manage pain.

When a child has a history of difficult-to-manage pain, the pain team may recommend that they come to the hospital for a consult before surgery. This allows clinicians to work with their family to create a plan to stay on top of pain, which may include learning cognitive behavioral techniques and other skills. The team also checks in with patients after discharge to make sure any remaining pain is being managed at home.  

4. Families should put safety first.

When it comes to opioids, parents understandably have a lot of concerns about addiction. But Dr. Greco and her colleagues advise families about other safety risks, too. “One of the biggest sources of opioids is unused pills in medicine cabinets,” she explains. “We teach families how to safeguard and dispose of leftover opioids to reduce the chance of inadvertent exposures, especially if there are younger kids in the home.”

Learn about the Inpatient Pain Service.