Choosing Wisely:

Don’t prescribe opioids for chronic pain management in patients with autoimmune disease.

Rationale and Comments: Opioids are generally acceptable in pediatric medicine for short-term pain control associated with surgery or trauma. They are not recommended for treatment of chronic pain. Research has shown morphine and similar medications are not superior to ibuprofen and have significantly more adverse effects (e.g., opioid dependence and withdrawal symptoms). Adverse effects may occur after as few as five days of use. Use of opioids for medical purposes in adolescence also increases the risk for long-term use and misuse in adulthood. Opioids do not reduce inflammation from active arthritis and should be reserved for short-term use in cases of severe pain secondary to joint damage. Long-term pain control should be addressed with a multidisciplinary approach combining pharmacologic, behavioral, and exercise-based modalities.
Sponsoring Organizations:
  • American Academy of Pediatrics – Section on Rheumatology
  • Sources:
  • Cochrane Database of Systematic Reviews
  • Disciplines:
  • Pediatric
  • Neurologic
  • Rheumatologic
  • References: • Eccleston C, Cooper T, Fisher E, Anderson B, Wilkinson N. Non-steroidal anti-inflammatory drugs (NSAIDs) for chronic non-cancer pain in children and adolescents. Cochrane Database Syst Rev. 2017;2(8).
    • Galinkin J, Koh J, Committee on Drugs, Section on Anesthesiology and Pain Medicine, American Academy of Pediatrics. Recognition and management of iatrogenically induced opioid dependence and withdrawal in children. Pediatrics. 2014;133(1):152-155.
    • Gmuca S, Sherry D. Fibromyalgia: treating pain in the juvenile patient. Paediatr Drugs. 2017;19(4):325-338.
    • Miech R, Johnston L, O’Malley P, Keyes K, Heard K. Prescription opioids in adolescence and future opioid misuse. Pediatrics. 2015;136(5):e1169-e1177.
    • Poonai N, Datoo N, Ali S, et al. Oral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: A randomized controlled trial. CMAJ. 2017;10(189(40)):E1252-E1258.

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