Opioids for the Management of Severe Chronic Nonmalignant Pain in Children: A Retrospective 1-Year Practice Survey in a Children's Hospital

Objective. This study reviewed opioid prescription for chronic severe nonmalignant pain in a multidisciplinary pediatric pain clinic. We looked at benefits and side effects of therapy, and compared our process of opioid prescription with the practice guidelines defined in adult literature. Design. Descriptive retrospective practice survey. Setting. Multidisciplinary pain clinic in a tertiary pediatric hospital. Patients. During a 12-month period, 104 patients were seen in the clinic, of which 49 received an opioid as part of their pain management; 11 received an opioid chronically, defined as more than 3 months in this study, and 5 of these were still on opioid at the end of the study period although data on one patient are lacking as she had been transferred to an adult clinic. Methods. Information about patients was obtained from chart review. Outcome Measures. Benefits and side effects of treatment, as well as the process of prescribing opioids and follow-up. Results. In the four patients studied, there seem to be better pain control and improved function in these patients while on opioid therapy, despite minor side effects. We identified some areas of improvement in our practice and made recommendations for the use of opioids in pediatric chronic severe nonmalignant pain. Conclusions. The evolution of our four patients seems to be in favor of treatment with an opioid for severe chronic nonmalignant pain in certain pediatric patients, in the context of prescribing in a multidisciplinary pain clinic with a multisystem approach to pain management although more data are needed to know if such therapy is safe and beneficial on a longer-term basis.