Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids

Abstract

Opioid therapy is the cornerstone of treatment for acute procedural and postoperative pain and is regularly prescribed for severe and debilitating chronic pain conditions. Although beneficial for many patients, opioid therapy may have side effects, limited efficacy, and potential negative outcomes. Multidisciplinary pain management treatments incorporating pharmacological and integrative non-pharmacological therapies have been shown to be effective in acute and chronic pain management for pediatric populations. A multidisciplinary approach can also benefit psychological functioning and quality of life, and may have the potential to reduce reliance on opioids. The aims of this paper are to: (1) provide a brief overview of a multidisciplinary pain management approach for pediatric patients with acute and chronic pain, (2) highlight the mechanisms of action and evidence base of commonly utilized integrative non-pharmacological therapies in pediatric multidisciplinary pain management, and (3) explore the opioid sparing effects of multidisciplinary treatment for pediatric pain.

Keywords: acupuncture; cognitive behavioral therapy; hypnosis; mindfulness-based stress reduction; multidisciplinary pain management strategies; non-pharmacological therapy; opioid reduction therapy; pain rehabilitation.

Figure 1

Multidisciplinary pain management treatment: key components in acute and chronic pain management. This figure displays the key treatment components in multidisciplinary treatment for both acute and chronic pain. In the acute setting, in addition to reduction of pain, the efficacy of multidisciplinary treatments is often measured by reduction in needed opioid doses to achieve comfort, while in the setting of chronic pain, the improvements obtained through a multidisciplinary approach are often measured by improvements in function. As is clinically appropriate, in both settings, pharmacologic treatments are combined with regional interventions [26], integrative non-pharmacological techniques, and rehabilitative services as is clinically appropriate to support pain management and improve patients’ pain symptoms, functioning and quality of life. Multidisciplinary analgesia treatment aims to ensure patient comfort and wellbeing, while at the same time potentially decreasing the need for opioid use in pediatric populations [25].

Figure 2

Multidisciplinary pain management: acute and chronic pain algorithms. In acute pain algorithms, the initial treatment begins with regional techniques or intravenous analgesia as a mainstay of therapy. As acute pain improves, therapies are then transitioned as appropriate to varying strengths of PO opioid medications, to adjuvants/NSAIDS, and ultimately integrative non-pharmacological strategies. For situations where severe pain is anticipated, adjuvants and integrative non-pharmacological strategies may be added on at the beginning of treatment, as an opioid sparing strategy, and to increase patient comfort. In chronic pain algorithms, treatment is delivered in the reverse order, beginning with integrative non-pharmacological techniques, then moving to adjuvants, and ultimately progressing to various strengths of opioids and regional techniques and stimulators as clinically appropriate.