American Academy of Pediatrics – Section on Rheumatology

View all recommendations from this society

August 6, 2019

Do not prescribe opioids for chronic pain management in patients with autoimmune disease.

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 5 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.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Pediatrics’ Section on Rheumatology (SORh) consists of pediatric rheumatologists, pediatricians, and allied health care professionals who are actively involved in some aspect of the study of rheumatologic disease in children and adolescents. The SORh strives to inform pediatricians, parents, communities, and policy makers on rheumatic disease in children. The fellow members of the SORh were queried to develop a list of diagnostic and management decisions that have resulted in misuse of laboratory studies and resources. Through a series of votes, the fellow members developed the list into five statements to address the most common misconceptions seen when encountering pediatric autoimmune conditions. The fellows involved in this project are: Kathleen Collins, Brian Dizon, Suhas Ganguli, Miriah Gillispie, Marla Guzman, Michael B. Nelson, Onengiya Harry, Meiqian Ma, MaiLan Nguyen, Amir Orandi, Amanda Schlefman, Laura Tasan, and Erin Treemarcki. The list was shared with membership of the SORh Executive Committee for feedback and then finalized by collaboration. These five clinical issues are the result. Various expert committees and sections of the AAP reviewed and approved the list. The AAP Executive Committee granted final approval of the list.

AAP’s disclosure and conflict of interest policy can be found at www.aap.org.

Sources

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 Anesthegiology and Pain Medicine, American Academy of Pediatrics. Recognition and management of iatrogenically induced opioid dependence and withdrawal in children. Galinkin J, Koh JL; Committee on Drugs; Section on Anesthesiology and Pain Medicine; American Academy of pediatrics. 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. Miech R, Johnston L, O’Malley PM, Keyes KM, Heard K. 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.