Opioids are rarely used in pediatric patients, despite US Food and Drug Administration approval of oxycodone for children aged 11 to 16 years. Common alternatives include traditional analgesics and off-label use of pharmacologic therapies routinely used for chronic pain in adults.

Cognitive behavioral therapies that target coping skills to improve distress tolerance have shown benefit in pediatric patients with chronic pain, the authors note. Mindfulness interventions can bolster a child’s ability to self-monitor their physical and psychological states, and slow impulsive responses to discomfort. 

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“Parents inherently want what is best for their kids [and] generally can’t tolerate witnessing their child’s pain,” Rita Agarwal, MD, FAAP, told Clinical Pain Advisor.

“Parents and patients need to be encouraged to use all the tools they have available. We definitely need better treatments, better [non-opioid] medicines, and more targeted treatments,” Dr Agarwal emphasized.

Dr Agarwal is a professor of anesthesiology at Stanford University School of Medicine in Stanford, California, and chairperson of the American Academy of Pediatrics’ section on Anesthesiology and Pain Medicine. She was not involved in the review.

Aging Increases Vulnerability to Pain

Elderly patients have a high prevalence of chronic pain; estimates suggest that up to 79% of individuals over the age of 85 are affected. Pain in older adults is associated with reduced activity, falls, mood disorders, sleep disturbances, isolation, and substantial disability. Persistent pain can lead to frailty, which can compromise quality of life and well-being. Chronic pain remains undertreated in the oldest old, African Americans, ethnic minorities, and individuals with cognitive impairment, the authors write.

Vulnerability to persistent severe pain increases with age as a function of reduced pain tolerance and impaired endogenous pain-modulating capacities. Chronic comorbidities, such as musculoskeletal disorders, diabetes, and cancer, can contribute to pain severity.

Long-term outcomes in elderly patients with chronic pain can be influenced factors such as lower socioeconomic status, lower educational level, obesity, and tobacco use.