Procedural Pain Management: Clinical Practice Recommendations.

Undergoing potentially painful procedures is necessary among patients of all ages. Nurses are responsible to optimize safety and minimize harm for patients. The American Society for Pain Management Nursing (ASPMN) holds the position that all patients undergoing painful procedures have the right to safe and effective pain management throughout the phases of care, and that the interprofessional healthcare team ensures such ethical obligation is fulfilled within a framework of the patients or their designees' goals and preferences. From that position, all nurses, clinicians, and health care organizations are strongly encouraged to offer multimodal pain management that includes integrative interventions when managing procedure related pain.

Procedural Pain Management: Clinical Practice Recommendations American Society for Pain Management Nursing.

Throughout the life span procedures are common within health care and have the potential to cause pain. Nurses have an ethical responsibility involving the care of people with pain. The American Society for Pain Management Nursing holds the position that all patients undergoing painful procedures have the right to safe and effective pain management throughout the phases of care and that the interprofessional health care team ensures such ethical obligation is fulfilled within a framework of patients or their designees' goals and preferences. It is recommended that nurses, other health care providers, and health care organizations offer the use of integrative intervention for managing pain during procedures.

Effects of the FDA Codeine Safety Investigation on Racial and Geographic Disparities in Opioid Prescribing after Pediatric Tonsillectomy and/or Adenoidectomy.

Objective. Our objective was to examine the impact of the U.S. FDA's 2013 black box warning against codeine on codeine and other opioid prescription filling after pediatric tonsillectomy and/or adenoidectomy (T/A) overall and by child race and provider urbanity/rurality. Methods. Patients ≤ 18 who underwent T/A in 8/2011 to 8/2016 were identified in Ohio Medicaid claims. Interrupted time series analyses were used to evaluate the impact of the FDA warning on codeine or other opioid prescription filling post-T/A. Results. In August 2011, codeine prescription filling was lower among black than white children (P < .001) and among children treated at institutions in metropolitan counties than less populous counties (P < .001). The FDA warning was associated with a 24.0% drop in codeine prescription filling (P < .001) and 5.5% increase in alternative opioid prescription filling (P = .046). At conclusion, there remained geographic but no longer racial disparities in codeine prescribing. Conclusion. Codeine prescribing after pediatric T/A decreased after the FDA's black box warning. However, geographic disparities in codeine prescribing remain.

Chronic Pain and Mental Health Co-Morbidity in Adolescents: An Urgent Call for Assessment and Evidence-Based Intervention.

BACKGROUND: Nearly 30% of children are affected by chronic pain which puts a significant burden on the child's family and society with estimated cost of over $19.5 billion each year. Children and adolescent's quality of life is often impacted leading to physical disability, low self-esteem, depression, anxiety, school stress or decreased performance, insomnia, and fatigue. The purposes of this paper are to: 1) provide an overview of chronic pain in children and adolescents; 2) describe findings from a quality improvement project that assessed the prevalence of negative mood, quality of life, functional disability, and coping with pain in teens with chronic pain, and 3) discuss screening, assessment and evidence-based management of co-morbid chronic pain and mental health problems in children and teens. FINDINGS: Findings for a quality improvement project indicated that 16.8% of the adolescents scored high risk for depression, which was higher than the national average. Approximately 57% of adolescents were screened as high risk on the Pediatric Quality of Life inventory (PedsQL™). One in four adolescents showed poor functioning on the Functional Disability Inventory and nearly one-third of the adolescents reported poor coping with pain on the Pain Coping Questionnaire. This project indicates that adolescents with chronic pain are at high risk for mental health problems. The outcomes suggest the mental health needs of adolescents with chronic pain need to be identified and addressed to help improve outcomes. DISCUSSION: Children and youth with chronic pain need to be routinely screened and assessed for mental health problems, especially anxiety and depression. The use of Cognitive Behavioral Therapy (CBT) or CBT-skills building for children and youth with anxiety and depressive disorders has been widely studied and are helpful for children with chronic pain include psychoeducation, which helps the child to learn age and developmental specific information on chronic pain. Evidence-based manualized and internet-based CBT programs should be scaled rapidly to decrease depression and anxiety in children and youth with chronic pain.

Opioid Prescription Filling Trends Among Children with Sickle Cell Disease After the Release of State-Issued Guidelines on Pain Management.

OBJECTIVE: To assess the impact of Ohio's 2012, 2013, and 2016 opioid prescribing guidelines on opioid and nonsteroidal anti-inflammatory drug (NSAID) prescription filling and health care utilization for pain among children with sickle cell disease (SCD). DESIGN: Quasi-experimental retrospective cohort study. SETTING: Ohio Medicaid claims data from August 2011 to August 2016. SUBJECTS: Medicaid beneficiaries under age 19 years with SCD. METHODS: Interrupted time series analyses comparing population-level rates of opioids and NSAID prescriptions filled, standardized amounts of opioids dispensed, and acute health care utilization for pain before and after release of each guideline. RESULTS: In our cohort of 1,505 children with SCD, there was a temporary but significant decrease in the opioid filling rate (-2.96 prescriptions per 100 children, P = 0.01) and in the amount of opioids dispensed (-31.39 milligram morphine equivalents per filled prescription, P < 0.001) after the 2013 guideline but a temporary but significant increase in the opioid filling rate (7.44 prescriptions per 100 children, P < 0.001) and in the amount of opioids dispensed (72.73 mg morphine equivalents per filled prescription, P < 0.001) after the 2016 guideline. The NSAID filling rate did not significantly change after any of the guidelines. Acute health care utilization rates for pain after the 2016 guideline were similar to those before the 2013 guideline (rate ratio = 1.04, P = 0.63). CONCLUSIONS: Our results suggest that Ohio's 2013 and 2016 guidelines were associated with significant but nonsustained changes in opioid prescription filling among children with SCD. Additional studies are needed to confirm that opioid guidelines have a sustained impact on excessive opioid prescribing, filling, and misuse.

Racial Disparities in Receipt of Postoperative Opioids After Pediatric Cholecystectomy.

BACKGROUND: Pediatric postoperative opioid prescribing has come under scrutiny as a result of the ongoing opioid epidemic. Previous research has demonstrated that African American adults are less likely to receive analgesics, particularly opioids, after surgery, even after controlling for pain severity. We sought to examine racial disparities in the filling of opioid prescriptions by pediatric surgical patients after cholecystectomy. METHODS: We studied patients aged 1 to 18 y who were enrolled in Ohio Medicaid and underwent cholecystectomy. Procedures performed in January 2013-July 2016 were included. The percentage of patients who filled a postoperative opioid prescription within 14 d of their procedure was compared between black and white patients using log binomial regression models fit using generalized estimating equations to account for patient clustering within hospitals. RESULTS: We identified 1277 patients who underwent a cholecystectomy. In unadjusted analyses, black children were significantly less likely than white children to fill an opioid prescription postoperatively (74.9% versus 85.7%, P < 0.001). After adjustment for patient-level clinical and demographic characteristics, we found that black children treated at non-children's hospitals in large-/medium-sized urban counties were significantly less likely to fill an opioid prescription after cholecystectomy when compared with white children treated at urban children's hospitals or to white children treated in non-children's hospitals in either large/medium urban counties or other counties. However, this association was partly explained by a longer average length of stay among black children. CONCLUSIONS: Black children who undergo cholecystectomy at urban non-children's hospitals are less likely to fill a postoperative opioid prescription than white children who undergo cholecystectomy at those same hospitals or other hospitals. Further research is needed to identify whether this disparity is due to a lower rate of opioid prescribing or a lower rate of prescription filling.

Barriers to Pediatric Pain Management: A Brief Report of Results from a Multisite Study.

BACKGROUND: Pain management is essential for the care of hospitalized children. Although multiple barriers have been identified that interfere with nurses' ability to provide optimal pain management, it is not known how pervasive are these barriers across the United States. AIMS: This study is the third in a series of studies examining barriers to pediatric pain management. The aim of this study was to examine barriers in different organizations using the same tool during the same period of time. SETTINGS/PARTICIPANTS: A sample of 808 nurses from three pediatric teaching hospitals responded to a survey addressing barriers to optimal pain management for children. RESULTS: Barriers unanimously identified as being most significant included inadequate or insufficient physician medication orders, insufficient time allowed to premedicate before procedures, insufficient premedication orders before procedures, and low priority given to pain management by medical staff. CONCLUSIONS: Barriers identified as the most and least significant were similar regardless of hospital location. Revealing similar barriers across multiple pediatric hospitals provides direction for nurses trying to provide solutions to these pain management barriers.