MyLibraryZotero19SickKidsAboutKidsHealthAboutKidsHealthINCLUDED-Main201901/25/2019Trusted information on everyday and complex child health conditions from The Hospital for Sick Children.en-CAhttps://www.aboutkidshealth.ca:443/article?contentid=3653&language=English/Users/meganridgway/Zotero/storage/3FFYBJZL/Article.html2023-07-11 00:28:56MyLibraryZotero19SickKidsAboutKidsHealthAboutKidsHealthINCLUDED-Main201901/25/2019Trusted information on everyday and complex child health conditions from The Hospital for Sick Children.en-CAhttps://www.aboutkidshealth.ca:443/article?contentid=3650&language=English/Users/meganridgway/Zotero/storage/6M746YC8/Article.html2023-07-11 00:21:59MyLibraryZotero19SickKidsAboutKidsHealthAboutKidsHealthINCLUDED-Main201901/25/2019Trusted information on everyday and complex child health conditions from The Hospital for Sick Children.en-CAhttps://www.aboutkidshealth.ca:443/article?contentid=3645&language=English/Users/meganridgway/Zotero/storage/UEDJ8M6E/Article.html2023-07-11 00:03:02MyLibraryZotero27Canadian Agency for Drugs and Technologies in Health4INCLUDED-Main202205/2022Canadian Agency for Drugs and Technologies in HealthSummary of evidenceenhttps://www.cadth.ca/sites/default/files/attachments/2022-05/HC0023_pre_surgery_screening_summary_0.pdf/Users/meganridgway/Zotero/storage/K77NMVDT/pre-surgical-screening-tools-and-risk-factors-chronic-post-surgical-pain-summary.html2023-07-10 23:52:23Summary of evidenceMyLibraryZotero27World Health Organization40INCLUDED-Main20202020World Health OrganizationISBN: 9789240017870Guidelines on the management of chronic pain in children, developing and implementing national and local policies for pain management and protocols in children, implementing national and local regulations for pain management in children, pain management and protocolsenhttps://apps.who.int/iris/rest/bitstreams/1323615/retrieve/Users/meganridgway/Zotero/storage/YB6V8HEQ/9789240017870.html2023-07-10 17:32:23MyLibraryZotero27Health Quality OntarioQuality StandardsINCLUDED-Main20182018Government of OntarioISBN: 978-1-4868-1419-0Quality standardenhttps://www.hqontario.ca/portals/0/documents/evidence/quality-standards/qs-opioid-chronic-pain-clinician-guide-en.pdf/Users/meganridgway/Zotero/storage/B4CHGESD/opioid-prescribing-for-chronic-pain.html2023-07-10 17:17:26Quality standardMyLibraryZotero17Kahan, MeldonWilson, LynnMailis-Gagnon, AngelaSrivastava, AnitaNational Opioid Use Guideline GroupCanadian Family Physician Medecin De Famille CanadienCanadian guideline for safe and effective use of opioids for chronic noncancer painCanadian Family Physician Medecin De Famille CanadienCan Fam Physician1269-1276, e419-428571111AdolescentAge FactorsAgedAged, 80 and overAnalgesics, OpioidAnxiety DisordersCanadaChronic PainFemaleHumansHypnotics and SedativesINCLUDED-MainMood DisordersNeuralgiaNociceptive PainOpioid-Related DisordersPregnancyPregnancy ComplicationsRisk Assessment20112011-111715-5258OBJECTIVE: To provide family physicians with a practical clinical summary of opioid prescribing for specific populations based on recommendations from the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. QUALITY OF EVIDENCE: Researchers for the guideline conducted a systematic review of the literature, focusing on reviews of the effectiveness and safety of opioids in specific populations. MAIN MESSAGE: Family physicians can minimize the risks of overdose, sedation, misuse, and addiction through the use of strategies tailored to the age and health status of patients. For patients at high risk of addiction, opioids should be reserved for well-defined nociceptive or neuropathic pain conditions that have not responded to first-line treatments. Opioids should be titrated slowly, with frequent dispensing and close monitoring for signs of misuse. Suspected opioid addiction is managed with structured opioid therapy, methadone or buprenorphine treatment, or abstinence-based treatment. Patients with mood and anxiety disorders tend to have a blunted analgesic response to opioids, are at higher risk of misuse, and are often taking sedating drugs that interact adversely with opioids. Precautions similar to those for other high-risk patients should be employed. The opioid should be tapered if the patient's pain remains severe despite an adequate trial of opioid therapy. In the elderly, sedation, falls, and overdose can be minimized through lower initial doses, slower titration, benzodiazepine tapering, and careful patient education. For pregnant women taking daily opioid therapy, the opioids should be slowly tapered and discontinued. If this is not possible, they should be tapered to the lowest effective dose. Opioid-dependent pregnant women should receive methadone treatment. Adolescents are at high risk of opioid overdose, misuse, and addiction. Patients with adolescents living at home should store their opioid medication safely. Adolescents rarely require long-term opioid therapy. CONCLUSION: Family physicians must take into consideration the patient's age, psychiatric status, level of risk of addiction, and other factors when prescribing opioids for chronic pain.PubMedeng, frehttp://www.ncbi.nlm.nih.gov/pubmed/22084456MyLibraryZotero17Krčevski Škvarč, NevenkaMorlion, BartVowles, Kevin E.Bannister, KirstyBuchsner, EricCasale, RobertoChenot, Jean-FrançoisChumbley, GillianDrewes, Asbjørn MohrDom, GeertJutila, LiisaO'Brien, TonyPogatzki-Zahn, EstherRakusa, MartinSuarez-Serrano, CarmenTölle, ThomasHäuser, WinfriedEuropean Journal of Pain (London, England)European clinical practice recommendations on opioids for chronic noncancer pain - Part 2European Journal of Pain (London, England)Eur J Pain969-9852555AdolescentAnalgesics, OpioidChildChronic PainEuropeHumansINCLUDED-AdditionalNorth AmericaOpioid-Related Disorders20212021-051532-214910.1002/ejp.1744BACKGROUND: Opioid use for chronic non-cancer pain (CNCP) is under debate. In the absence of pan-European guidance on this issue, a position paper was commissioned by the European Pain Federation (EFIC). METHODS: The clinical practice recommendations were developed by eight scientific societies and one patient self-help organization under the coordination of EFIC. A systematic literature search in MEDLINE (up until January 2020) was performed. Two categories of guidance are given: Evidence-based recommendations (supported by evidence from systematic reviews of randomized controlled trials or of observational studies) and Good Clinical Practice (GCP) statements (supported either by indirect evidence or by case-series, case-control studies and clinical experience). The GRADE system was applied to move from evidence to recommendations. The recommendations and GCP statements were developed by a multiprofessional task force (including nursing, service users, physicians, physiotherapy and psychology) and formal multistep procedures to reach a set of consensus recommendations. The clinical practice recommendations were reviewed by five external reviewers from North America and Europe and were also posted for public comment. RESULTS: The European Clinical Practice Recommendations give guidance for combination with other medications, the management of frequent (e.g. nausea, constipation) and rare (e.g. hyperalgesia) side effects, for special clinical populations (e.g. children and adolescents, pregnancy) and for special situations (e.g. liver cirrhosis). CONCLUSION: If a trial with opioids for chronic noncancer pain is conducted, detailed knowledge and experience are needed to adapt the opioid treatment to a special patient group and/or clinical situation and to manage side effects effectively. SIGNIFICANCE: If a trial with opioids for chronic noncancer pain is conducted, detailed knowledge and experience are needed to adapt the opioid treatment to a special patient group and/or clinical situation and to manage side effects effectively. A collaboration of medical specialties and of all health care professionals is needed for some special populations and clinical situations.PubMedeng/Users/meganridgway/Zotero/storage/CKGHLUEA/Krčevski Škvarč et al. - 2021 - European clinical practice recommendations on opio.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/33655678MyLibraryZotero17Moulin, DwightBoulanger, AlineClark, A. J.Clarke, HanceDao, ThuanFinley, G. A.Furlan, AndreaGilron, IanGordon, AllanMorley-Forster, Patricia K.Sessle, Barry J.Squire, PamelaStinson, JenniferTaenzer, PaulVelly, AnaWare, Mark A.Weinberg, Erica L.Williamson, Owen D.Canadian Pain SocietyPain Research & ManagementPharmacological management of chronic neuropathic painPain Research & ManagementPain Res Manag328-3351966AnalgesicsCanadaChronic PainHumansINCLUDED-MainNeuralgiaPain Management201420141918-152310.1155/2014/754693BACKGROUND: Neuropathic pain (NeP), redefined as pain caused by a lesion or a disease of the somatosensory system, is a disabling condition that affects approximately two million Canadians. OBJECTIVE: To review the randomized controlled trials (RCTs) and systematic reviews related to the pharmacological management of NeP to develop a revised evidence-based consensus statement on its management. METHODS: RCTs, systematic reviews and existing guidelines on the pharmacological management of NeP were evaluated at a consensus meeting in May 2012 and updated until September 2013. Medications were recommended in the consensus statement if their analgesic efficacy was supported by at least one methodologically sound RCT (class I or class II) showing significant benefit relative to placebo or another relevant control group. Recommendations for treatment were based on the degree of evidence of analgesic efficacy, safety and ease of use. RESULTS: Analgesic agents recommended for first-line treatments are gabapentinoids (gabapentin and pregabalin), tricyclic antidepressants and serotonin noradrenaline reuptake inhibitors. Tramadol and controlled-release opioid analgesics are recommended as second-line treatments for moderate to severe pain. Cannabinoids are now recommended as third-line treatments. Recommended fourth-line treatments include methadone, anticonvulsants with lesser evidence of efficacy (eg, lamotrigine, lacosamide), tapentadol and botulinum toxin. There is support for some analgesic combinations in selected NeP conditions. CONCLUSIONS: These guidelines provide an updated, stepwise approach to the pharmacological management of NeP. Treatment should be individualized for each patient based on efficacy, side-effect profile and drug accessibility, including cost. Additional studies are required to examine head-to-head comparisons among analgesics, combinations of analgesics, long-term outcomes and treatment of pediatric, geriatric and central NeP.PubMedeng/Users/meganridgway/Zotero/storage/4WWV8DSH/Moulin et al. - 2014 - Pharmacological management of chronic neuropathic .pdfhttp://www.ncbi.nlm.nih.gov/pubmed/25479151MyLibraryZotero17Eccleston, ChristopherAldington, DominicMoore, Andrewde C Williams, Amanda C.Lancet (London, England)Pragmatic but flawedLancet (London, England)Lancet2029-20313971028910289Chronic PainGuidelines as TopicHumansINCLUDED-AdditionalPain ManagementUnited Kingdom20212021-05-291474-547X10.1016/S0140-6736(21)01058-8PubMedeng/Users/meganridgway/Zotero/storage/J64F82DJ/Eccleston et al. - 2021 - Pragmatic but flawed the NICE guideline on chroni.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/34062133MyLibraryZotero17Cohen, Steven P.Vase, LeneHooten, William M.Lancet (London, England)Chronic painLancet (London, England)Lancet2082-20973971028910289Chronic PainHumansINCLUDED-AdditionalPainPain Management20212021-05-291474-547X10.1016/S0140-6736(21)00393-7Chronic pain exerts an enormous personal and economic burden, affecting more than 30% of people worldwide according to some studies. Unlike acute pain, which carries survival value, chronic pain might be best considered to be a disease, with treatment (eg, to be active despite the pain) and psychological (eg, pain acceptance and optimism as goals) implications. Pain can be categorised as nociceptive (from tissue injury), neuropathic (from nerve injury), or nociplastic (from a sensitised nervous system), all of which affect work-up and treatment decisions at every level; however, in practice there is considerable overlap in the different types of pain mechanisms within and between patients, so many experts consider pain classification as a continuum. The biopsychosocial model of pain presents physical symptoms as the denouement of a dynamic interaction between biological, psychological, and social factors. Although it is widely known that pain can cause psychological distress and sleep problems, many medical practitioners do not realise that these associations are bidirectional. While predisposing factors and consequences of chronic pain are well known, the flipside is that factors promoting resilience, such as emotional support systems and good health, can promote healing and reduce pain chronification. Quality of life indicators and neuroplastic changes might also be reversible with adequate pain management. Clinical trials and guidelines typically recommend a personalised multimodal, interdisciplinary treatment approach, which might include pharmacotherapy, psychotherapy, integrative treatments, and invasive procedures.PubMedenghttp://www.ncbi.nlm.nih.gov/pubmed/34062143MyLibraryZotero17Silva, CarlosOliveira, DoraPestana-Santos, MárciaPortugal, FranciscoCapelo, PaulaBrazilian Journal of Anesthesiology (Elsevier)Chronic non-cancer pain in adolescentsBrazilian Journal of Anesthesiology (Elsevier)Braz J Anesthesiol648-6567255Abdominal PainAdolescentAnalgesics, OpioidAnxietyChildChronic painChronic PainHumansINCLUDED-AdditionalMusculoskeletal PainPain managementPediatrics202220222352-229110.1016/j.bjane.2021.04.033INTRODUCTION: Chronic pain is defined as a pain lasting more than 3-6 months. It is estimated that 25% of the pediatric population may experience some kind of pain in this context. Adolescence, corresponding to a particular period of development, seems to present the ideal territory for the appearance of maladaptive mechanisms that can trigger episodes of persistent or recurrent pain. METHODS: A narrative review, in the PubMed/Medline database, in order to synthetize the available evidence in the approach to chronic pain in adolescents, highlighting its etiology, pathophysiology, diagnosis, and treatment. RESULTS: Pain is seen as a result from the interaction of biological, psychological, individual, social, and environmental factors. Headache, abdominal pain, and musculoskeletal pain are frequent causes of chronic pain in adolescents. Pain not only has implications on adolescents, but also on family, society, and how they interact. It has implications on daily activities, physical capacity, school performance, and sleep, and is associated with psychiatric comorbidities, such as anxiety and depression. The therapeutic approach of pain must be multimodal and multidisciplinary, involving adolescents, their families, and environment, using pharmacological and non-pharmacological strategies. DISCUSSION AND CONCLUSION: The acknowledgment, prevention, diagnosis, and treatment of chronic pain in adolescent patients seem not to be ideal. The development of evidence-based forms of treatment, and the training of health professionals at all levels of care are essential for the diagnosis, treatment, and early referral of these patients.PubMedeng/Users/meganridgway/Zotero/storage/LG8W3AC6/Silva et al. - 2022 - Chronic non-cancer pain in adolescents a narrativ.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/34153363MyLibraryZotero27Chief Medical Officer DirectorateManagement of chronic pain in children and young peopleINCLUDED-Main20183/23/2018Scottish GovernmentISBN: 9781788517157A Scottish Government summary of the available evidence, combined with a consensus group agreement on key recommendations and suggested patient pathways.advice and guidanceenhttp://www.gov.scot/publications/management-chronic-pain-children-young-people//Users/meganridgway/Zotero/storage/5LIZYL9A/management-chronic-pain-children-young-people.html2023-07-10 16:45:10advice and guidanceMyLibraryZotero17Anand, Kanwaljeet J. S.Willson, Douglas F.Berger, JohnHarrison, RickMeert, Kathleen L.Zimmerman, JerryCarcillo, JosephNewth, Christopher J. L.Prodhan, ParthakDean, J. MichaelNicholson, CarolEunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research NetworkPediatricsPediatricsPediatricse1208-122512555Analgesics, OpioidBrainChildChild, PreschoolCritical IllnessDrug ToleranceHumansINCLUDED-AdditionalInfantInfant, NewbornNeuronsOpioid-Related DisordersPainReceptors, OpioidSubstance Withdrawal SyndromeTachyphylaxis20102010-051098-427510.1542/peds.2009-0489OBJECTIVE: After prolonged opioid exposure, children develop opioid-induced hyperalgesia, tolerance, and withdrawal. Strategies for prevention and management should be based on the mechanisms of opioid tolerance and withdrawal. PATIENTS AND METHODS: Relevant manuscripts published in the English language were searched in Medline by using search terms "opioid," "opiate," "sedation," "analgesia," "child," "infant-newborn," "tolerance," "dependency," "withdrawal," "analgesic," "receptor," and "individual opioid drugs." Clinical and preclinical studies were reviewed for data synthesis. RESULTS: Mechanisms of opioid-induced hyperalgesia and tolerance suggest important drug- and patient-related risk factors that lead to tolerance and withdrawal. Opioid tolerance occurs earlier in the younger age groups, develops commonly during critical illness, and results more frequently from prolonged intravenous infusions of short-acting opioids. Treatment options include slowly tapering opioid doses, switching to longer-acting opioids, or specifically treating the symptoms of opioid withdrawal. Novel therapies may also include blocking the mechanisms of opioid tolerance, which would enhance the safety and effectiveness of opioid analgesia. CONCLUSIONS: Opioid tolerance and withdrawal occur frequently in critically ill children. Novel insights into opioid receptor physiology and cellular biochemical changes will inform scientific approaches for the use of opioid analgesia and the prevention of opioid tolerance and withdrawal.PubMedeng/Users/meganridgway/Zotero/storage/56GFK34B/Anand et al. - 2010 - Tolerance and withdrawal from prolonged opioid use.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/20403936MyLibraryZotero17Fisher, DeborahAACN advanced critical careOpioid tapering in childrenAACN advanced critical careAACN Adv Crit Care139-1452122Analgesics, OpioidChildHumansINCLUDED-Additional201020101559-777610.1097/NCI.0b013e3181ceda3cPURPOSE: To synthesize and critically analyze literature related to pediatric opioid withdrawal. DESIGN: Critical review of literature related to pediatric opioid tapering and withdrawal. METHODS: Studies published in peer-reviewed journals were systematically searched using Cochrane, MEDLINE, CINAHL, and PsychINFO. Articles meeting the inclusion criteria were reviewed and analyzed for themes and similarities. FINDINGS: The majority of published research has focused on the episodic nature of withdrawal symptoms during opioid tapering. Only 1 study produced a valid and reliable pediatric opioid withdrawal symptom assessment-instrument and 1 study produced a valid and reliable pediatric opioid and benzodiazepine symptom assessment instrument. One study conducted in an adult and pediatric population analyzed the effect of the use of an opioid taper algorithm on occurrence and nature of opioid withdrawal symptoms. CONCLUSIONS: The scope of research on pediatric opioid withdrawal is limited. Studies examining the effect of an opioid taper algorithm on incidence of withdrawal symptoms in children are sorely needed. Further validation of the 2 withdrawal assessment tools for children is warranted.PubMedenghttp://www.ncbi.nlm.nih.gov/pubmed/20431442MyLibraryZotero17Mahendra, VijaitaSinghal, SaritaDzara, KristinaJain, GauravPilla, Trinadha R.Manworren, ReneeKaye, Alan D.Pain PhysicianLong-term neuropsychological effects of opioid use in childrenPain PhysicianPain Physician109-1181722Analgesics, OpioidCognition DisordersDatabases, FactualDevelopmental DisabilitiesHumansINCLUDED-AdditionalOpioid-Related DisordersPainPediatricsUnited States201420142150-1149BACKGROUND: Use of opioids in the management of pain and its consequences in children presents a substantial challenge. A significant concern in pediatric pain management is the long-term neuropsychological consequences of opioids. OBJECTIVES: The authors aim to provide a descriptive review of the current literature surrounding the neuropsychological impact of opioid use in children, along with possible extrapolations from their use in adults and animal models. STUDY DESIGN: Systematic review of published literature. SETTING: Various universities in the United States. METHODS: The electronic review for papers published between January 1992 and December 2012 was conducted using Medline/Pubmed, PsychInfo, CINAHL, the Cochrane Library database, and Google Scholar. RESULTS: Findings assessing pediatric pain patients treated with opioids demonstrated no significant differences in intelligence, behavior, vocabulary, or motor skills. One study reported a decrease in a visuo-constructional ability, which measured higher order executive function. Studies from prenatal illicit opioid exposure found poorer performance on measures of language, verbal ability, mathematics, reading, impulse control, and school readiness skills. The literature from adult prescribed opioid users has mixed results. Some showed impairment in the neuropsychological domains of memory, decision-making, attention, concentration, information processing, psychomotor speed, visual special skills, and hand-eye coordination, while others found no differences or revealed improved perceptual-cognitive status, possibly due to the removal of pain as a stressor. LIMITATIONS: Very few studies looked into the long term neuropsychological and cognitive effects of the opioids in pediatric population. In an attempt to extrapolate from other groups, this review also included literature from adult patients, prenatal opioid exposure, and animal studies. CONCLUSION: Opioid medications have the potential to produce long-lasting neuropsychological side effects. However, given the negative consequences of untreated pain, the potential benefit may offset their risk. More studies are needed to clarify this complex interaction.PubMedenghttp://www.ncbi.nlm.nih.gov/pubmed/24658471MyLibraryZotero27Banerjee, SrabaniButcher, RobynINCLUDED-Main20205/5/2020OttawaCanadian Agency for Drugs and Technologies in HealthRC1275-000Summary with critical appraisalenhttps://www.cadth.ca/sites/default/files/pdf/htis/2020/RC1275%20Ped%20Chronic%20Pain%20Guidelines%20Final.pdf/Users/meganridgway/Zotero/storage/3ATBED9I/pharmacological-interventions-chronic-pain-pediatric-patients-review-guidelines.html2023-07-10 16:35:24Summary with critical appraisalMyLibraryZotero17Wiffen, Philip J.Cooper, Tess E.Anderson, Anna-KareniaGray, Andrew L.Grégoire, Marie-ClaudeLjungman, GustafZernikow, BorisThe Cochrane Database of Systematic ReviewsThe Cochrane Database of Systematic ReviewsCochrane Database Syst RevCD012564777AdolescentAnalgesics, OpioidCancer PainChildChild, PreschoolHumansINCLUDED-AdditionalInfantInfant, Newborn20172017-07-191469-493X10.1002/14651858.CD012564.pub2BACKGROUND: Pain is a common feature of childhood and adolescence around the world, and for many young people, that pain is chronic. The World Health Organization (WHO) guidelines for pharmacological treatments for children's persisting pain acknowledge that pain in children is a major public health concern of high significance in most parts of the world. Views on children's pain have changed over time and relief of pain is now seen as important. In the past, pain was largely dismissed and was frequently left untreated, and it was assumed that children quickly forgot about painful experiences.We designed a suite of seven reviews in chronic non-cancer pain and cancer pain (looking at antidepressants, antiepileptic drugs, non-steroidal anti-inflammatory drugs, opioids, and paracetamol) to review the evidence for children's pain using pharmacological interventions.As one of the leading causes of mortality and morbidity for children and adolescents in the world today, childhood cancer (and its associated pain) is a major health concern. Cancer pain in infants, children, and adolescents is primarily nociceptive pain with negative long term effects. Cancer-related pain is generally caused directly by the tumour itself such as compressing on the nerve or inflammation of the organs. Cancer-related pain generally occurs as a result of perioperative procedures, nerve damage caused by radiation or chemotherapy treatments, or mucositis. However, this review focused on pain caused directly by the tumour itself such as nerve infiltration, external nerve compression, and other inflammatory events.Opioids are used worldwide for the treatment of pain. Currently available opioids include: buprenorphine, codeine, fentanyl, hydromorphone, methadone, morphine, oxycodone, and tramadol. Opioids are generally available in healthcare settings across most developed countries but access may be restricted in developing countries. To achieve adequate pain relief in children using opioids, with an acceptable grade of adverse effects, the recommended method is to start with a low dose gradually titrated to effect or unacceptable adverse effect in the child. OBJECTIVES: To assess the analgesic efficacy, and adverse events, of opioids used to treat cancer-related pain in children and adolescents aged between birth and 17 years, in any setting. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online, MEDLINE via Ovid and Embase via Ovid from inception to 22 February 2017. We also searched the reference lists of retrieved studies and reviews, and searched online clinical trial registries. SELECTION CRITERIA: Randomised controlled trials (RCTs), with or without blinding, of any dose, and any route, treating cancer-related pain in children and adolescents, comparing opioids with placebo or an active comparator. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for eligibility. We planned to use dichotomous data to calculate risk ratio and number needed to treat for one additional event, using standard methods. We assessed GRADE (Grading of Recommendations Assessment, Development and Evaluation) and planned to create a 'Summary of findings' table. MAIN RESULTS: No studies were identified that were eligible for inclusion in this review (very low quality evidence). Several studies tested opioids on adults with cancer-related pain, but none in participants aged from birth to 17 years.We rated the quality of evidence as very low, downgraded due to a lack of available data; no analyses could be undertaken. AUTHORS' CONCLUSIONS: No conclusions can be drawn about efficacy or harm in the use of opioids to treat cancer-related pain in children and adolescents. As a result, there is no RCT evidence to support or refute the use of opioids to treat cancer-related pain in children and adolescents.PubMedeng/Users/meganridgway/Zotero/storage/SVL6Z8YW/Wiffen et al. - 2017 - Opioids for cancer-related pain in children and ad.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/28722116MyLibraryZotero17Li, YanMa, JunLu, GuijunDou, ZhiKnaggs, RogerXia, JunZhao, SaiDong, SitongYang, LiqiangThe Cochrane Database of Systematic ReviewsThe Cochrane Database of Systematic ReviewsCochrane Database Syst RevCD011108888AdultAnalgesics, OpioidCancer PainChildHumansHydromorphoneINCLUDED-AdditionalMaleMiddle AgedMorphineNeoplasmsOxycodone20212021-08-051469-493X10.1002/14651858.CD011108.pub3BACKGROUND: This is an update of the original Cochrane Review first published in Issue 10, 2016. For people with advanced cancer, the prevalence of pain can be as high as 90%. Cancer pain is a distressing symptom that tends to worsen as the disease progresses. Evidence suggests that opioid pharmacotherapy is the most effective of these therapies. Hydromorphone appears to be an alternative opioid analgesic which may help relieve these symptoms. OBJECTIVES: To determine the analgesic efficacy of hydromorphone in relieving cancer pain, as well as the incidence and severity of any adverse events. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and clinical trials registers in November 2020. We applied no language, document type or publication status limitations to the search. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared hydromorphone with placebo, an alternative opioid or another active control, for cancer pain in adults and children. Primary outcomes were participant-reported pain intensity and pain relief; secondary outcomes were specific adverse events, serious adverse events, quality of life, leaving the study early and death. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data. We calculated risk ratio (RR) and 95% confidence intervals (CI) for binary outcomes on an intention-to-treat (ITT) basis. We estimated mean difference (MD) between groups and 95% CI for continuous data. We used a random-effects model and assessed risk of bias for all included studies. We assessed the evidence using GRADE and created three summary of findings tables. MAIN RESULTS: With four new identified studies, the review includes a total of eight studies (1283 participants, with data for 1181 participants available for analysis), which compared hydromorphone with oxycodone (four studies), morphine (three studies) or fentanyl (one study). All studies included adults with cancer pain, mean age ranged around 53 to 59 years and the proportion of men ranged from 42% to 67.4%. We judged all the studies at high risk of bias overall because they had at least one domain with high risk of bias. We found no studies including children. We did not complete a meta-analysis for the primary outcome of pain intensity due to skewed data and different comparators investigated across the studies (oxycodone, morphine and fentanyl). Comparison 1: hydromorphone compared with placebo We identified no studies comparing hydromorphone with placebo. Comparison 2: hydromorphone compared with oxycodone Participant-reported pain intensity We found no clear evidence of a difference in pain intensity (measured using a visual analogue scale (VAS)) in people treated with hydromorphone compared with those treated with oxycodone, but the evidence is very uncertain (3 RCTs, 381 participants, very low-certainty evidence). Participant-reported pain relief We found no studies reporting participant-reported pain relief. Specific adverse events We found no clear evidence of a difference in nausea (RR 1.13 95% CI 0.74 to 1.73; 3 RCTs, 622 participants), vomiting (RR 1.18, 95% CI 0.72 to 1.94; 3 RCTs, 622 participants), dizziness (RR 0.91, 95% CI 0.58 to 1.44; 2 RCTs, 441 participants) and constipation (RR 0.92, 95% CI 0.72 to 1.19; 622 participants) (all very low-certainty evidence) in people treated with hydromorphone compared with those treated with oxycodone, but the evidence is very uncertain. Quality of life We found no studies reporting quality of life. Comparison 3: hydromorphone compared with morphine Participant-reported pain intensity We found no clear evidence of a difference in pain intensity (measured using the Brief Pain Inventory (BPI) or VAS)) in people treated with hydromorphone compared with those treated with morphine, but the evidence is very uncertain (2 RCTs, 433 participants; very low-certainty evidence). Participant-reported pain relief We found no clear evidence of a difference in the number of clinically improved participants, defined by 50% or greater pain relief rate, in the hydromorphone group compared with the morphine group, but the evidence is very uncertain (RR 0.99, 95% CI 0.84 to 1.18; 1 RCT, 233 participants; very low-certainty evidence). Specific adverse events At 24 days of treatment, morphine may reduce constipation compared with hydromorphone, but the evidence is very uncertain (RR 1.56, 95% CI 1.12 to 2.17; 1 RCT, 200 participants; very low-certainty evidence). We found no clear evidence of a difference in nausea (RR 0.94, 95% CI 0.66 to 1.30; 1 RCT, 200 participants), vomiting (RR 0.87, 95% CI 0.58 to 1.31; 1 RCT, 200 participants) and dizziness (RR 1.15, 95% CI 0.71 to 1.88; 1 RCT, 200 participants) (all very low-certainty evidence) in people treated with hydromorphone compared with those treated with morphine, but the evidence is very uncertain. Quality of life We found no studies reporting quality of life. Comparison 4: hydromorphone compared with fentanyl Participant-reported pain intensity We found no clear evidence of a difference in pain intensity (measured by numerical rating scale (NRS)) at 60 minutes in people treated with hydromorphone compared with those treated with fentanyl, but the evidence is very uncertain (1 RCT, 82 participants; very low-certainty evidence). Participant-reported pain relief We found no studies reporting participant-reported pain relief. Specific adverse events We found no studies reporting specific adverse events. Quality of life We found no studies reporting quality of life. AUTHORS' CONCLUSIONS: The evidence of the benefits and harms of hydromorphone compared with other analgesics is very uncertain. The studies reported some adverse events, such as nausea, vomiting, dizziness and constipation, but generally there was no clear evidence of a difference between hydromorphone and morphine, oxycodone or fentanyl for this outcome. There is insufficient evidence to support or refute the use of hydromorphone for cancer pain in comparison with other analgesics on the reported outcomes. Further research with larger sample sizes and more comprehensive outcome data collection is required.PubMedeng/Users/meganridgway/Zotero/storage/PBZQLD6D/Li et al. - 2021 - Hydromorphone for cancer pain.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/34350974MyLibraryZotero17Cooper, Tess E.Fisher, EmmaGray, Andrew L.Krane, ElliotSethna, Navilvan Tilburg, Miranda AlZernikow, BorisWiffen, Philip J.The Cochrane Database of Systematic ReviewsThe Cochrane Database of Systematic ReviewsCochrane Database Syst RevCD012538777AdolescentAnalgesics, OpioidChildChild, PreschoolChronic PainHumansINCLUDED-AdditionalInfantInfant, Newborn20172017-07-261469-493X10.1002/14651858.CD012538.pub2BACKGROUND: Pain is a common feature of childhood and adolescence around the world, and for many young people, that pain is chronic. The World Health Organization guidelines for pharmacological treatments for children's persisting pain acknowledge that pain in children is a major public health concern of high significance in most parts of the world. While in the past, pain was largely dismissed and was frequently left untreated, views on children's pain have changed over time, and relief of pain is now seen as importantWe designed a suite of seven reviews on chronic non-cancer pain and cancer pain (looking at antidepressants, antiepileptic drugs, non-steroidal anti-inflammatory drugs, opioids, and paracetamol as priority areas) in order to review the evidence for children's pain utilising pharmacological interventions in children and adolescents.As the leading cause of morbidity in children and adolescents in the world today, chronic disease (and its associated pain) is a major health concern. Chronic pain (lasting three months or longer) can arise in the paediatric population in a variety of pathophysiological classifications: nociceptive, neuropathic, idiopathic, visceral, nerve damage pain, chronic musculoskeletal pain, and chronic abdominal pain, and other unknown reasons.Opioids are used worldwide for the treatment of pain. They bind to opioid receptors in the central nervous system (mu, kappa, delta, and sigma) and can be agonists, antagonists, mixed agonist-antagonists, or partial agonists. Opioids are generally available in healthcare settings across most high-income countries, but access may be restricted in low- and middle-income countries. For example, opioids currently available in the UK include: buprenorphine, codeine, fentanyl, hydromorphone, methadone, morphine, oxycodone, and tramadol. Opioids are used in varying doses (generally based on body weight for paediatric patients) by means of parenteral, transmucosal, transdermal, or oral administration (immediate release or modified release). To achieve adequate pain relief in children using opioids, with an acceptable grade of adverse effects, the recommended method is a lower dose gradually titrated to effect in the child. OBJECTIVES: To assess the analgesic efficacy and adverse events of opioids used to treat chronic non-cancer pain in children and adolescents aged between birth and 17 years, in any setting. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library, MEDLINE via Ovid, and Embase via Ovid from inception to 6 September 2016. We also searched the reference lists of retrieved studies and reviews, and searched online clinical trial registries. SELECTION CRITERIA: Randomised controlled trials, with or without blinding, of any dose and any route, treating chronic non-cancer pain in children and adolescents, comparing opioids with placebo or an active comparator. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for eligibility. We planned to use dichotomous data to calculate risk ratio and number needed to treat, using standard methods. We assessed GRADE (Grading of Recommendations Assessment, Development and Evaluation) and planned to create a 'Summary of findings' table. MAIN RESULTS: No studies were eligible for inclusion in this review. We rated the quality of the evidence as very low. We downgraded the quality of evidence by three levels due to the lack of data reported for any outcome. AUTHORS' CONCLUSIONS: There was no evidence from randomised controlled trials to support or refute the use of opioids to treat chronic non-cancer pain in children and adolescents. We are unable to comment about efficacy or harm from the use of opioids to treat chronic non-cancer pain in children and adolescents.We know from adult randomised controlled trials that some opioids, such as morphine and codeine, can be effective in certain chronic pain conditions.This means that no conclusions could be made about efficacy or harm in the use of opioids to treat chronic non-cancer pain in children and adolescents.PubMedeng/Users/meganridgway/Zotero/storage/PYQRGS3P/Cooper et al. - 2017 - Opioids for chronic non-cancer pain in children an.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/28745394MyLibraryZotero17Kelley-Quon, Lorraine I.Kirkpatrick, Matthew G.Ricca, Robert L.Baird, RobertHarbaugh, Calista M.Brady, AshleyGarrett, PaulaWills, HaleArgo, JonathanDiefenbach, Karen A.Henry, Marion C. W.Sola, Juan E.Mahdi, Elaa M.Goldin, Adam B.St Peter, Shawn D.Downard, Cynthia D.Azarow, Kenneth S.Shields, TracyKim, EugeneJAMA surgeryGuidelines for Opioid Prescribing in Children and Adolescents After SurgeryJAMA surgeryJAMA Surg76-9015611AdolescentAge FactorsAnalgesics, OpioidAttitude of Health PersonnelHumansINCLUDED-MainPain, PostoperativePatient SelectionPractice Guidelines as TopicPractice Patterns, Physicians'20212021-01-012168-626210.1001/jamasurg.2020.5045IMPORTANCE: Opioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking. OBJECTIVE: To assemble a multidisciplinary team of health care experts and leaders in opioid stewardship, review current literature regarding opioid use and risks unique to pediatric populations, and develop a broad framework for evidence-based opioid prescribing guidelines for children who require surgery. EVIDENCE REVIEW: Reviews of relevant literature were performed including all English-language articles published from January 1, 1988, to February 28, 2019, found via searches of the PubMed (MEDLINE), CINAHL, Embase, and Cochrane databases. Pediatric was defined as children younger than 18 years. Animal and experimental studies, case reports, review articles, and editorials were excluded. Selected articles were graded using tools from the Oxford Centre for Evidence-based Medicine 2011 levels of evidence. The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument was applied throughout guideline creation. Consensus was determined using a modified Delphi technique. FINDINGS: Overall, 14 574 articles were screened for inclusion, with 217 unique articles included for qualitative synthesis. Twenty guideline statements were generated from a 2-day in-person meeting and subsequently reviewed, edited, and endorsed externally by pediatric surgical specialists, the American Pediatric Surgery Association Board of Governors, the American Academy of Pediatrics Section on Surgery Executive Committee, and the American College of Surgeons Board of Regents. Review of the literature and guideline statements underscored 3 primary themes: (1) health care professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids, (2) nonopioid analgesic use should be optimized in the perioperative period, and (3) patient and family education regarding perioperative pain management and safe opioid use practices must occur both before and after surgery. CONCLUSIONS AND RELEVANCE: These are the first opioid-prescribing guidelines to address the unique needs of children who require surgery. Health care professionals caring for children and adolescents in the perioperative period should optimize pain management and minimize risks associated with opioid use by engaging patients and families in opioid stewardship efforts.PubMedeng/Users/meganridgway/Zotero/storage/3G6QFGP4/Kelley-Quon et al. - 2021 - Guidelines for Opioid Prescribing in Children and .pdfhttp://www.ncbi.nlm.nih.gov/pubmed/33175130MyLibraryZotero17Gall, O.Comité douleur-anesthésie locorégionale et le comité des référentiels de la SfarAnnales Francaises D'anesthesie Et De ReanimationAnnales Francaises D'anesthesie Et De ReanimationAnn Fr Anesth Reanime43-472822AdolescentAge FactorsAnalgesia, Patient-ControlledChildChild, PreschoolDose-Response Relationship, DrugDroperidolDrug Administration RoutesGastrointestinal DiseasesHumansINCLUDED-AdditionalInfantInfant, NewbornMorphineNaloxoneNarcoticsPain, PostoperativePractice Guidelines as TopicPruritusRespiratory InsufficiencyRisk AssessmentUrinary Retention20092009-021769-662310.1016/j.annfar.2008.12.002PubMedfrehttp://www.ncbi.nlm.nih.gov/pubmed/19150592MyLibraryZotero17Howard, Meredith L.Isaacs, Alex N.Nisly, Sarah A.Journal of Pharmacy PracticeJournal of Pharmacy PracticeJ Pharm Pract66-813111Anti-Inflammatory Agents, Non-Steroidalcontinuous infusionHumansINCLUDED-AdditionalInfusions, Intravenousnonsteroidal anti-inflammatory drugpainPain ManagementPain, PostoperativeperioperativePerioperative Caresafety20182018-021531-193710.1177/0897190016665539PURPOSE: To review the use of continuous infusion (CI) nonsteroidal anti-inflammatory drugs (NSAIDs) as an alternative modality for pain control in surgical patient populations. METHODS: A PubMed and MEDLINE search was conducted from 1964 through February 2016 using the following search terms alone or in combinations: continuous, infusion, nonsteroidal anti-inflammatory drug, diclofenac, ibuprofen, indomethacin, ketoprofen, ketorolac, and surgery. All English-language, prospective and retrospective, adult and pediatric studies evaluating intravenous or intramuscular CI NSAIDs for surgical pain were evaluated for inclusion in this review. RESULTS: Twenty four prospective and retrospective publications evaluating CI NSAIDs were identified: 12 in abdominal surgery, 7 in orthopedic surgery, and 5 in pediatric surgery. Specific CI NSAIDs utilized included diclofenac, indomethacin, ketoprofen, and ketorolac. Most studies compared the CI NSAID to placebo or an alternative analgesic and evaluated pain control, supplemental opioid use, and related adverse effects. In these surgical populations, CI NSAIDs decreased opioid consumption, alongside provision of adequate pain control. While long-term adverse effects were rarely collected, a decrease in nausea and sedation was often seen with the CI NSAID groups. CONCLUSIONS: In the abdominal, orthopedic, and pediatric surgical populations, CI NSAIDs represent a feasible alternative modality for perioperative pain control.PubMedenghttp://www.ncbi.nlm.nih.gov/pubmed/27580638MyLibraryZotero27Institute for Safe Medication Practices CanadaINCLUDED-Main20182018frhttps://www.ismp-canada.org/download/OpioidStewardship/OpioidsAfterSurgery-FR.pdf2023-07-10MyLibraryZotero27Institute for Safe Medication Practices CanadaINCLUDED-Main20182018enhttps://www.ismp-canada.org/download/OpioidStewardship/OpioidsAfterSurgery-EN.pdf2023-07-10MyLibraryZotero27Paquette, JulieINCLUDED-Main201904/2019CHU Sainte-JustineF-1438 GRM : 3001 0380 (Révisé : avril 2019)frhttps://www.chusj.org/getmedia/7809bf9f-4192-4e40-af76-cf407127e414/F1438_analgesie-controlee.pdf.aspx?ext=.pdf2023-07-10MyLibraryZotero17American Society of Anesthesiologists Task Force on Acute Pain ManagementAnesthesiologyPractice guidelines for acute pain management in the perioperative settingAnesthesiologyAnesthesiology248-27311622Acute DiseaseAdvisory CommitteesAnesthesiologyHumansINCLUDED-AdditionalPain ManagementPerioperative CareResearch ReportSocieties, MedicalUnited States20122012-021528-117510.1097/ALN.0b013e31823c1030PubMedeng/Users/meganridgway/Zotero/storage/VZ6ZJXSI/American Society of Anesthesiologists Task Force on Acute Pain Management - 2012 - Practice guidelines for acute pain management in t.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/22227789MyLibraryZotero17Vittinghoff, MariaLönnqvist, Per-ArneMossetti, ValeriaHeschl, StefanSimic, DusicaColovic, VesnaDmytriiev, DmytroHölzle, MartinZielinska, MarzenaKubica-Cielinska, AnnaLorraine-Lichtenstein, ElizabethBudić, IvanaKarisik, MarijanaMaria, Belen De JosèSmedile, FrancescoMorton, Neil S.Paediatric AnaesthesiaPostoperative pain management in childrenPaediatric AnaesthesiaPaediatr Anaesth493-5062866analgesicsAnesthesiologyChildEuropeHumansINCLUDED-Mainnonopioid drugsopioidsPain ManagementPain, PostoperativePediatricsperioperative painregional anesthesiaSocieties, Medical20182018-061460-959210.1111/pan.13373The main remit of the European Society for Paediatric Anaesthesiology (ESPA) Pain Committee is to improve the quality of pain management in children. The ESPA Pain Management Ladder is a clinical practice advisory based upon expert consensus to help to ensure a basic standard of perioperative pain management for all children. Further steps are suggested to improve pain management once a basic standard has been achieved. The guidance is grouped by the type of surgical procedure and layered to suggest basic, intermediate, and advanced pain management methods. The committee members are aware that there are marked differences in financial and personal resources in different institutions and countries and also considerable variations in the availability of analgesic drugs across Europe. We recommend that the guidance should be used as a framework to guide best practice.PubMedeng/Users/meganridgway/Zotero/storage/2V8C4GTM/Vittinghoff et al. - 2018 - Postoperative pain management in children Guidanc.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/29635764MyLibraryZotero17Constant, I.Ayari Khalfallah, S.Brunaud, A.Deramoudt, V.Fayoux, P.Giovanni, A.Mareau, C.Marianowski, R.Michel, J.Mondain, M.Paganelli, A.Pondaven, S.Schultz, P.Treluyer, J. M.Wood, C.Nicolas, R.SFORL Work GroupEuropean Annals of Otorhinolaryngology, Head and Neck DiseasesHow to replace codeine after tonsillectomy in children under 12 years of age?European Annals of Otorhinolaryngology, Head and Neck DiseasesEur Ann Otorhinolaryngol Head Neck Dis233-23813144AnalgesiaAnalgesicsAnti-inflammatoriesChildChild, PreschoolCodeineCorticosteroidsHemorrhageHumansINCLUDED-AdditionalInfantObstructive sleep apneaPainPain ManagementPain, PostoperativeRespiratory depressionRisk AssessmentTonsillectomyVomiting20142014-091879-730X10.1016/j.anorl.2014.06.001The authors present the guidelines of the French Oto-rhino-laryngology--Head and Neck Surgery Society (SFORL) regarding pain management in children and adults following tonsillectomy. A multidisciplinary work group was entrusted with a literature review. Guidelines were drawn up based on the articles retrieved and the group members' experience. They were read over by an editorial group independent of the work group. A coordination meeting drew up the final version. Guidelines were graded A, B or C or as professional agreement in decreasing order of level of evidence. At home, non-steroid anti-inflammatory drugs (NSAIDs) are recommended in association with paracetamol in elevated respiratory risk and especially obstructive sleep apnea syndrome; in elevated hemorrhagic risk (hemostasis disorder, surgical problems, etc.), tramadol is recommended. Two other treatment schedules (modified NSAIDs and corticosteroids) have not undergone dedicated study and should be assessed. Management of post-tonsillectomy pain in children is founded on individual risk/benefit analysis.PubMedeng/Users/meganridgway/Zotero/storage/HR4DRJPC/Constant et al. - 2014 - How to replace codeine after tonsillectomy in chil.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/25106698MyLibraryZotero17Barrette, Louis-XavierHarris, JacobDe Ravin, EmmaBalar, EeshaMoreira, Alvaro G.Rajasekaran, KarthikInternational Journal of Pediatric OtorhinolaryngologyClinical practice guidelines for pain management after tonsillectomyInternational Journal of Pediatric OtorhinolaryngologyInt J Pediatr Otorhinolaryngol111091156AGREE IIChildClinical practice guidelinesHumansINCLUDED-MainOpioidPain ManagementPediatricsReproducibility of ResultsTonsillectomy20222022-051872-846410.1016/j.ijporl.2022.111091PURPOSE: We identified and appraised clinical practice guidelines (CPGs) for the management of post-tonsillectomy pain using the Appraisal of Guidelines for Research and Evaluation (AGREE II) guideline research tool. MATERIALS AND METHODS: We conducted a literature search to identify CPGs addressing pain management after tonsillectomy. CPGs meeting inclusion criteria were then appraised by four independent reviewers in six areas of quality, as defined by AGREE II. Scaled domain scores were calculated for each quality domain. Intraclass correlation coefficients (ICC) were calculated in each domain to assess interrater reliability across guideline appraisals. RESULTS: Nine guidelines meeting inclusion criteria were identified from a systematic search of the literature. The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guideline detailing tonsillectomy and postoperative management in pediatric patients received the highest average score, with a mean of 90.1% in the six areas of quality. Three guidelines scored higher than >60% in five domains or more, defining 'high' quality per AGREE II: AAO-HNS, Scottish Intercollegiate Guides Network (SIGN), and Ontario Ministry of Health CPGs. The highest-scoring domain was domain 4: Clarity of presentation (87.4%) across guidelines, while the lowest scoring domain was domain 5: Applicability (49.4%). Variability in scaled domain scores between all CPGs was relatively consistent across domains, with a mean standard deviation of 22.4%. The average ICC calculated across all six domains was 0.78, indicating 'strong agreement' between reviewers regarding guideline quality. CONCLUSION: Of the nine available guidelines detailing pain management following tonsillectomy we identified, only three (33%) were deemed 'high'-quality after appraisal using the AGREE II instrument, suggesting a need for development of novel, methodologically rigorous CPGs.PubMedenghttp://www.ncbi.nlm.nih.gov/pubmed/35240561MyLibraryZotero17Boric, KrsteDosenovic, SvjetlanaJelicic Kadic, AntoniaBatinic, MarijanCavar, MarijaUrlic, MarjanMarkovina, NikolinaPuljak, LiviaPaediatric AnaesthesiaInterventions for postoperative pain in childrenPaediatric AnaesthesiaPaediatr Anaesth893-9042799analgesiachildChildHumansINCLUDED-Additionalmethodspain managementPain, PostoperativePediatricspostoperative painRandomized Controlled Trials as TopicreviewReview Literature as Topic20172017-091460-959210.1111/pan.13203The aim of this study was to conduct an overview of systematic reviews that summarizes the results about efficacy and safety from randomized controlled trials involving the various strategies used for postoperative pain management in children. We searched the Cochrane Database of Systematic Reviews, CINAHL, Database of Reviews of Effect, Embase, MEDLINE, and PsycINFO from the earliest date to January 24, 2016. This overview included 45 systematic reviews that evaluated interventions for postoperative pain in children. Out of 45 systematic reviews that investigated various interventions for postoperative pain in children, 19 systematic reviews (42%) presented conclusive evidence of efficacy. Positive conclusive evidence was reported in 18 systematic reviews (40%) for the efficacy of diclofenac, ketamine, caudal analgesia, dexmedetomidine, music therapy, corticosteroid, epidural analgesia, paracetamol, and/or nonsteroidal anti-inflammatory drugs and transversus abdominis plane block. Only one systematic review reported conclusive evidence of equal efficacy that involved a comparison of dexmedetomidine vs morphine and fentanyl. Safety of interventions was reported as conclusive in 14 systematic reviews (31%), with positive conclusive evidence for dexmedetomidine, corticosteroid, epidural analgesia, transversus abdominis plane block, and clonidine. Seven systematic reviews reported equal conclusive safety for epidural infusion, diclofenac intravenous vs ketamine added to opioid analgesia, bupivacaine, ketamine, paracetamol, and dexmedetomidine vs intravenous infusions of various opioid analgesics, oral suspension and suppository of diclofenac, only opioid, normal saline, no treatment, placebo, and midazolam. Negative conclusive statement for safety was reported in one systematic review for caudal analgesia vs noncaudal regional analgesia. More than half of systematic reviews included in this overview were rated as having medium methodological quality. Of 45 included systematic reviews, 10 were Cochrane reviews and they had higher methodological quality than non-Cochrane reviews. As evidence concerning efficacy and safety is inconclusive for most of the analyzed interventions, our review points out the need for more rigorous trials concerning pain management in children.PubMedenghttp://www.ncbi.nlm.nih.gov/pubmed/28707454MyLibraryZotero17Aubrun, FrédéricNouette-Gaulain, KarineFletcher, DominiqueBelbachir, AnissaBeloeil, HélèneCarles, MichelCuvillon, PhilippeDadure, ChristopheLebuffe, GillesMarret, EmmanuelMartinez, ValeriaOlivier, MichelSabourdin, NadaZetlaoui, PaulAnaesthesia, Critical Care & Pain MedicineAnaesthesia, Critical Care & Pain MedicineAnaesth Crit Care Pain Med405-4113844AdolescentAdultAnalgesia, EpiduralAnalgesicsAnalgesics, OpioidAnti-Inflammatory Agents, Non-SteroidalCatheterization, PeripheralChildChild, PreschoolContraindications, DrugDexamethasoneDrug Administration RoutesDrug InteractionsHemorrhageHumansINCLUDED-MainInfantInfant, NewbornKetamineLidocaineMonitoring, PhysiologicPain ManagementPain MeasurementPain, PostoperativePostoperative painRisk FactorsUpdate of experts’ guidelines20192019-082352-556810.1016/j.accpm.2019.02.011The French Society of Anaesthesia and Intensive Care Medicine (SFAR) published experts' guidelines on the care of postoperative pain. This was an update of the 2008 guidelines. Fourteen experts analysed the literature (PubMed™, Cochrane™) on questions that had not been treated in the previous guidelines, or to modify the guidelines following new data in the published literature. The used method is invariably the GRADE© method, which guarantees a rigorous work. Seventeen recommendations were formalised on the assessment of perioperative pain, and most particularly in non-communicating patients, on opioid and non-opioid analgesics and on anti-hyperalgesic drugs, such as ketamine and gabapentinoids, as well as on local and regional anaesthesia. The concept of vulnerability and therefore the identification of the most fragile patients in terms of analgesics requirements were specified. Because of the absence of sufficient data or new information, no recommendation was made about analgesia monitoring, the procedures for the surveillance of patients in conventional care structures, or perinervous or epidural catheterism.PubMedeng/Users/meganridgway/Zotero/storage/VN584AYN/Aubrun et al. - 2019 - Revision of expert panel's guidelines on postopera.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/30822542MyLibraryZotero17Aldamluji, N.Burgess, A.Pogatzki‐Zahn, E.Raeder, J.Beloeil, H.the PROSPECT Working Group collaborators*Albrecht, EBeloeil, HBonnet, FFreys, SJoshi, G. P.Kehlet, HLavand’homme, P.Lirk, PLobo, DPogatzki‐Zahn, ERawal, NRaeder, JSauter, ASchug, SVan De Velde, MAnaesthesiaPROSPECT guideline for tonsillectomyAnaesthesiaAnaesthesia947-9617677INCLUDED-Main202107/20210003-2409, 1365-204410.1111/anae.15299DOI.org (Crossref)enhttps://onlinelibrary.wiley.com/doi/10.1111/anae.15299/Users/meganridgway/Zotero/storage/NGSQAVPS/Aldamluji et al. - 2021 - PROSPECT guideline for tonsillectomy systematic r.pdf2023-07-10 15:37:45MyLibraryZotero17Rodríguez, Maria ClaudiaVillamor, PerlaCastillo, TatianaInternational Journal of Pediatric OtorhinolaryngologyInternational Journal of Pediatric OtorhinolaryngologyInternational Journal of Pediatric Otorhinolaryngology138-14990INCLUDED-Main201611/20160165587610.1016/j.ijporl.2016.09.015DOI.org (Crossref)enhttps://linkinghub.elsevier.com/retrieve/pii/S01655876163031592023-07-10 15:35:46MyLibraryZotero17Koh, Way SiongLeslie, KateCurrent Opinion in AnaesthesiologyCurrent Opinion in Anaesthesiology543-5483555INCLUDED-Additional202210/20220952-7907, 1473-650010.1097/ACO.0000000000001168DOI.org (Crossref)enhttps://journals.lww.com/10.1097/ACO.00000000000011682023-07-10 15:21:05MyLibraryZotero17Jitpakdee, ThanapornMandee, SahatsaPaediatric AnaesthesiaPaediatric AnaesthesiaPaediatr Anaesth561-5682466adverse effectsAnalgesics, OpioidchildChildHumansINCLUDED-Mainmultimodal treatmentopioid analgesicspainPain ManagementPain, PostoperativepediatricspostoperativePostoperative Complications20142014-061460-959210.1111/pan.12420BACKGROUND AND OBJECTIVES: Opioid is the gold standard for treating moderate-to-severe pain in pediatric patients. However, its undesirable side effects lead to unsatisfied postoperative pain management outcome (Pediatr Anesth, 17, 2007, 756). The most commonly reported opioid-related side effects are vomiting (40%), pruritus (20-60%) (Anesthesiology, 77, 1992, 162; Drugs, 67, 2007, 2323), and constipation (15-90%) (Int J Clin Pract, 61, 2007, 1181). The potential life-threatening adverse event, respiratory depression, is less common (0.0013%) (Pediatr Anesth, 20, 2010, 119). The aim of this review was to evaluate prevention strategies that have been shown to decrease opioid side effects in pediatric patients during the postoperative period. METHODS: Literature searches were conducted from 1984 to February 2013. Meta-analysis, systematic review, and randomized, placebo-controlled studies were obtained from PubMed and the Cochrane Library. The medical subject heading (MeSH) terms were opioid analgesics, adverse effects, pediatrics, children, side effects, and postoperative pain. RESULTS AND CONCLUSION: Data from 62 studies were reviewed. The strategies that could effectively prevent and reduce opioid side effects in pediatric patients during the postoperative period included minimizing the amount of opioid consumption by a multimodal approach, opioid titration, using local anesthetic techniques and providing the specific prophylaxis for each side effect.PubMedenghttp://www.ncbi.nlm.nih.gov/pubmed/24809837MyLibraryZotero17Feinberg, Adina E.Chesney, Tyler R.Srikandarajah, SanjhoAcuna, Sergio A.McLeod, Robin S.Best Practice in Surgery GroupAnnals of SurgeryOpioid use after discharge in postoperative patientsAnnals of SurgeryAnn Surg1056-106226766Analgesics, OpioidDrug PrescriptionsDrug StorageHumansINCLUDED-AdditionalPain ManagementPain, PostoperativePatient DischargePractice Patterns, Physicians'20182018-061528-114010.1097/SLA.0000000000002591BACKGROUND: Over the past 2 decades, there has been an increase in opioid use and subsequently, opioid deaths. The amount of opioid prescribed to surgical patients has also increased. The aim of this systematic review was to determine postdischarge opioid consumption in surgical patients compared with the amount of opioid prescribed. Secondary outcomes included adequacy of pain control and disposal methods for unused opioids. OBJECTIVE: The objective of this study is to characterize postdischarge opioid consumption and prescription patterns in surgical patients. METHODS: A systematic search in MEDLINE and EMBASE identified 11 patient survey studies reporting on postdischarge opioid use in 3525 surgical patients. RESULTS: The studies reported on a variety of surgical operations, including abdominal surgery, orthopedic procedures, tooth extraction, and dermatologic procedures. The majority of patients consumed 15 pills or less postdischarge. The proportion of used opioids ranged from 5.6% to 59.1%, with an outlier of 90.1% in pediatric spinal fusion patients. Measured pain scores of those taking opioids ranged between 2 and 5 out of 10 and the majority of patients were satisfied with their pain control. Seventy percent of patients kept the excess opioids. Where planned disposal methods were reported, between 4% and 59% of patients planned proper disposal. CONCLUSION: This study suggests that surgical patients are using substantially less opioid than prescribed. There is a lack of awareness regarding proper disposal of leftover medication, leaving excess opioid that may be used inappropriately by the patient or others. Education for providers and clinical practice guidelines that provide guidance on prescription of outpatient of opioids are required.PubMedenhttp://www.ncbi.nlm.nih.gov/pubmed/29215370MyLibraryZotero17Badin, DanielOrtiz-Babilonia, Carlos D.Gupta, ArjunLeland, Christopher R.Musharbash, FarahParrish, James M.Aiyer, Amiethab A.Clinical Orthopaedics and Related ResearchPrescription patterns, associated factors, and outcomes of opioids for operative foot and ankle fracturesClinical Orthopaedics and Related ResearchClin Orthop Relat Res2187-22014801111AdultAnalgesics, OpioidAnkle FracturesChildHumansINCLUDED-AdditionalKetorolacMiddle AgedMorphineObservational Studies as TopicOpioid-Related DisordersPain, PostoperativePrescriptionsRetrospective Studies20222022-11-011528-113210.1097/CORR.0000000000002307BACKGROUND: Pain management after foot and ankle surgery must surmount unique challenges that are not present in orthopaedic surgery performed on other parts of the body. However, disparate and inconsistent evidence makes it difficult to draw meaningful conclusions from individual studies. QUESTIONS/PURPOSES: In this systematic review, we asked: what are (1) the patterns of opioid use or prescription (quantity, duration, incidence of persistent use), (2) factors associated with increased or decreased risk of persistent opioid use, and (3) the clinical outcomes (principally pain relief and adverse events) associated with opioid use in patients undergoing foot or ankle fracture surgery? METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for our review. We searched PubMed, Embase, Scopus, Cochrane, and Web of Science on October 15, 2021. We included studies published from 2010 to 2021 that assessed patterns of opioid use, factors associated with increased or decreased opioid use, and other outcomes associated with opioid use after foot or ankle fracture surgery (principally pain relief and adverse events). We excluded studies on pediatric populations and studies focused on acute postoperative pain where short-term opioid use (< 1 week) was a secondary outcome only. A total of 1713 articles were assessed and 18 were included. The quality of the 16 included retrospective observational studies and two randomized trials was evaluated using the Methodological Index for Non-Randomized Studies criteria and the Jadad scale, respectively; study quality was determined to be low to moderate for observational studies and good for randomized trials. Mean patient age ranged from 42 to 53 years. Fractures studied included unimalleolar, bimalleolar, trimalleolar, and pilon fractures. RESULTS: Proportions of postoperative persistent opioid use (defined as use beyond 3 or 6 months postoperatively) ranged from 2.6% (546 of 20,992) to 18.5% (32 of 173) and reached 39% (28 of 72) when including patients with prior opioid use. Among the numerous associations reported by observational studies, two or more preoperative opioid prescriptions had the strongest overall association with increased opioid use, but this was assessed by only one study (OR 11.92 [95% confidence interval (CI) 9.16 to 13.30]; p < 0.001). Meanwhile, spinal and regional anesthesia (-13.5 to -41.1 oral morphine equivalents (OME) difference; all p < 0.01) and postoperative ketorolac use (40 OME difference; p = 0.037) were associated with decreased opioid consumption in two observational studies and a randomized trial, respectively. Three observational studies found that opioid use preoperatively was associated with a higher proportion of emergency department visits and readmission (OR 1.41 to 17.4; all p < 0.001), and opioid use at 2 weeks postoperatively was associated with slightly higher pain scores compared with nonopioid regimens (β = 0.042; p < 0.001 and Likert scale 2.5 versus 1.6; p < 0.05) in one study. CONCLUSION: Even after noting possible inflation of the harms of opioids in this review, our findings nonetheless highlight the need for opioid prescription guidelines specific for foot and ankle surgery. In this context, surgeons should utilize short (< 1 week) opioid prescriptions, regional anesthesia, and multimodal pain management techniques, especially in patients at increased risk of prolonged opioid use. LEVEL OF EVIDENCE: Level III, therapeutic study.PubMedenhttp://www.ncbi.nlm.nih.gov/pubmed/35901447MyLibraryZotero17Zhu, AlyssaBenzon, Hubert A.Anderson, T. AnthonyAnesthesia and AnalgesiaEvidence for the efficacy of systemic opioid-sparing analgesics in pediatric surgical populationsAnesthesia and AnalgesiaAnesth Analg1569-158712555AdolescentAge FactorsAnalgesicsAnalgesics, OpioidChildChild, PreschoolDrug Administration ScheduleDrug Dosage CalculationsEvidence-Based MedicineHumansINCLUDED-AdditionalInfantInfant, NewbornMeta-Analysis as TopicPain MeasurementPain, PostoperativeRandomized Controlled Trials as TopicTreatment Outcome20172017-111526-759810.1213/ANE.0000000000002434While a large number of studies has examined the efficacy of opioid-sparing analgesics in adult surgical populations, fewer studies are available to guide postoperative pain treatment in pediatric patients. We systematically reviewed available publications on the use of systemic nonopioid agents for postoperative analgesia in pediatric surgical populations. A comprehensive literature search identified meta-analyses and randomized controlled trials (RCTs) assessing the effects of systemic, nonopioid agents on postoperative narcotic requirements or pain scores in pediatric surgical populations. If a meta-analysis was located, we summarized its results and any RCTs published after it. We located and reviewed 11 acetaminophen RCTs, 1 nonsteroidal anti-inflammatory drug (NSAID) meta-analysis, 2 NSAID RCTs, 1 dexamethasone meta-analysis, 3 dexamethasone RCTs, 2 ketamine meta-analyses, 5 ketamine RCTs, 2 gabapentin RCTs, 1 clonidine meta-analysis, 3 magnesium RCTs, 2 dexmedetomidine meta-analyses, and 1 dextromethorphan RCT. No meta-analyses or RCTs were found assessing the perioperative efficacy of intravenous lidocaine, amantadine, pregabalin, esmolol, or caffeine in pediatric surgical patients. The available evidence is limited, but suggests that perioperative acetaminophen, NSAIDs, dexamethasone, ketamine, clonidine, and dexmedetomidine may decrease postoperative pain and opioid consumption in some pediatric surgical populations. Not enough, or no, data exist from which to draw conclusions on the perioperative use of gabapentin, magnesium, dextromethorphan, lidocaine, amantadine, pregabalin, esmolol, and caffeine in pediatric surgical patients. Further pharmacokinetic and pharmacodynamics studies to establish both the clinical benefit and efficacy of nonopioid analgesia in pediatric populations are needed.PubMedenghttp://www.ncbi.nlm.nih.gov/pubmed/29049110MyLibraryZotero17Wong, IvanSt John-Green, CeliaWalker, Suellen M.Paediatric AnaesthesiaPaediatric AnaesthesiaPaediatr Anaesth475-4952366AcetaminophenAdolescentAnalgesia, Patient-ControlledAnalgesics, Non-NarcoticAnalgesics, OpioidAnti-Inflammatory Agents, Non-SteroidalChildChild, PreschoolDose-Response Relationship, DrugFemaleFentanylHumansINCLUDED-MainInfantInfant, NewbornMaleMorphinePain MeasurementPain, PostoperativePatient SatisfactionRandomized Controlled Trials as TopicTreatment Outcome20132013-061460-959210.1111/pan.12163BACKGROUND AND OBJECTIVES: Perioperative pain in children can be effectively managed with systemic opioids, but addition of paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce opioid requirements and potentially improve analgesia and/or reduce adverse effects. METHODS: A systematic literature search was conducted to identify trials evaluating postoperative opioid requirements in children and comparing NSAID and/or paracetamol with placebo. Studies were stratified according to design: continuous availability of intravenous opioid (PCA/NCA) vs intermittent 'as needed' bolus; and single vs multiple dose paracetamol/NSAIDs. Primary outcome data were extracted, and the percentage decrease in mean opioid consumption was calculated for statistically significant reductions compared with placebo. Secondary outcomes included differences in pain intensity, adverse effects (sedation, respiratory depression, postoperative nausea and vomiting, pruritus, urinary retention, bleeding), and patient/parent satisfaction. RESULTS: Thirty-one randomized controlled studies, with 48 active treatment arms compared with placebo, were included. Significant opioid sparing was reported in 38 of 48 active treatment arms, across 21 of the 31 studies. Benefit was most consistently reported when multiple doses of study drug were administered, and 24 h PCA or NCA opioid requirements were assessed. The proportion of positive studies was less with paracetamol, but was influenced by dose and route of administration. Despite availability of opioid for titration, a reduction in pain intensity by NSAIDs and/or paracetamol was reported in 16 of 29 studies. Evidence for clinically significant reductions in opioid-related adverse effects was less robust. CONCLUSION: This systematic review supports addition of NSAIDs and/or paracetamol to systemic opioid for perioperative pain management in children.PubMeden/Users/meganridgway/Zotero/storage/B95GGI5B/Wong et al. - 2013 - Opioid-sparing effects of perioperative paracetamo.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/23570544MyLibraryZotero17Michelet, DaphneAndreu-Gallien, JulietteBensalah, TarikHilly, JulieWood, ChantalNivoche, YvesMantz, JeanDahmani, SouhaylAnesthesia and AnalgesiaAnesthesia and AnalgesiaAnesth Analg393-40611422AdolescentAge FactorsAnalgesics, Non-NarcoticAnalgesics, OpioidAnti-Inflammatory Agents, Non-SteroidalChildChild, PreschoolDrug Therapy, CombinationEvidence-Based MedicineHumansINCLUDED-AdditionalInfantOdds RatioPain MeasurementPain, PostoperativePostoperative Nausea and VomitingRandomized Controlled Trials as TopicTreatment Outcome20122012-021526-759810.1213/ANE.0b013e31823d0b45BACKGROUND: Opioid side effects are a great concern during the postoperative period in children. Nonsteroidal antiinflammatory drugs (NSAIDs) have been shown to effectively decrease postoperative pain, but their opioid-sparing effect is still controversial. In this present meta-analysis, we investigated the postoperative opioid-sparing effect of NSAIDs in children. METHODS: A comprehensive literature search was conducted to identify clinical trials using NSAIDs and opioids as perioperative analgesic compounds in children and infants. Outcomes measured were opioid consumption, pain intensity, postoperative nausea and vomiting (PONV), and urinary retention. All outcomes were studied during postanesthesia care unit (PACU) stay and the first 24 postoperative hours. Data from each trial were combined to calculate the pooled odds ratios (ORs) or standardized mean difference (SMD) and their 95% confidence interval. RESULTS: Twenty-seven randomized controlled studies were analyzed. Perioperative administration of NSAIDs decreased postoperative opioid requirement (both in the PACU and during the first 24 postoperative hours; SMD = -0.66 [-0.84, -0.48] and -0.83 [-1.11, -0.55], respectively), pain intensity in the PACU (SMD = -0.85 [-1.24, -0.47]), and PONV during the first 24 postoperative hours (OR = 0.75 [0.57-0.99]). NSAIDs did not decrease pain intensity during the first 24 postoperative hours (OR = 0.56 [0.26-1.2]) and PONV during PACU stay (OR = 1.02 [0.73-1.44]). Subgroup analysis according to the timing of NSAID administration (intraoperative versus postoperative), type of surgery, or coadministration of paracetamol did not show any influence of these factors on the studied outcomes except the reduction of pain intensity and the incidence of PONV during the first 24 postoperative hours, which were influenced by the coadministration of paracetamol and the type of surgery, respectively. CONCLUSION: This meta-analysis shows that perioperative NSAID administration reduces opioid consumption and PONV during the postoperative period in children.PubMedenhttp://www.ncbi.nlm.nih.gov/pubmed/22104069MyLibraryZotero17Duedahl, Tina HoffHansen, Ebba HolmePaediatric AnaesthesiaPaediatric AnaesthesiaPaediatr Anaesth756-7741788AdolescentAnalgesics, OpioidChildChild, PreschoolDouble-Blind MethodHumansINCLUDED-AdditionalInfantMorphinePain, PostoperativePediatricsPostoperative Nausea and VomitingRandomized Controlled Trials as Topic20072007-081155-564510.1111/j.1460-9592.2007.02213.xBACKGROUND: Postoperative pain management in children is often empirical rather than evidence based. Morphine is the pharmacological treatment most widely used and although considered safe for children, adequate scientific data on morphine's pharmacokinetics, efficacy and safety are lacking. This systematic review aimed to evaluate the available literature examining different pediatric morphine regimens with respect to dosage, analgesic efficacy and incidence of side effects. METHODS: Thirty-six randomized, double-blind controlled clinical trials with 49 comparisons, including multiple dosage regimens and routes of administration were included. The primary outcome measures for analgesic efficacy (pain intensity, time to first analgesic request and need for rescue analgesics) together with the incidence of morphine-related side effects were evaluated qualitatively by significant difference (P < 0.05) as reported in the original investigations. RESULTS: Overall, significant improvements in the defined outcome measures on analgesic efficacy were only observed when morphine was compared with inactive control interventions. No relation between morphine dosage and analgesic efficacy was detected. The most common morphine-related side effects were vomiting and sedation, with significantly higher incidences observed after morphine administration in half of all comparisons. CONCLUSIONS: Although several factors may justify its use as first line therapy in many parts of the world, morphine alone is not the most suitable analgesic for postoperative pain in pediatric patients, as it does not have superior analgesic effect and a higher incidence of side effects compared with active control interventions. More standardized clinical trials with multimodal regimens as well as guidelines for evaluating pediatric medicines are desirable in the future.PubMedenhttp://www.ncbi.nlm.nih.gov/pubmed/17596221MyLibraryZotero17Dautremont, Erin A.Ebramzadeh, EdwardBeck, Jennifer J.Bowen, Richard E.Sangiorgio, Sophia N.JBJS reviewsOpioid Prescription and Usage in Adolescents Undergoing Orthopaedic Surgery in the United StatesJBJS reviewsJBJS Reve5588AdolescentAnalgesics, OpioidDrug PrescriptionsHumansINCLUDED-AdditionalOpioid-Related DisordersOrthopedic ProceduresPain ManagementPain, PostoperativePractice Patterns, Physicians'Self MedicationUnited States20172017-082329-918510.2106/JBJS.RVW.16.00093BACKGROUND: The proper use of opioid analgesia for postoperative pain management is controversial. While opioids are considered the standard of care for multimodal postoperative pain modulation in the United States, there is a lack of established protocols for prescribing opioids in adolescents undergoing outpatient orthopaedic surgery. The objective of this review was to identify and report on current literature on opioid prescription for pain management in adolescents undergoing all procedures, as well as in adults undergoing outpatient orthopaedic surgery. METHODS: A comprehensive literature search using PRISMA guidelines was performed to identify all articles relevant to opioid use in adolescents for postoperative pain and in adults following outpatient orthopaedic procedures. RESULTS: A total of 4,446 results were identified from databases and relevant journal web sites. Of these, 9 articles were selected that fit the criteria for review. Five studies discussed the dosage and type of opioids prescribed in adolescent populations, and 4 quantified patient self-administration in adult populations. CONCLUSIONS: Adolescent opioid pain management following outpatient orthopaedic surgery is not documented. Current recommendations for opioid prescription in adolescents lack support and are primarily based on adult dosages. Adult studies suggest that opioid medications may be overprescribed following outpatient orthopaedic surgery. These results clearly indicate that there is a pressing need for quantitative research on pain management following outpatient orthopaedic surgery in the adolescent population in the United States. CLINICAL RELEVANCE: There appear to be no studies on self-administered opioid pain medication following orthopaedic surgery in an adolescent population, suggesting that there is no objective basis for the current prescription recommendations.PubMedenhttp://www.ncbi.nlm.nih.gov/pubmed/28796696MyLibraryZotero27CHU St Justine Pain Management Committee (GAN)INCLUDED-Main20212021CHU Sainte-JustineF-848A GRM 30004606 (rev. 10-2021)enhttps://www.chusj.org/getmedia/e3aa98f7-0be1-4339-b06e-a8ca5ddd0a2d/depliant_F-848_Analgesiques-opioides-a-courte-action_FR.pdf.aspx?ext=.pdf2023-07-10 04:51:15MyLibraryZotero19SickKidsAboutKidsHealthAboutKidsHealthINCLUDED-Main201901/25/2019Trusted information on everyday and complex child health conditions from The Hospital for Sick Children.en-CAhttps://www.aboutkidshealth.ca:443/article?contentid=3642&language=English/Users/meganridgway/Zotero/storage/59E28J8V/Article.html2023-07-10 04:48:06MyLibraryZotero19SickKidsAboutKidsHealthAboutKidsHealthINCLUDED-Main201901/25/2019Trusted information on everyday and complex child health conditions from The Hospital for Sick Children.en-CAhttps://www.aboutkidshealth.ca:443/article?contentid=3661&language=English/Users/meganridgway/Zotero/storage/CTJ7LZR2/Article.html2023-07-10 04:44:17MyLibraryZotero19SickKidsAboutKidsHealthAboutKidsHealthINCLUDED-Main201901/25/2019Trusted information on everyday and complex child health conditions from The Hospital for Sick Children.en-CAhttps://www.aboutkidshealth.ca:443/article?contentid=3637&language=English/Users/meganridgway/Zotero/storage/UR5XM8U6/Article.html2023-07-10 04:41:00MyLibraryZotero27SickKidsAboutKidsHealthINCLUDED-MainThe Hospital for Sick Childrenpamphletenhttps://assets.aboutkidshealth.ca/AKHAssets/OpioidSafetyChecklist.pdf2023-07-05pamphletMyLibraryZotero19SickKidsAboutKidsHealthAboutKidsHealthINCLUDED-Main20145/16/2014Trusted information on everyday and complex child health conditions from The Hospital for Sick Children.en-CAhttps://www.aboutkidshealth.ca:443/article?contentid=2999&language=english/Users/meganridgway/Zotero/storage/27WK6LQK/article.html2023-07-05 15:37:23MyLibraryZotero19SickKidsAboutKidsHealthAboutKidsHealthINCLUDED-Main201901/25/2019Trusted information on everyday and complex child health conditions from The Hospital for Sick Children.en-CAhttps://www.aboutkidshealth.ca:443/article?contentid=3635&language=English/Users/meganridgway/Zotero/storage/VLBLCYW3/Article.html2023-07-10 04:32:46MyLibraryZotero27Hoffe, JBailey, BThibault, MTrottier, Evelyne DINCLUDED-Main202010/2020Urgence CHU Sainte-Justinefrhttps://www.urgencehsj.ca/protocoles/fentanyl-intranasal-2//Users/meganridgway/Zotero/storage/6E9ZDY76/fentanyl-intranasal-2.html2023-07-10 04:13:57MyLibraryZotero17Trottier, Evelyne DDoré-Bergeron, Marie-JoëlleChauvin-Kimoff, LaurelBaerg, KristaAli, SaminaPaediatrics & Child HealthPaediatrics & Child Health509-5212488INCLUDED-Main20192019-12-091205-7088, 1918-148510.1093/pch/pxz026Abstract Common medical procedures to assess and treat patients can cause significant pain and distress. Clinicians should have a basic approach for minimizing pain and distress in children, particularly for frequently used diagnostic and therapeutic procedures. This statement focuses on infants (excluding care provided in the NICU), children, and youth who are undergoing common, minor but painful medical procedures. Simple, evidence-based strategies for managing pain and distress are reviewed, with guidance for integrating them into clinical practice as an essential part of health care. Health professionals are encouraged to use minimally invasive approaches and, when painful procedures are unavoidable, to combine simple pain and distress-minimizing strategies to improve the patient, parent, and health care provider experience. Health administrators are encouraged to create institutional policies, improve education and access to guidelines, create child- and youth-friendly environments, ensure availability of appropriate staff, equipment and pharmacological agents, and perform quality audits to ensure pain management is optimal.DOI.org (Crossref)enhttps://academic.oup.com/pch/article/24/8/509/5670802/Users/meganridgway/Zotero/storage/KPRNWISK/Trottier et al. - 2019 - Managing pain and distress in children undergoing .pdf2023-07-10 04:08:42MyLibraryZotero27Health Quality OntarioQuality Standards48INCLUDED-Main201805/07/2018Government of OntarioCL28611This quality standard provides guidance on the appropriate prescribing, monitoring, and tapering of opioids to treat acute pain for people 15 years of age and older in all care settings. It does not address opioid prescribing for chronic pain or end-of-life care, nor does it address the management of opioid use disorder in depth. Please refer to Health Quality Ontario’s Opioid Prescribing for Chronic Pain quality standard and Opioid Use Disorder quality standard for detailed quality statements related to these topics.Quality standardenhttps://www.hqontario.ca/evidence-to-improve-care/quality-standards/view-all-quality-standards/opioid-prescribing-for-acute-pain/Users/meganridgway/Zotero/storage/GFE5MQJM/opioid-prescribing-for-acute-pain.html2023-07-10 03:35:54Quality standardMyLibraryZotero17Hachimi-Idrissi, SaïdDobias, ViliamHautz, Wolf E.Leach, RobertSauter, Thomas C.Sforzi, IdannaCoffey, FrankInternal and Emergency MedicineApproaching acute pain in emergency settings; European Society for Emergency Medicine (EUSEM) guidelines-part 2Internal and Emergency MedicineIntern Emerg Med1141-11551577Acute painAcute PainAnalgesiaEmergency careEmergency departmentEmergency MedicineEmergency Service, HospitalEuropeHumansINCLUDED-MainNon-pharmacological treatmentPain managementPain ManagementPain MeasurementPharmacological treatmentPractice guidelinePre-hospital20202020-101970-936610.1007/s11739-020-02411-2BACKGROUND: In Europe, healthcare systems and education, as well as the clinical care and health outcomes of patients, varies across countries. Likewise, the management of acute events for patients also differs, dependent on the emergency care setting, e.g. pre-hospital or emergency department. There are various barriers to adequate pain management and factors common to both settings including lack of knowledge and training, reluctance to give opioids, and concerns about drug-seeking behaviour or abuse. There is no single current standard of care for the treatment of pain in an emergency, with management based on severity of pain, injury and local protocols. Changing practices, attitudes and behaviour can be difficult, and improvements and interventions should be developed with barriers to pain management and the needs of the individual emergency setting in mind. METHODS: With these principles at the forefront, The European Society for Emergency Medicine (EUSEM) launched a programme-the European Pain Initiative (EPI)-with the aim of providing information, advice, and guidance on acute pain management in emergency settings. RESULTS AND CONCLUSIONS: This article provides treatment recommendations from recently developed guidelines, based on a review of the literature, current practice across Europe and the clinical expertise of the EPI advisors. The recommendations have been developed, evaluated, and refined for both adults and children (aged ≥ 1 year, ≤ 15 years), with the assumption of timely pain assessment and reassessment and the possibility to implement analgesia. To provide flexibility for use across Europe, options are provided for selection of appropriate pharmacological treatment.PubMedenghttp://www.ncbi.nlm.nih.gov/pubmed/32930964MyLibraryZotero17Beck, Carolyn E.Trottier, Evelyne D.Kirby-Allen, MelaniePastore, YvesPaediatrics & Child HealthAcute complications in children with sickle cell diseasePaediatrics & Child HealthPaediatr Child Health50-622711HemoglobinopathyHemolytic anemiaHydroxyureaINCLUDED-MainNewborn screening20222022-031205-708810.1093/pch/pxab096Sickle cell disease (SCD) is a chronic, multi-system disease that requires comprehensive care. The sickling of red blood cells leads to hemolysis and vascular occlusion. Complications include hemolytic anemia, pain syndromes, and organ damage. Patterns of immigration and an increase in newborn screening mean that paediatric health care providers across Canada, in small and large centres alike, need to be knowledgeable about SCD. This statement focuses on principles of prevention, advocacy, and the rapid treatment of common acute complications. Guidance includes the current status of newborn screening, recommendations for immunizations and antibiotic prophylaxis, and an introduction to hydroxyurea, a medication that reduces both morbidity and mortality in children with SCD. Case vignettes demonstrate principles of care for common acute complications of SCD: vaso-occlusive episodes (VOE), acute chest syndrome (ACS), fever, splenic sequestration, aplastic crises, and stroke. Finally, principles of blood transfusion are highlighted, along with indications for both straight and exchange blood transfusions.PubMedeng, eng/Users/meganridgway/Zotero/storage/57ZRBD22/Beck et al. - 2022 - Acute complications in children with sickle cell d.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/35273671MyLibraryZotero27Li, Ke Xin (Chloe)Ford, CaitlynINCLUDED-Additional201911/2019Canadian Agency for Drugs and Technologies in HealthRC1200-000Summary with critical appraisalenhttps://www.cadth.ca/codeine-pediatric-patients-acute-pain-review-clinical-effectiveness/Users/meganridgway/Zotero/storage/V7D9UQRM/codeine-pediatric-patients-acute-pain-review-clinical-effectiveness.html2023-07-10 02:56:01Summary with critical appraisalMyLibraryZotero17Radman, MarijaBabic, AndrijaRunjic, EditaJelicic Kadic, AntoniaJeric, MilkaMoja, LorenzoPuljak, LiviaEuropean Journal of Pain (London, England)Revisiting established medicinesEuropean Journal of Pain (London, England)Eur J Pain1071-10822366AcetaminophenAdolescentAnalgesics, Non-NarcoticAnalgesics, OpioidAnti-Inflammatory Agents, Non-SteroidalChildChronic PainHumansIbuprofenINCLUDED-Additional20192019-071532-214910.1002/ejp.1380BACKGROUND AND OBJECTIVE: We explored how systematic reviews evaluated paracetamol and ibuprofen for treating pain in children, as these two non-opioid analgesics are well-established medicines included in most national essential medicines lists. DATABASES AND DATA TREATMENT: We carried out an overview of systematic reviews (SRs) of randomized controlled trials (RCTs) of interventions (PROSPERO registration: 42016045367). We searched MEDLINE, EMBASE, Cochrane Database of Systematic Reviews (CDSR) and Database of Reviews of Effects (DARE) up to 23 August 2017. We used AMSTAR checklist to analyse methodological quality of included SRs. RESULTS: We found 17 SRs with 72 unique RCTs; the majority of those trials included under 100 children. Positive conclusive evidence was found in only one SR, regarding safety of paracetamol. Conclusions of other SRs for efficacy and safety of ibuprofen and paracetamol were inconclusive, unclear, or there was no opinion. Only one SR analysed efficacy of ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) in chronic pain and the conclusion was that there was no evidence from RCTs that NSAIDs were effective for chronic non-cancer pain in children and adolescents. Most of the SRs addressed very narrow questions, included few trials, with few children and were of low or medium methodological quality. CONCLUSIONS: Most SRs on two relevant medicines have inconsistent conclusions and doubt upon their effectiveness. Instead of focusing on very narrow questions, SRs should examine more comprehensive research topics to obtain a general sense of consistency, particularly when analysing established medicines. SIGNIFICANCE: Evidence behind two analgesics-ibuprofen and paracetamol-that are well-established medicines for children in most countries appears limited, judging by the systematic reviews. The discrepancy between clinical use and the extensive evidence we reviewed may be a result of the selective criteria in the reviews examined. We need new, and better evidence syntheses supporting the use of these two medicines in wide indications regarding pain in children.PubMedeng/Users/meganridgway/Zotero/storage/RQH5ZKNA/Radman et al. - 2019 - Revisiting established medicines An overview of s.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/30793444MyLibraryZotero17Hartling, LisaAli, SaminaDryden, Donna M.Chordiya, PritamJohnson, David W.Plint, Amy C.Stang, AntoniaMcGrath, Patrick J.Drendel, Amy L.Pain Research & ManagementHow Safe Are Common Analgesics for the Treatment of Acute Pain for Children?Pain Research & ManagementPain Res Manag53468192016AcetaminophenAcute PainAnalgesicsAnalgesics, Non-NarcoticAnti-Inflammatory Agents, Non-SteroidalChildDrug Therapy, CombinationHumansINCLUDED-AdditionalNauseaTreatment OutcomeVomiting201620161918-152310.1155/2016/5346819Background. Fear of adverse events and occurrence of side effects are commonly cited by families and physicians as obstructive to appropriate use of pain medication in children. We examined evidence comparing the safety profiles of three groups of oral medications, acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids, to manage acute nonsurgical pain in children (<18 years) treated in ambulatory settings. Methods. A comprehensive search was performed to July 2015, including review of national data registries. Two reviewers screened articles for inclusion, assessed methodological quality, and extracted data. Risks (incidence rates) were pooled using a random effects model. Results. Forty-four studies were included; 23 reported on adverse events. Based on limited current evidence, acetaminophen, ibuprofen, and opioids have similar nausea and vomiting profiles. Opioids have the greatest risk of central nervous system adverse events. Dual therapy with a nonopioid/opioid combination resulted in a lower risk of adverse events than opioids alone. Conclusions. Ibuprofen and acetaminophen have similar reported adverse effects and notably less adverse events than opioids. Dual therapy with a nonopioid/opioid combination confers a protective effect for adverse events over opioids alone. This research highlights challenges in assessing medication safety, including lack of more detailed information in registry data, and inconsistent reporting in trials.PubMedeng/Users/meganridgway/Zotero/storage/DL3KV2XF/Hartling et al. - 2016 - How Safe Are Common Analgesics for the Treatment o.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/28077923MyLibraryZotero17Ali, SaminaDrendel, Amy L.Pediatric Emergency Medicine PracticePediatric Emergency Medicine PracticePediatr Emerg Med Pract1-242011AdolescentAdultAnalgesics, OpioidChildChronic PainEmergency Service, HospitalHumansINCLUDED-MainOpioid-Related DisordersPractice Patterns, Physicians'20232023-011549-9669Untreated pain in childhood may have ramifications well into adulthood. Opioid medications have an important role in care for moderate to severe pain that cannot be relieved by first-line interventions, but clinicians must approach opioid use in the emergency department in an evidence-based, socially responsible manner. This issue reviews evidence-based approaches to with a focus on optimizing nonopioid pain management as a first approach and using opioid medications safely, when appropriate. Recommendations are provided for safer opioid prescribing, including assessment of risk factors for opioid misuse, careful family counseling and education, and suggested prescribing limits. Prescription and use of naloxone in the emergency department and as take-home kits are also discussed.PubMedenghttps://pubmed.ncbi.nlm.nih.gov/36592388/http://www.ncbi.nlm.nih.gov/pubmed/36592388MyLibraryZotero17Setlur, AnuradhaFriedland, HowardPain ManagementTreatment of pain with intranasal fentanyl in pediatric patients in an acute care settingPain ManagementPain Manag341-352855acuteAcute PainAdministration, IntranasalanalgesiaAnalgesics, OpioidChildemergencyfentanylFentanylHumansINCLUDED-Additionalintranasalpainpediatrics20182018-09-011758-187710.2217/pmt-2018-0016AIM: The primary objective of this review is to provide an updated, comprehensive overview on the efficacy of intranasal fentanyl (INF) for acute pain relief in the pediatric population. METHODS: Utilizing the Preferred Reporting Instructions for Systematic Reviews and Meta-Analyses (PRISMA), we were able to screen articles based on key words to reach a final number of 10 studies. RESULTS: All but one study showed that INF was efficacious for pain relief in this select pediatric population. CONCLUSION: It is evident that INF is efficacious for analgesia, but other agents should also be considered in this patient population. As a result, further research is needed to investigate the clinically efficacy of INF in an acute care setting for pediatric patients.PubMedenghttp://www.ncbi.nlm.nih.gov/pubmed/30278812MyLibraryZotero17Qiu, JinXie, MianMedicineInfluence of ketamine versus fentanyl on pain relief for pediatric orthopedic emergenciesMedicineMedicine (Baltimore)e274091004242AdolescentChildChild, PreschoolDrug Administration RoutesEmergenciesFemaleFentanylHumansINCLUDED-AdditionalInfantKetamineMaleOrthopedicsPainPain ManagementRandomized Controlled Trials as Topic20212021-10-221536-596410.1097/MD.0000000000027409INTRODUCTION: The comparison of ketamine with fentanyl for pain control of pediatric orthopedic emergencies remains controversial. We conduct a systematic review and meta-analysis to explore the influence of ketamine versus fentanyl on pain management among pediatric orthopedic emergencies. METHODS: We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through September 2020 for randomized controlled trials assessing the effect of ketamine versus fentanyl on pain management for pediatric orthopedic emergencies. RESULTS: Five randomized controlled trials are included in the meta-analysis. Overall, compared with fentanyl for pediatric orthopedic emergencies, ketamine led to similar change in pain scores at 15 to 20 minutes (standard mean difference = -0.05; 95% confidence interval [CI] = -0.38 to 0.28; P = .77) and 30 minutes (standard mean difference = 0.11; 95% CI = -0.20 to 0.42; P = .49), as well as rescue analgesia (RR = 0.90; 95% CI = 0.54 to 1.51; P = .69), but revealed the increase in nausea/vomiting (RR = 2.65; 95% CI = 1.13 to 6.18; P = .02) and dizziness (RR = 3.83; 95% CI = 1.38 to 10.60; P = .01). CONCLUSIONS: Ketamine may be similar to fentanyl in terms of the analgesic efficacy for pediatric orthopedic emergencies.PubMedeng/Users/meganridgway/Zotero/storage/FMFGKES5/Qiu and Xie - 2021 - Influence of ketamine versus fentanyl on pain reli.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/34678869MyLibraryZotero17Poonai, NaveenPaskar, DavidKonrad, Shauna-LeeRieder, MichaelJoubert, GaryLim, RodrickGolozar, AsiehUledi, SefuWorster, AndrewAli, SaminaAcademic Emergency Medicine: Official Journal of the Society for Academic Emergency MedicineOpioid analgesia for acute abdominal pain in childrenAcademic Emergency Medicine: Official Journal of the Society for Academic Emergency MedicineAcad Emerg Med1183-1192211111Abdominal PainAnalgesiaAnalgesics, OpioidChildHumansINCLUDED-AdditionalPain Management20142014-111553-271210.1111/acem.12509OBJECTIVES: There are long-held concerns that analgesia in patients with acute abdominal pain may obscure the physical examination and lead to missing a diagnosis of appendicitis. Despite evidence to the contrary, analgesia continues to be underutilized and suboptimally dosed in children with acute abdominal pain. The objective of this systematic review and meta-analysis was to determine if opioids provide analgesia without an increase in side effects and appendicitis-related complications. METHODS: Trials were identified through electronic searches of MEDLINE (1946-2013), EMBASE (1980-2013), Cochrane Central Register of Controlled Trials (2013), CINAHL (1981-2013), and Google Scholar (2013). All randomized controlled trials (RCTs) of children aged 0-18 years with acute abdominal pain that compared any opioid analgesic to placebo were included. The methodologic qualities of studies and the overall quality of evidence were evaluated using the Cochrane Collaboration's Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system, respectively. RESULTS: Six RCTs met inclusion criteria, and each compared a single-dose parenteral opioid to a placebo, providing data on 342 children aged 5 to 18 years. The pooled mean pre/post difference in self-reported pain scores was 19.61 mm (95% confidence interval [CI] = -1.16 to 40.37 mm) lower in those receiving opioid analgesia. There was no significant increase in the risk of perforation or abscess associated with opioids in cases of appendicitis (relative risk [RR] = 1.03, 95% CI = 0.55 to 1.93). The risk of side effects was significantly greater in patients who received opioids (RR = 6.06, 95% CI = 1.10 to 33.49). Subtherapeutic dosing of opioids was detected in all six trials. CONCLUSIONS: The use of opioids in undifferentiated acute abdominal pain in children is associated with no difference in pain scores and an increased risk of mild side effects. However, there is no increased risk of perforation or abscess. The overall quality of evidence is low, suggesting the need for larger, high-quality trials that are powered to detect both serious complications of appendicitis and determine the most efficacious opioid dosing for children.PubMedenghttp://www.ncbi.nlm.nih.gov/pubmed/25377394MyLibraryZotero17Parri, NiccolòLazzeri, SimonePloS OneEfficacy of ibuprofen in musculoskeletal post-traumatic pain in childrenPloS OnePLoS Onee0243314151212AdolescentAdultAnalgesics, Non-NarcoticAnti-Inflammatory Agents, Non-SteroidalChildFemaleHumansIbuprofenINCLUDED-AdditionalMaleMusculoskeletal PainPain ManagementWounds and Injuries202020201932-620310.1371/journal.pone.0243314Musculoskeletal (MSK) injuries are one of the most frequent reason for pain-related evaluation in the emergency department (ED) in children. There is still no consensus as to what constitutes the best analgesic for MSK pain in children. However, ibuprofen is reported to be the most commonly prescribed analgesic and is considered the standard first-line treatment for MSK injury pain in children, even if it is argued that it provides inadequate relief for many patients. The purpose of this study was to review the most recent literature to assess the efficacy of ibuprofen for pain relief in MSK injuries in children evaluated in the ED. We performed a systematic review of randomized controlled trials on pharmacological interventions in children and adolescents under 19 years of age with MSK injuries according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome was the risk ratio for successful reduction in pain scores. Six studies met the inclusion criteria and provided data on 1028 children. A meta-analysis was not performed since studies were not comparable due to the different analgesic treatment used. No significant difference in term of main pain score reduction between all the analgesics used in the included studies was noted. Patients who received oral opioids had side effects more frequently when compared to children who received ibuprofen. The combination of effect on pain relief and tolerability would suggest ibuprofen as the initial drug of choice in providing relief from mild-to-moderate MSK pain in children in the ED. The results obtained in this review and current research suggest that there's no straightforward statistically significant evidence of the optimal analgesic agent to be used. However, ibuprofen may be preferable as the initial drug of choice in providing relief from MSK pain due to the favorable combination of effectiveness and safety profile. In fact, despite the non-significant pain reduction as compared to children who received opioids, there are less side effect associated to ibuprofen within studies. The wide range of primary outcomes measured in respect of pain scores and timing of recorded measures warrants a future standardization of study designs.PubMedeng/Users/meganridgway/Zotero/storage/CX6APFMC/Parri and Lazzeri - 2020 - Efficacy of ibuprofen in musculoskeletal post-trau.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/33270748MyLibraryZotero17Murphy, AdrianO'Sullivan, RonanWakai, AbelGrant, Timothy S.Barrett, Michael J.Cronin, JohnMcCoy, Siobhan C.Hom, JeffreyKandamany, NandiniThe Cochrane Database of Systematic ReviewsThe Cochrane Database of Systematic ReviewsCochrane Database Syst RevCD00994220141010Acute PainAdministration, IntranasalAnalgesics, OpioidChildFentanylHumansINCLUDED-AdditionalMorphinePain MeasurementRandomized Controlled Trials as Topic20142014-10-101469-493X10.1002/14651858.CD009942.pub2BACKGROUND: Pain is the most common symptom in the emergency setting; however, timely management of acute pain in children continues to be suboptimal. Intranasal drug delivery has emerged as an alternative method of achieving quicker drug delivery without adding to the distress of a child by inserting an intravenous cannula. OBJECTIVES: We identified and evaluated all randomized controlled trials (RCTs) and quasi-randomized trials to assess the effects of intranasal fentanyl (INF) versus alternative analgesic interventions in children with acute pain, with respect to reduction in pain score, occurrence of adverse events, patient tolerability, use of "rescue analgesia," patient/parental satisfaction and patient mortality. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 1); MEDLINE (Ovid SP, from 1995 to January 2014); EMBASE (Ovid SP, from 1995 to January 2014); the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO Host, from 1995 to January 2014); the Latin American and Caribbean Health Science Information Database (LILACS) (BIREME, from 1995 to January 2014); Commonwealth Agricultural Bureaux (CAB) Abstracts (from 1995 to January 2014); the Institute for Scientific Information (ISI) Web of Science (from 1995 to January 2014); BIOSIS Previews (from 1995 to January 2014); the China National Knowledge Infrastructure (CNKI) (from 1995 to January 2014); International Standard Randomized Controlled Trial Number (ISRCTN) (from 1995 to January 2014); ClinicalTrials.gov (from 1995 to January 2014); and the International Clinical Trials Registry Platform (ICTRP) (to January 2014). SELECTION CRITERIA: We included RCTs comparing INF versus any other pharmacological/non-pharmacological intervention for the treatment of children in acute pain (aged < 18 years). DATA COLLECTION AND ANALYSIS: Two independent review authors assessed each title and abstract for relevance. Full copies of all studies that met the inclusion criteria were retrieved for further assessment. Mean difference (MD), odds ratio (OR) and 95% confidence interval (CI) were used to measure effect sizes. Two review authors independently assessed and rated the methodological quality of each trial using the tool of The Cochrane Collaboration to assess risk of bias, as per Chapter 8 of the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS: Three studies (313 participants) met the inclusion criteria. One study compared INF versus intramuscular morphine (IMM); another study compared INF versus intravenous morphine (IVM); and another study compared standard concentration INF (SINF) versus high concentration INF (HINF). All three studies reported a reduction in pain score following INF administration. INF produced a greater reduction in pain score at 10 minutes post administration when compared with IMM (INF group pain score: 1/5 vs IMM group pain score: 2/5; P value 0.014). No other statistically significant differences in pain scores were reported at any other time point. When INF was compared with IVM and HINF, no statistically significant differences in pain scores were noted between treatment arms, before analgesia or at 5, 10, 20 and 30 minutes post analgesia. Specifically, when INF was compared with IVM, both agents were seen to produce a statistically significant reduction in pain score up to 20 minutes post analgesia. No further reduction in pain score was noted after this time. When SINF was compared with HINF, a statistically and clinically significant reduction in pain scores over study time was observed (median decrease for both groups 40 mm, P value 0.000). No adverse events (e.g. opiate toxicity, death) were reported in any study following INF administration. One study described better patient tolerance to INF compared with IMM, which achieved statistical significance. The other studies described reports of a "bad taste" and vomiting with INF. Overall the risk of bias in all studies was considered low. AUTHORS' CONCLUSIONS: INF may be an effective analgesic for the treatment of patients with acute moderate to severe pain, and its administration appears to cause minimal distress to children. However, this review of published studies does not allow any definitive conclusions regarding whether INF is superior, non-inferior or equivalent to intramuscular or intravenous morphine. Limitations of this review include the following: few eligible studies for inclusion (three); no study examined the use of INF in children younger than three years of age; no study included children with pain from a "medical" cause (e.g. abdominal pain seen in appendicitis); and all eligible studies were conducted in Australia. Consequently, the findings may not be generalizable to other healthcare settings, to children younger than three years of age and to those with pain from a "medical" cause.PubMedeng/Users/meganridgway/Zotero/storage/WPNTM8L9/Murphy et al. - 2014 - Intranasal fentanyl for the management of acute pa.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/25300594MyLibraryZotero17Jones, PeterLamdin, RainDalziel, Stuart R.The Cochrane Database of Systematic ReviewsThe Cochrane Database of Systematic ReviewsCochrane Database Syst RevCD007789888AcetaminophenAcute DiseaseAdministration, OralAdultAnalgesicsAnalgesics, OpioidAnti-Inflammatory Agents, Non-SteroidalBiasChildContusionsFemaleHumansINCLUDED-AdditionalMaleMiddle AgedPainRandomized Controlled Trials as TopicSoft Tissue InjuriesSprains and StrainsTime-to-TreatmentYoung Adult20202020-08-121469-493X10.1002/14651858.CD007789.pub3BACKGROUND: Acute soft tissue injuries are common and costly. The best drug treatment for such injuries is not certain, although non-steroidal anti-inflammatory drugs (NSAIDs) are often recommended. There is concern about the use of oral opioids for acute pain leading to dependence. This is an update of a Cochrane Review published in 2015. OBJECTIVES: To assess the benefits or harms of NSAIDs compared with other oral analgesics for treating acute soft tissue injuries. SEARCH METHODS: We searched the CENTRAL, 2020 Issue 1, MEDLINE (from 1946), and Embase (from 1980) to January 2020; other databases were searched to February 2019. SELECTION CRITERIA: We included randomised or quasi-randomised controlled trials involving people with acute soft tissue injury (sprain, strain, or contusion of a joint, ligament, tendon, or muscle occurring within 48 hours of inclusion in the study), and comparing oral NSAIDs versus paracetamol (acetaminophen), opioid, paracetamol plus opioid, or complementary and alternative medicine. The outcomes were pain, swelling, function, adverse effects, and early re-injury. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for eligibility, extracted data, and assessed risk of bias. We assessed the quality of the evidence using GRADE methodology. MAIN RESULTS: We included 20 studies, with 3305 participants. Three studies included children only. The others included predominantly young adults; approximately 60% were male. Seven studies recruited people with ankle sprains only. Most studies were at low or unclear risk of bias; however, two were at high risk of selection bias, three were at high risk of bias from lack of blinding, and five were at high risk of selective outcome reporting bias. Some evidence relating to pain relief was high certainty. Other evidence was either moderate, low or very low certainty, reflecting study limitations, indirectness, imprecision, or combinations of these. Thus, we are certain or moderately certain about some of the estimates, and uncertain or very uncertain of others. Eleven studies, involving 1853 participants compared NSAIDs with paracetamol. There were no differences between the two groups in pain at one to two hours (1178 participants, 6 studies; high-certainty evidence), at days one to three (1232 participants, 6 studies; high-certainty evidence), and at day seven or later (467 participants, 4 studies; low-certainty evidence). There was little difference between the groups in numbers of participants with minimal swelling at day seven or later (77 participants, 1 study; low-certainty evidence). Very low-certainty evidence from three studies (386 participants) means we are uncertain of the finding of little difference between the two groups in return to function at day seven or later. There was low-certainty evidence from 10 studies (1504 participants) that NSAIDs may slightly increase the risk of gastrointestinal adverse events compared with paracetamol. There was low-certainty evidence from nine studies (1679 participants) of little difference in neurological adverse events between the NSAID and paracetamol groups. Six studies, involving 1212 participants compared NSAIDs with opioids. There was moderate-certainty evidence of no difference between the groups in pain at one hour (1058 participants, 4 studies), and low-certainty evidence for no difference in pain at days four or seven (706 participants, 1 study). There was very low-certainty evidence of no important difference between the groups in swelling (84 participants, 1 study). Participants in the NSAIDs group were more likely to return to function in 7 to 10 days (542 participants, 2 studies; low-certainty evidence). There was moderate-certainty evidence (1143 participants, 5 studies) that NSAIDs were less likely to result in gastrointestinal or neurological adverse events compared with opioids. Four studies, involving 240 participants, compared NSAIDs with the combination of paracetamol and an opioid. The applicability of findings from these studies is in question because the dextropropoxyphene combination analgesic agents used are no longer in general use. Very low-certainty evidence means we are uncertain of the findings of no differences between the two interventions in the numbers with little or no pain at day one (51 participants, 1 study), day three (149 participants, 2 studies), or day seven (138 participants, 2 studies); swelling (230 participants, 3 studies); return to function at day seven (89 participants, 1 study); and the risk of gastrointestinal or neurological adverse events (141 participants, 3 studies). No studies reported re-injury rates. No studies compared NSAIDs with oral complementary and alternative medicines, AUTHORS' CONCLUSIONS: Compared with paracetamol, NSAIDs make no difference to pain at one to two hours and at two to three days, and may make no difference at day seven or beyond. NSAIDs may result in a small increase in gastrointestinal adverse events and may make no difference in neurological adverse events compared with paracetamol. Compared with opioids, NSAIDs probably make no difference to pain at one hour, and may make no difference at days four or seven. NSAIDs probably result in fewer gastrointestinal and neurological adverse effects compared with opioids. The very low-certainly evidence for all outcomes for the NSAIDs versus paracetamol with opioid combination analgesics means we are uncertain of the findings of no differences in pain or adverse effects. The current evidence should not be extrapolated to adults older than 65 years, as this group was not well represented in the studies.PubMedeng/Users/meganridgway/Zotero/storage/UY27IMUV/Jones et al. - 2020 - Oral non-steroidal anti-inflammatory drugs versus .pdfhttp://www.ncbi.nlm.nih.gov/pubmed/32797734MyLibraryZotero17Alanazi, ElhamThe American Journal of Emergency MedicineThe Effectiveness of Ketamine Compared to Opioid Analgesics for management of acute pain in Children in The Emergency DepartmentThe American Journal of Emergency MedicineAm J Emerg Med143-15161Acute PainAnalgesiaAnalgesicsAnalgesics, OpioidChildChildrenEmergency Service, HospitalFentanylHumansINCLUDED-AdditionalIntramuscularIntranasalIntravenousKetamineManagementMorphineOpioidPaediatricsPainRandomized Controlled Trials as Topic20222022-111532-817110.1016/j.ajem.2022.08.004AIM: The first objective of this systematic review was to investigate the effectiveness of ketamine compared to opioid analgesics for pain management in children aged two months to 18 years who have acute pain in the emergency department. The second objective was to compare the adverse events and side effects associated with ketamine with those associated with opioids used for pain management. BACKGROUND: Ketamine is increasingly being used as an alternative to opioids in the management of acute pain in the emergency department. In turn, there is increasing research attention to prove the efficacy of ketamine as an analgesic in children presenting in the emergency department. DESIGN: The design was pertinent for gathering and appraisal of evidence presented in the available RCTs. METHODS: A systematic review, using the JBI systematic review was completed. A computerised search from five databases; CINAHL, EMBASE, EMCARE and PubMed, and Cochrane. The included studies were appraised by JBI critical appraisal tool for randomized controlled trials and the study results analysed. RESULTS: Four randomized control trial studies were included in this systematic review. All the included studies compared ketamine with opioids (morphine and fentanyl) for the management of severe pain in children. The studies were of high methodological quality based on JBI critical appraisal outcome. Meta-analysis was not possible because of the heterogeneity of the studies, especially in terms of different outcome measures, and the approaches (pain assessment tool) used to measure the pain outcomes. The review identified that that ketamine demonstrated non-inferior analgesia effect compared to opioid medication (morphine or fentanyl) as determined by various pain scores used in different studies. However, ketamine use was associated with increased frequency of occurrence of temporary adverse effects that do not require clinical attention. DISCUSSION: Ketamine is a suitable alternative for opioid analgesics for the management of acute and severe pain in children in ED. The evidence generated by this study is that ketamine is non-inferior to opioids (morphine and fentanyl) in controlling acute pain in children. CONCLUSION: Based on the findings from the review, ketamine is a suitable alternative for opioid analgesics for the management of acute and severe pain in children in ED. The minor transient side effects associated with ketamine should not limit the use of ketamine. Future studies should investigate the appropriate dosage and route of administration of ketamine to be used while managing pain among children with acute and severe pain in the emergency department. IMPLICATIONS FOR NURSING & HEALTH POLICY: In this systematic review, the Joanna Briggs Institute standards [14] have been followed. is advisable for the Emergency Department health professionals to determine the appropriate dose for ketamine based on the child's characteristics, such as weight, age, and disease condition.PubMedenghttp://www.ncbi.nlm.nih.gov/pubmed/36113377MyLibraryZotero17Abebe, YonasHetmann, FredrikSumera, KacperHolland, MattStaff, TrineScandinavian Journal of Trauma, Resuscitation and Emergency MedicineThe effectiveness and safety of paediatric prehospital pain managementScandinavian Journal of Trauma, Resuscitation and Emergency MedicineScand J Trauma Resusc Emerg Med1702911Acute PainAdditionalAmbulanceAnalgesiaAnalgesicsAnalgesics, OpioidChildChildrenEmergency Medical ServicesFentanylHumansINCLUDED-AdditionalKetamineMethoxyfluraneMorphinePaediatricsPain managementPrehospital20212021-12-111757-724110.1186/s13049-021-00974-3BACKGROUND: Clinically meaningful pain reduction with respect to severity and the adverse events of drugs used in prehospital pain management for children are areas that have not received sufficient attention. The present systematic review therefore aims to perform a comprehensive search of databases to examine the preferable drugs for prehospital pain relief in paediatric patients with acute pain, irrespective of aetiology. METHODS: The systematic review includes studies from 2000 and up to 2020 that focus on children's prehospital pain management. The study protocol is registered in PROSPERO with registration no. CRD42019126699. Pharmacological pain management using any type of analgesic drug and in all routes of administration was included. The main outcomes were (1) measurable pain reduction (effectiveness) and (2) no occurrence of any serious adverse events. Searches were conducted in PubMed, Medline, Embase, CINAHL, Epistemonikos and Cochrane library. Finally, the risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist and a textual narrative analysis was performed due to the heterogeneity of the results. RESULTS: The present systematic review on the effectiveness and safety of analgesic drugs in prehospital pain relief in children identified a total of eight articles. Most of the articles reviewed identified analgesic drugs such as fentanyl (intranasal/IV), morphine (IV), methoxyflurane (inhalational) and ketamine (IV/IM). The effects of fentanyl, morphine and methoxyflurane were examined and all of the included analgesic drugs were evaluated as effective. Adverse events of fentanyl, methoxyflurane and ketamine were also reported, although none of these were considered serious. CONCLUSION: The systematic review revealed that fentanyl, morphine, methoxyflurane and combination drugs are effective analgesic drugs for children in prehospital settings. No serious adverse events were reported following the administration of fentanyl, methoxyflurane and ketamine. Intranasal fentanyl and inhalational methoxyflurane seem to be the preferred drugs for children in pre-hospital settings due to their ease of administration, similar effect and safety profile when compared to other analgesic drugs. However, the level of evidence (LOE) in the included studies was only three or four, and further studies are therefore necessary.PubMedeng/Users/meganridgway/Zotero/storage/K4ZBWDE6/Abebe et al. - 2021 - The effectiveness and safety of paediatric prehosp.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/34895311MyLibraryZotero27Health CanadaINCLUDED-Main20162016-07-28OttawaGovernment of CanadaIt is known hydrocodone can slow breathing when too much is taken. The labelling for these drugs already warns of this risk and it applies to all ages, including childrenassessmentsenhttps://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/safety-reviews/summary-safety-review-hydrocodone-containing-products-assessing-risk-serious-breathing.html/Users/meganridgway/Zotero/storage/TASHJK8G/summary-safety-review-hydrocodone-containing-products-assessing-risk-serious-breathing.html2023-06-19 14:47:19assessmentsMyLibraryZotero27Health CanadaINCLUDED-Additional20152015-12-09Government of CanadaSummary Safety Review - CODEINE PRESCRIPTION PRODUCTS Indicated for Cough - Further Assessing the Risk of Serious Breathing Problems in Children and Adolescentsassessmentsenhttps://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/safety-reviews/summary-safety-review-codeine-prescription-products-indicated-cough-further-assessing-risk-serious-breathing-problems-children-adolescents-1.html/Users/meganridgway/Zotero/storage/BRZN7NIN/summary-safety-review-codeine-prescription-products-indicated-cough-further-assessing-risk-seri.html2023-07-05 03:52:58assessmentsMyLibraryZotero27Institute for Safe Medication Practices CanadaINCLUDED-Mainpamphletfrhttps://www.ismp-canada.org/download/OpioidStewardship/storage-disposal-information.pdf2023-07-06pamphletMyLibraryZotero27Institute for Safe Medication Practices CanadaINCLUDED-Additional20162016Health Canadapamphletenhttps://www.ismp-canada.org/download/OpioidStewardship/OpioidStorageDisposal-patient.pdf2023-07-06pamphletMyLibraryZotero27Food and Drug AdministrationINCLUDED-AdditionalUS Department of Health and Human Services, National Institutes of Healthenhttps://www.fda.gov/media/123332/download2023-07-06MyLibraryZotero27Reiter, EliseAli, SaminaINCLUDED-Main202105/2021Stollery Children's Hospital/University of AlbertaInfographic leafletEnglishhttps://kidsinpain.ca/wp-content/uploads/2021/04/ED_opioids_19Apr2021_Final.pdf2023-07-06Infographic leafletMyLibraryZotero27BC Children's HospitalINCLUDED-AdditionalBC Children's Hospitalhttp://www.cw.bc.ca/library/pdf/pamphlets/BCCH_Medication_Opioids.pdf2023-07-06MyLibraryZotero27Health CanadaINCLUDED-Additional202003/19/2020Government of CanadaISBN: 978-0-660-28620-4Learn about talking to your health care provider about opioids.education and awarenessenghttps://www.canada.ca/en/health-canada/services/publications/healthy-living/talking-to-health-care-provider-opioids-fact-sheet.html/Users/meganridgway/Zotero/storage/THN5242S/talking-to-health-care-provider-opioids-fact-sheet.html2023-07-06 20:27:25education and awarenessMyLibraryZotero27Institute for Safe Medication Practices CanadaINCLUDED-Additional20162016Infographicenhttps://www.ismp-canada.org/download/MedRec/MedSafety_5_questions_to_ask_poster.pdf/Users/meganridgway/Zotero/storage/QFXLNZR6/5questions.html2023-07-05 16:11:06InfographicMyLibraryZotero23He, TracyHo, CertinaHospital NewsHospital News38-39

Safe Medication

INCLUDED-Additional201704/2017enhttps://www.ismp-canada.org/download/hnews/201704-HospitalNews-SwissCheese.pdf2023-07-05MyLibraryZotero27Health CanadaCodeineINCLUDED-Additional202302/08/2023Government of CanadaCodeine is a common opioid medication used to relieve cough and pain. Codeine can be addictive when used in high doses and over the long term.education and awarenessenghttps://www.canada.ca/en/health-canada/services/substance-use/controlled-illegal-drugs/codeine.html/Users/meganridgway/Zotero/storage/4DYZIYLB/codeine.html2023-07-05 15:52:35education and awarenessMyLibraryZotero27SickKidsChildKind InternationalPain Education, Pain Treatment - Pharmacologic, Withdrawal AssessmentBenzodiazepineINCLUDED-MainOpioidWeaning202111/27/2021Version 2Medication Guideline, Treatment Guidelineenhttps://childkindinternational.org/wp-content/uploads/Prevention-and-treatment-of-opioid-and-benzodiazepine-withdrawal.pdf/Users/meganridgway/Zotero/storage/8KNVUKXR/prevention-and-treatment-of-opioid-and-benzodiazepine-withdrawal.html2023-07-05 15:30:56Medication Guideline, Treatment GuidelineMyLibraryZotero27TREKKINCLUDED-Main202208/2022EMSC Innovation and Improvement Center3.1enhttps://trekk.ca/system/assets/assets/attachments/588/original/2022-10-07PainTreatmentBLR_FINAL_v3.1.pdf?1665168885MyLibraryZotero27Institute for Safe Medication Practices CanadaINCLUDED-Additional201403/19/201414, (3)ISMP Canada Safety Bulletinenhttps://ismpcanada.ca/wp-content/uploads/ISMPCSB2014-3_HospitalOpioidSafetyForChildren.pdf/Users/meganridgway/Zotero/storage/TNHDCU86/advancing-opioid-safety-for-children-in-hospitals.html2023-07-05 14:49:45ISMP Canada Safety BulletinMyLibraryZotero27UCSF Benioff Children's HospitalChildKind InternationalPain Assessment, Pain Education, Pain Treatment - Pharmacologic, Withdrawal AssessmentINCLUDED-MainOpioidOral morphine equivalentsWeaningwithdrawal20181/2018Education for Professionals, Medication Guideline, Treatment Guidelineenhttps://childkindinternational.org/wp-content/uploads/Pediatric-Acute-Care-Opioid-Weaning-Guidelines.pdf/Users/meganridgway/Zotero/storage/U2QC9Y66/pediatric-acute-care-opioid-weaning-guidelines.html2023-07-05 14:44:39Education for Professionals, Medication Guideline, Treatment GuidelineMyLibraryZoteroHealth Standards Organization (HSO)INCLUDED-Main20232023-03Health Standards Organization (HSO)The Pediatric Pain Management Standard will address pain management for children in Canada, defined as those from infancy to late adolescence and including healthy children and those with acute and chronic disease. It will cover acute, procedural, post-surgical, and chronic pain management as well as parental and caregiver engagement in pain management.enhttps://store.healthstandards.org/products/pediatric-pain-management-can-hso-13200-2023-eMyLibraryZotero27Health CanadaINCLUDED-Additional20192019-09-17Government of CanadaRA-71003Information Updateenghttps://recalls-rappels.canada.ca/en/alert-recall/health-canada-advises-canadians-exercise-caution-when-taking-gabapentin-or-pregabalin/Users/meganridgway/Zotero/storage/B7F38EFW/health-canada-advises-canadians-exercise-caution-when-taking-gabapentin-or-pregabalin.html2023-07-05 03:55:35Information UpdateMyLibraryZotero3Institute for Safe Medication Practices Canada8INCLUDED-Main20177/24/2017https://www.youtube.com/playlist?list=PLvQDf5LHFSkM0I6nMFN9s2-yduDODTC2N/Users/meganridgway/Zotero/storage/P9P2K6C4/playlist.html2023-07-06 20:48:00Youtube Video SeriesMyLibraryZotero27SickKidsChildKind InternationalPain Treatment - PharmacologicBenzodiazepineINCLUDED-AdditionalOpioidWeaningMedication Guideline, Treatment Guidelineenhttps://childkindinternational.org/wp-content/uploads/Weaning-algorithms-for-opioids-and-benzodiazepines.pdf/Users/meganridgway/Zotero/storage/RPXZYTAF/weaning-algorithm-for-combination-use-of-opioids-and-benzodiazepines.html2023-06-19 16:26:32Medication Guideline, Treatment GuidelineMyLibraryZotero27Institute for Safe Medication Practices CanadaINCLUDED-Mainpamphletfrhttps://www.ismp-canada.org/download/OpioidStewardship/information-sur-le-stockage-elimination.pdf2023-07-06pamphletMyLibraryZotero17Galinkin, JeffreyKoh, Jeffrey LeeCommittee on DrugsSection On Anesthesiology and Pain MedicineFrattarelli, Daniel A. C.Green, Thomas P.Johnson, Timothy D.Neville, Kathleen A.Paul, Ian M.Van Den Anker, John N.Bannister, Carolyn FlemingTobias, JosephAnderson, Corrie T. M.Goldschneider, Kenneth R.Polaner, David MarkPediatricsPediatricsPediatrics152-15513311INCLUDED-Additional20142014-01-010031-400510.1542/peds.2013-3398Opioids are often prescribed to children for pain relief related to procedures, acute injuries, and chronic conditions. Round-the-clock dosing of opioids can produce opioid dependence within 5 days. According to a 2001 Consensus Paper from the American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine, dependence is defined as “a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.” Although the experience of many children undergoing iatrogenically induced withdrawal may be mild or goes unreported, there is currently no guidance for recognition or management of withdrawal for this population. Guidance on this subject is available only for adults and primarily for adults with substance use disorders. The guideline will summarize existing literature and provide readers with information currently not available in any single source specific for this vulnerable pediatric population.Silverchairhttps://doi.org/10.1542/peds.2013-3398/Users/meganridgway/Zotero/storage/EPWMFJ55/Galinkin et al. - 2014 - Recognition and Management of Iatrogenically Induc.pdf/Users/meganridgway/Zotero/storage/YTIPAW3Q/Recognition-and-Management-of-Iatrogenically.html2023-06-19 16:20:56MyLibraryZotero17Barrington, KjPaediatrics & Child HealthPaediatrics & Child HealthPaediatr Child Health159-1711633BradycardiaEndotracheal intubationHypertensionHypoxiaINCLUDED-AdditionalNewbornPainPremedication20112011-031918-148510.1093/pch/16.3.159Endotracheal intubation, a common procedure in newborn care, is associated with pain and cardiorespiratory instability. The use of premedication reduces the adverse physiological responses of bradycardia, systemic hypertension, intracranial hypertension and hypoxia. Perhaps more importantly, premedication decreases the pain and discomfort associated with the procedure. All newborn infants, therefore, should receive analgesic premedication for endotracheal intubation except in emergency situations. Based on current evidence, an optimal protocol for premedication is to administer a vagolytic (intravenous [IV] atropine 20 μg/kg), a rapid-acting analgesic (IV fentanyl 3 μg/kg to 5 μg/kg; slow infusion) and a short-duration muscle relaxant (IV succinylcholine 2 mg/kg). Intubations should be performed or supervised by trained staff, with close monitoring of the infant throughout.PubMedeng, fre/Users/meganridgway/Zotero/storage/E9HCKVDJ/Barrington - 2011 - Premedication for endotracheal intubation in the n.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/22379381MyLibraryZotero17Trottier, Evelyne DAli, SaminaDoré-Bergeron, Marie-JoëlleChauvin-Kimoff, LaurelPaediatrics & Child HealthPaediatrics & Child HealthPaediatrics & Child Health429-4372777INCLUDED-Main20222022-12-011205-708810.1093/pch/pxac048Pain assessment and management are essential components of paediatric care. Developmentally appropriate pain assessment is an important first step in optimizing pain management. Self-reported pain should be prioritized. Alternatively, developmentally appropriate behavioural tools should be used. Acute pain management and prevention guidelines and strategies that combine physical, psychological, and pharmacological approaches should be accessible in all health care settings. Chronic pain is best managed using combined treatment modalities and counselling, with the primary goal of attaining functional improvement. The planning and implementation of pain management strategies for children should always be personalized and family-centred.Silverchairhttps://doi.org/10.1093/pch/pxac048/Users/meganridgway/Zotero/storage/W4TWFPI8/Trottier et al. - 2022 - Best practices in pain assessment and management f.pdf/Users/meganridgway/Zotero/storage/KEXSDHTP/6885178.html2023-06-19 15:06:12MyLibraryZotero17Rieder, Michael J.Jong, Geert 'tPaediatrics & Child HealthPaediatrics & Child HealthPaediatr Child Health120-1272622HydromorphoneINCLUDED-MainMorphineOxycodoneTramadol202120211205-708810.1093/pch/pxaa133Pain is a common problem for children, and pain management comprises both pharmacologic and nonpharmacologic measures. For moderate to severe pain, oral opioids have been a popular choice for the last few decades. Codeine has historically been the best-known oral opioid for use in children. However, availability and use of codeine have sharply declined due to safety concerns. A variety of other opioids have been used in place of codeine, but data are limited regarding their efficacy and safety in children. While the same pathways metabolize oral oxycodone as codeine, oxycodone's pharmacokinetics varies widely. There are also limited data on the safety and efficacy of oral hydromorphone and tramadol use for children. Oral morphine is the opiate alternative to codeine for which there is the most evidence of safety and efficacy in children. Research is needed to investigate both other opioids and non-opioid approaches to guide evidence-based analgesic therapy and treatment for moderate-to-severe pain in children.PubMedeng, eng/Users/meganridgway/Zotero/storage/LGA8F7B8/Rieder and Jong - 2021 - The use of oral opioids to control children's pain.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/33747307MyLibraryZotero12National Institute on Drug AbuseScreening to Brief Intervention (S2BI)Screening to Brief Intervention (S2BI)INCLUDED-MainTeens Screening Toolhttps://nida.nih.gov/s2bi/Users/meganridgway/Zotero/storage/QCU5AHKS/s2bi.html2023-07-11 05:04:30Teens Screening ToolMyLibraryZotero12National Institute on Drug AbuseBrief screener for tobacco, alcohol, and other drugsBrief screener for tobacco, alcohol, and other drugsINCLUDED-MainTeens Screening Toolenhttps://nida.nih.gov/bstad//Users/meganridgway/Zotero/storage/ZC7VY2NF/bstad.html2023-07-11 04:43:39Teens Screening ToolMyLibraryZotero12Center for Adolescent Behavioral Health Research (CABHRe)INCLUDED-Main20202020en-UShttps://crafft.org/get-the-crafft//Users/meganridgway/Zotero/storage/GGP6K8I9/get-the-crafft.html2023-07-11 04:51:12MyLibraryZotero12National Institute on Drug AbuseINCLUDED-Main20192019-05-30NIDA Launches Two Brief Online Validated Adolescent Substance Use Screening Tools NIDA has launched two brief online screening tools that providers can use to assess for substance use disorder (SUD) risk among adolescents 12-17 years old. With the American Academy of Pediatrics recommending universal screening in pediatric primary care settings, these tools help providers quickly and easily introduce brief, evidence-based screenings into their clinical practices.enhttps://nida.nih.gov/nidamed-medical-health-professionals/screening-tools-resources/screening-tools-adolescent-substance-use/Users/meganridgway/Zotero/storage/7443AMFA/screening-tools-adolescent-substance-use.html2023-07-11 04:20:57MyLibraryZotero12Drug Free Kids CanadaParent Support HubParent Support HubINCLUDED-Main20232023https://www.drugfreekidscanada.org/drug-spotlights/fentanyl//Users/meganridgway/Zotero/storage/HSBRIY7J/fentanyl.html2023-07-11 04:15:56MyLibraryZotero27Drug Free Kids CanadaINCLUDED-Main202001/2020Government of Canadaenhttps://www.drugfreekidscanada.org/wp-content/uploads/2020/01/DFK_Opioids_Booklet_FINAL.pdf/Users/meganridgway/Zotero/storage/4GUZ6S78/DFK_Opioids_Booklet_FINAL.pdf2023-07-11 03:54:22MyLibraryZotero27Centre for Addiction and Mental HealthINCLUDED-Main20202020Centre for Addictions and Mental Healthhttps://www.camh.ca/-/media/files/guides-and-publications/prescription-opioids-youth-en.pdf/Users/meganridgway/Zotero/storage/66HQV232/prescription-opioids-youth-en.pdf2023-07-11 03:47:09MyLibraryZotero27Centre for Addiction and Mental HealthINCLUDED-Main20122012Centre for Addiction and Mental Healthhttps://camh.ca/-/media/files/guides-and-publications/youth-prescription-drugs.pdf2023-07-10MyLibraryZotero27Foundry BCINCLUDED-Main202108/2021Victoria, BCGovernment of British ColumbiaWe are forging a new, province-wide culture of care through the development of a network of centres and e-health services.enhttps://foundrybc.ca/stories/parents-like-us-have-something-to-say//Users/meganridgway/Zotero/storage/L24972QT/parents-like-us-have-something-to-say.html2023-07-11 03:36:30MyLibraryZotero17Oliver, JuneCoggins, CandaceCompton, PeggyHagan, SusanMatteliano, DeborahStanton, MarshaSt Marie, BarbaraStrobbe, StephenTurner, Helen N.American Society for Pain Management NursingJournal of Addictions NursingAmerican Society for Pain Management nursing position statementJournal of Addictions NursingJ Addict Nurs210-2222333AdolescentAnalgesics, OpioidBehavior, AddictiveChildEthics, NursingFemaleHumansINCLUDED-MainMaleMiddle AgedModels, TheoreticalPainPain ManagementPrescription DrugsSelf MedicationSocial StigmaSocieties, NursingSubstance-Related DisordersTerminology as TopicUnited States20122012-101548-714810.1097/JAN.0b013e318271c123The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high-quality pain assessment and management. Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders. Topics addressed in this position statement include the scope of substance use and related disorders, conceptual models of addiction, ethical considerations, addiction risk stratification, and clinical recommendations.PubMedeng/Users/meganridgway/Zotero/storage/UE93FMML/Oliver et al. - 2012 - American Society for Pain Management nursing posit.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/24335741MyLibraryZotero17Koh, Justin J.Klaiman, MichelleMiles, IsabelleCook, JoleneKumar, TharaSheikh, HasanDong, KathrynOrkin, Aaron M.Ali, SaminaShouldice, ElizabethCanadian Journal of Emergency MedicineCAEP Position StatementCanadian Journal of Emergency MedicineCJEM768-7712266AdolescentAnalgesics, OpioidCanadaChildDrug OverdoseEmergency Service, HospitalHarm reductionHumansINCLUDED-MainnaloxoneNaloxoneopioid prescribingopioid use disorderOpioid-Related Disordersopioidsoverdose preventionpain management20202020-111481-804310.1017/cem.2020.459Deaths due to opioid overdose have reached unprecedented levels in Canada; over 12,800 opioid-related deaths occurred between January 2016 and March 2019, and overdose death rates increased by approximately 50% from 2016 to 2018.1 In 2016, Health Canada declared the opioid epidemic a national public health crisis,2 and life expectancy increases have halted in Canada for the first time in decades.3 Children are not exempt from this crisis, and the Chief Public Health Officer of Canada has recently prioritized the prevention of problematic substance use among Canadian youth.4.PubMedenghttp://www.ncbi.nlm.nih.gov/pubmed/33028446MyLibraryZotero17Committee on Substance use and PreventionPediatricsPediatricsPediatricse2016189313833AdolescentBuprenorphineHumansINCLUDED-MainMedication AdherenceNaltrexoneNarcotic AntagonistsOpiate Substitution TreatmentOpioid-Related Disorders20162016-091098-427510.1542/peds.2016-1893Opioid use disorder is a leading cause of morbidity and mortality among US youth. Effective treatments, both medications and substance use disorder counseling, are available but underused, and access to developmentally appropriate treatment is severely restricted for adolescents and young adults. Resources to disseminate available therapies and to develop new treatments specifically for this age group are needed to save and improve lives of youth with opioid addiction.PubMedenghttp://www.ncbi.nlm.nih.gov/pubmed/27550978MyLibraryZotero27British Columbia Centre on Substance UseINCLUDED-Main20186/13/2018British Columbia Ministry of HealthGuideline supplementenhttps://www.bccsu.ca/wp-content/uploads/2018/06/OUD-Youth.pdf/Users/meganridgway/Zotero/storage/45DW928S/OUD-Youth.pdf2023-07-11 03:16:57Guideline supplementMyLibraryZotero17Abraham, OlufunmilolaSzela, LisaBrasel, KelseyHoernke, MargaretJournal of the American Pharmacists Association: JAPhAJournal of the American Pharmacists Association: JAPhAJ Am Pharm Assoc (2003)441-4496222AdolescentAdultAnalgesics, OpioidHumansINCLUDED-AdditionalOpioid-Related DisordersPrescription Drug MisusePrescriptionsSchoolsStudentsUnited States202220221544-345010.1016/j.japh.2021.10.016BACKGROUND: Opioid misuse continues to be a major concern in the United States, affecting both adults and adolescents. Unfortunately, even legitimate prescription opioid misuse in adolescence increases the risk for misuse later in life. Although adolescence is a critical period for learning, little is known about adolescents' preferences for opioid safety education. One potential avenue for prescription opioid education is the use of serious games. Serious games can result in better health outcomes and understanding for adolescents and allow them to safely experience real-life scenarios. However, few studies have examined the use of serious games for adolescent opioid education. OBJECTIVE: This study explored adolescents' preferences for prescription opioid education and design of a serious game focused on opioid safety education. METHODS: A focus group guide was adapted from 2 statewide surveys about participants' perspectives on opioids. Recruitment packets with consent documents and an introduction to the study were sent home to eligible students. Ten focus groups were conducted with 68 middle and high school students in Wisconsin. Adolescents were asked to discuss their preferences for prescription opioid safety education and to design a serious game to educate teens about opioid safety. Focus groups were audio-recorded, professionally transcribed, and underwent content and thematic analyses using NVivo 12 software. RESULTS: Three preferred approaches for opioid safety education were identified, including the use of presentations, videos and websites, and serious games. Adolescents desired short presentations delivering personal stories to smaller audiences. They preferred websites and brief, engaging videos from reliable sources because of ease of access. Adolescents also preferred serious games for opioid education that were realistic and relatable. CONCLUSION: When educating adolescents on prescription opioids, the use of presentations, particularly personal stories, brief and engaging websites and videos, or serious games with realistic and relatable scenarios should be incorporated.PubMedeng/Users/meganridgway/Zotero/storage/CI8ELF9U/Abraham et al. - 2022 - Engaging youth in the design of prescription opioi.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/34736864MyLibraryZotero17Voepel-Lewis, TerriMalviya, ShobhaGrant, John A.Dwyer, SarahBecher, AsifSchwartz, Jacob H.Tait, Alan R.PainEffect of a brief scenario-tailored educational program on parents' risk knowledge, perceptions, and decisions to administer prescribed opioidsPainPain976-98516233Analgesics, OpioidChildHumansINCLUDED-AdditionalOpioid-Related DisordersPain ManagementParentsPerception20212021-03-011872-662310.1097/j.pain.0000000000002095This randomized, controlled trial evaluated whether a brief educational program (ie, Scenario-Tailored Opioid Messaging Program [STOMP]) would improve parental opioid risk knowledge, perceptions, and analgesic efficacy; ensure safe opioid use decisions; and impact prescription opioid use after surgery. Parent-child dyads (n = 604) who were prescribed an opioid for short-term use were randomized to routine instruction (Control) or routine plus STOMP administered preoperatively. Baseline and follow-up surveys assessed parents' awareness and perceived seriousness of adverse opioid effects, and their analgesic efficacy. Parents' decisions to give an opioid in hypothetical scenarios and total opioid doses they gave to children at home were assessed at follow-up. Scenario-Tailored Opioid Messaging Program parents gained enhanced perceptions of opioid-related risks over time, whereas Controls did not; however, risk perceptions did not differ between groups except for addiction risk. Scenario-Tailored Opioid Messaging Program parents exhibited marginally greater self-efficacy compared to Controls (mean difference vs controls = 0.58 [95% confidence interval 0.08-1.09], P = 0.023). Scenario-Tailored Opioid Messaging Program parents had a 53% lower odds of giving an opioid in an excessive sedation scenario (odds ratio 0.47 [95% confidence interval 0.28-0.78], P = 0.003), but otherwise made similar scenario-based opioid decisions. Scenario-Tailored Opioid Messaging Program was not associated with total opioid doses administered at home. Instead, parents' analgesic efficacy and pain-relief preferences explained 7%, whereas child and surgical factors explained 22% of the variance in opioid doses. Scenario-tailored education enhanced parents' opioid risk knowledge, perceptions, and scenario-based decision-making. Although this may inform later situation-specific decision-making, our research did not demonstrate an impact on total opioid dosing, which was primarily driven by surgical and child-related factors.PubMedeng/Users/meganridgway/Zotero/storage/P668W582/Voepel-Lewis et al. - 2021 - Effect of a brief scenario-tailored educational pr.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/33009245MyLibraryZotero17Nairn, Stephanie A.Audet, MarionStewart, Sherry H.Hawke, Lisa D.Isaacs, Jason Y.Henderson, JoannaSaah, RebeccaKnight, RodFast, DanyaKhan, FariaLam, AliceConrod, PatriciaCanadian Journal of Psychiatry. Revue Canadienne De PsychiatrieInterventions to Reduce Opioid Use in Youth At-Risk and in Treatment for Substance Use DisordersCanadian Journal of Psychiatry. Revue Canadienne De PsychiatrieCan J Psychiatry881-898671212AdolescentAnalgesics, Opioidbiopsychosocialgenderharm reductionHumansINCLUDED-MaininterventionMaleopioid use disorderOpioid-Related Disordersopioidsprescription opioidstraumaYoung Adultyouth20222022-121497-001510.1177/07067437221089810BACKGROUND: Youth and young adults have been significantly impacted by the opioid overdose and health crisis in North America. There is evidence of increasing morbidity and mortality due to opioids among those aged 15-29. Our review of key international reports indicates there are few youth-focused interventions and treatments for opioid use. Our scoping review sought to identify, characterize, and qualitatively evaluate the youth-specific clinical and pre-clinical interventions for opioid use among youth. METHOD: We searched MedLine and PsycInfo for articles that were published between 2013 and 2021. Previous reports published in 2015 and 2016 did not identify opioid-specific interventions for youth and we thus focused on the time period following the periods covered by these prior reports. We input three groups of relevant keywords in the aforementioned search engines. Specifically, articles were included if they targeted a youth population (ages 15-25), studied an intervention, and measured impacts on opioid use. RESULTS: We identified 21 studies that examined the impacts of heterogeneous interventions on youth opioid consumption. The studies were classified inductively as psycho-social-educational, pharmacological, or combined pharmacological-psycho-social-educational. Most studies focused on treatment of opioid use disorder among youth, with few studies focused on early or experimental stages of opioid use. A larger proportion of studies focused heavily on male participants (i.e., male gender and/or sex). Very few studies involved and/or included youth in treatment/program development, with one study premised on previous research about sexual minority youth. CONCLUSIONS: Research on treatments and interventions for youth using or at-risk of opioids appears to be sparse. More youth involvement in research and program development is vital. The intersectional and multi-factorial nature of youth opioid use and the youth opioid crisis necessitates the development and evaluation of novel treatments that address youth-specific contexts and needs (i.e., those that address socio-economic, neurobiological, psychological, and environmental factors that promote opioid use among youth).PubMedeng/Users/meganridgway/Zotero/storage/5ANXA8Y8/Nairn et al. - 2022 - Interventions to Reduce Opioid Use in Youth At-Ris.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/35535396MyLibraryZotero17McCarty, DennisChan, BrianBuchheit, Bradley M.Bougatsos, ChristinaGrusing, SaraChou, RogerJournal of Addiction MedicineEffectiveness of and Access to Medications for Opioid Use Disorder for Adolescents and Young AdultsJournal of Addiction MedicineJ Addict Mede157-e1641633AdolescentAgedAnalgesics, OpioidBuprenorphineHealth Services AccessibilityHumansINCLUDED-AdditionalOpiate Substitution TreatmentOpioid-Related DisordersRetrospective StudiesYoung Adult20222022 May-Jun 011935-322710.1097/ADM.0000000000000898OBJECTIVE: A scoping review assessed access to medications for opioid use disorder (MOUD) and treatment outcomes among adolescents (12 - 17 years) and young adults (18 - 25 years). METHODS: Studies addressing adolescent and young adult opioid use disorder and treatment with MOUD on patient outcomes (eg, retention in care) were included. Randomized trials and controlled observational studies were prioritized. Investigators extracted key information, summarized findings, noted methodological weaknesses, and tabled the details. RESULTS: The search identified 4 randomized trials (N = 241), 1 systematic review with 52 studies (total N = 125,994), and 5 retrospective analyses of health insurance claims. The trials reported buprenorphine and extended-release naltrexone reduced opioid use. Return to use was observed when pharmacotherapy ceased. A systematic review concluded that adolescents and young adults had lower retention in care than older adults. The observational studies found that adolescents were unlikely to receive MOUD. There was some evidence that non-Hispanic Black adolescents and young adults were less likely than non-Hispanic Whites to receive MOUD. CONCLUSIONS: MOUD therapies reduce opioid use among adolescent and young adults but few receive MOUD. MOUD services for adolescents and young adults should be developed and tested. Randomized clinical trials are necessary to develop appropriate clinical guidelines for using MOUD with adolescents and young adults.PubMedeng/Users/meganridgway/Zotero/storage/ZVZ294IP/McCarty et al. - 2022 - Effectiveness of and Access to Medications for Opi.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/34282085MyLibraryZotero17Nielsen, SuzanneTse, Wai ChungLarance, BrionyThe Cochrane Database of Systematic ReviewsThe Cochrane Database of Systematic ReviewsCochrane Database Syst RevCD011117999AdolescentAnalgesics, OpioidBuprenorphineHeroinHumansINCLUDED-AdditionalMethadoneOpioid-Related DisordersPharmaceutical Preparations20222022-09-051469-493X10.1002/14651858.CD011117.pub3BACKGROUND: There are ongoing concerns regarding pharmaceutical opioid-related harms, including overdose and dependence, with an associated increase in treatment demand. People dependent on pharmaceutical opioids appear to differ in important ways from people who use heroin, yet most opioid agonist treatment research has been conducted in people who use heroin.  OBJECTIVES: To assess the effects of maintenance opioid agonist pharmacotherapy for the treatment of pharmaceutical opioid dependence. SEARCH METHODS: We updated our searches of the following databases to January 2022: the Cochrane Drugs and Alcohol Group Specialised Register, CENTRAL, MEDLINE, four other databases, and two trial registers. We checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA: We included RCTs with adults and adolescents examining maintenance opioid agonist treatments that made the following two comparisons. 1. Full opioid agonists (methadone, morphine, oxycodone, levo-alpha-acetylmethadol (LAAM), or codeine) versus different full opioid agonists or partial opioid agonists (buprenorphine) for maintenance treatment. 2. Full or partial opioid agonist maintenance versus non-opioid agonist treatments (detoxification, opioid antagonist, or psychological treatment without opioid agonist treatment). DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. MAIN RESULTS: We identified eight RCTs that met inclusion criteria (709 participants). We found four studies that compared methadone and buprenorphine maintenance treatment, and four studies that compared buprenorphine maintenance to either buprenorphine taper (in addition to psychological treatment) or a non-opioid maintenance treatment comparison. We found low-certainty evidence from three studies of a difference between methadone and buprenorphine in favour of methadone on self-reported opioid use at end of treatment (risk ratio (RR) 0.49, 95% confidence interval (CI) 0.28 to 0.86; 165 participants), and low-certainty evidence from four studies finding a difference in favour of methadone for retention in treatment (RR 1.21, 95% CI 1.02 to 1.43; 379 participants). We found low-certainty evidence from three studies showing no difference between methadone and buprenorphine on substance use measured with urine drug screens at end of treatment (RR 0.81, 95% CI 0.57 to 1.17; 206 participants), and moderate-certainty evidence from one study of no difference in days of self-reported opioid use (mean difference 1.41 days, 95% CI 3.37 lower to 0.55 days higher; 129 participants). There was low-certainty evidence from three studies of no difference between methadone and buprenorphine on adverse events (RR 1.13, 95% CI 0.66 to 1.93; 206 participants). We found low-certainty evidence from four studies favouring maintenance buprenorphine treatment over non-opioid treatments in terms of fewer opioid positive urine drug tests at end of treatment (RR 0.66, 95% CI 0.52 to 0.84; 270 participants), and very low-certainty evidence from four studies finding no difference on self-reported opioid use in the past 30 days at end of treatment (RR 0.63, 95% CI 0.39 to 1.01; 276 participants). There was low-certainty evidence from three studies of no difference in the number of days of unsanctioned opioid use (standardised mean difference (SMD) -0.19, 95% CI -0.47 to 0.09; 205 participants). There was moderate-certainty evidence from four studies favouring buprenorphine maintenance over non-opioid treatments on retention in treatment (RR 3.02, 95% CI 1.73 to 5.27; 333 participants). There was moderate-certainty evidence from three studies of no difference in adverse effects between buprenorphine maintenance and non-opioid treatments (RR 0.50, 95% CI 0.07 to 3.48; 252 participants). The main weaknesses in the quality of the data was the use of open-label study designs, and difference in follow-up rates between treatment arms. AUTHORS' CONCLUSIONS: There is  very low- to moderate-certainty evidence supporting the use of maintenance agonist pharmacotherapy for pharmaceutical opioid dependence. Methadone or buprenorphine did not differ on some outcomes, although on the outcomes of retention and self-reported substance use some results favoured methadone. Maintenance treatment with buprenorphine appears more effective than non-opioid treatments. Due to the overall very low- to moderate-certainty evidence and small sample sizes, there is the possibility that the further research may change these findings.PubMedenghttp://www.ncbi.nlm.nih.gov/pubmed/36063082MyLibraryZotero17Minozzi, SilviaAmato, LauraBellisario, CristinaDavoli, MarinaThe Cochrane Database of Systematic ReviewsThe Cochrane Database of Systematic ReviewsCochrane Database Syst RevCD00674944AdolescentBuprenorphineClonidineHumansINCLUDED-AdditionalMaintenance ChemotherapyNaloxoneNaltrexoneNarcotic AntagonistsOpiate Substitution TreatmentOpioid-Related DisordersPatient DropoutsRandomized Controlled Trials as Topic20142014-04-291469-493X10.1002/14651858.CD006749.pub3BACKGROUND: The scientific literature examining effective treatments for opioid dependent adults clearly indicates that pharmacotherapy is a necessary and acceptable component of effective treatments for opioid dependence. Nevertheless, no studies have been published that systematically assess the effectiveness of the pharmacological detoxification among adolescents. OBJECTIVES: To assess the effectiveness of any detoxification treatment alone or in combination with psychosocial intervention compared with no intervention, other pharmacological intervention or psychosocial interventions on completion of treatment, reducing the use of substances and improving health and social status. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (2014, Issue 1), PubMed (January 1966 to January 2014), EMBASE (January 1980 to January 2014), CINHAL (January 1982 to January 2014), Web of Science (1991-January 2014) and reference lists of articles. SELECTION CRITERIA: Randomised controlled clinical trials comparing any pharmacological interventions alone or associated with psychosocial intervention aimed at detoxification with no intervention, placebo, other pharmacological intervention or psychosocial intervention in adolescents (13 to 18 years). DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by The Cochrane Collaboration MAIN RESULTS: Two trials involving 190 participants were included. One trial compared buprenorphine with clonidine for detoxification. No difference was found for drop out: risk ratio (RR) 0.45 (95% confidence interval (CI): 0.20 to 1.04) and acceptability of treatment: withdrawal score mean difference (MD): 3.97 (95% CI -1.38 to 9.32). More participants in the buprenorphine group initiated naltrexone treatment: RR 11.00 (95% CI 1.58 to 76.55), quality of evidence moderate.The other trial compared maintenance treatment versus detoxification treatment: buprenorphine-naloxone maintenance versus buprenorphine detoxification. For drop out the results were in favour of maintenance treatment: RR 2.67 (95% CI 1.85, 3.86), as well as for results at follow-up RR 1.36 [95% CI 1.05to 1.76); no differences for use of opiate, quality of evidence low. AUTHORS' CONCLUSIONS: It is difficult to draw conclusions on the basis of two trials with few participants. Furthermore, the two studies included did not consider the efficacy of methadone that is still the most frequent drug utilised for the treatment of opioid withdrawal. One possible reason for the lack of evidence could be the difficulty in conducting trials with young people due to practical and ethical reasons.PubMedenghttp://www.ncbi.nlm.nih.gov/pubmed/24777492MyLibraryZotero17Lyons, Rachael M.Yule, Amy M.Schiff, DavidaBagley, Sarah M.Wilens, Timothy E.Journal of Child and Adolescent PsychopharmacologyRisk Factors for Drug Overdose in Young PeopleJournal of Child and Adolescent PsychopharmacologyJ Child Adolesc Psychopharmacol487-4972977AdolescentAdultAge FactorsDrug OverdoseHumansINCLUDED-AdditionaloverdosePrevalencerisk factorsRisk FactorsSubstance Abuse, Intravenoussubstance use disorderSubstance-Related DisordersYoung Adultyoung people20192019-081557-899210.1089/cap.2019.0013Objectives: Drug overdose (OD) deaths have been increasing over the past 20 years. Although risk factors for drug OD have been identified in adult populations, less is known about risk factors for OD in young people. The aim of this review is to systematically examine the literature to identify risk factors for drug OD specific to young people, including adolescents and young adults. Methods: Our initial PubMed search identified 4001 articles. Included were cross-sectional and longitudinal cohort studies published in English that compared young people who experienced a drug OD to those who did not. Review articles, meta-analyses, case-reports, editorials, epidemiological studies, and qualitative studies were excluded. Two investigators reviewed the full texts of all relevant articles and extracted data on sample demographics, prevalence of OD, and correlates associated with OD. Results: Twelve relevant studies were identified reflective of a sample of 5020 unique individuals with an age range of 14-30 years, and a mean age range of 20.2-26 years. The lifetime prevalence of OD in these young people ranged from 24% to 48%. Substance use characteristics most often associated with OD included injection drug, opioid, and tranquilizer use. Polysubstance use was also found to be strongly associated with OD in three studies. Other replicated risk factors for OD in young people included histories of psychopathology, incarceration, unstable housing, and witnessing an OD. Conclusion: Opioid, tranquilizer, and injection drug use have been identified as risk factors for OD in both younger and older adult populations. Risk factors that emerged as noteworthy predictors of OD in young people specifically include polysubstance use, psychiatric comorbidity, unstable housing, and witnessing an OD. There remains a paucity of literature on drug OD risk factors in young people, with little information regarding medical and treatment history risk factors.PubMedeng/Users/meganridgway/Zotero/storage/HQL7R2MJ/Lyons et al. - 2019 - Risk Factors for Drug Overdose in Young People A .pdfhttp://www.ncbi.nlm.nih.gov/pubmed/31246496MyLibraryZotero17Dyson, Michele P.Dong, KathrynSevcik, WilliamGraham, Samir Z.Saba, SabrinaHartling, LisaAli, SaminaJournal of the American College of Emergency Physicians OpenQuantifying unused opioids following emergency and ambulatory careJournal of the American College of Emergency Physicians OpenJ Am Coll Emerg Physicians Opene12822355acute painINCLUDED-Mainopioid usageoutpatientpain medications20222022-102688-115210.1002/emp2.12822OBJECTIVE: To quantify unused opioids among adult and pediatric patients discharged from the emergency department (ED) or ambulatory care settings with a prescription for acute pain. METHODS: We searched MEDLINE, Embase, CINHAL, PsycINFO, the Cochrane Library, and the gray literature from inception to April 29, 2021. We included observational studies in which any patient with an acutely painful condition received a prescription for an opioid on discharge from an outpatient care setting, and unused opioids were quantified. Two reviewers screened records for eligibility, extracted data, and conducted the quality assessment. Where possible, we pooled data and otherwise described the results of studies narratively. Total unused prescriptions were synthesized using a weighted average. Random effects models were used, and heterogeneity was measured by the I2 statistic. Our primary outcome was the quantity of unused opioid medication available after receiving a prescription for acute pain. Secondary outcomes were the proportion of patients with unused opioids following a prescription, the proportion of patients using no opioids, morphine equivalents of unused opioids, and factors associated with leftover opioids. RESULTS: In this systematic review and meta-analysis of 9 studies in emergency and ambulatory care settings, 59.6% of prescribed opioids remained unused; pediatric patients had 69.3% of their prescriptions remaining, compared to 54.6% among adult patients. The highest proportion of unused opioids was found following dental extractions (82.6%). CONCLUSIONS AND RELEVANCE: More than 50% of opioids remain unused following prescriptions for acute pain. Responsible prescribing must be accompanied by education on safer use, storage, and disposal.PubMedeng/Users/meganridgway/Zotero/storage/CWQX8JKT/Dyson et al. - 2022 - Quantifying unused opioids following emergency and.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/36203538MyLibraryZotero17Beauchemin, MelissaDorritie, RichardHershman, Dawn L.Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in CancerOpioid use and misuse in children, adolescents, and young adults with cancerSupportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in CancerSupport Care Cancer4521-45272988AdolescentAdolescent and young adultsAnalgesics, OpioidAYAsCancer PainChildDrug OverdoseFemaleHumansINCLUDED-MainMaleOpioid misuseOpioid prescribingOpioid-Related DisordersYoung Adult20212021-081433-733910.1007/s00520-020-05980-2Adolescents and young adults (AYAs) are at increased risk for negative opioid-related outcomes, including misuse and overdose. High-quality cancer care requires adequate pain management and often includes opioids for tumor- and/or treatment-related pain. Little is known about opioid use and misuse in children and AYAs with cancer, and we therefore conducted a systematic review of the literature using PRISMA guidelines to identify all relevant studies that evaluated opioid use and/or misuse among this population. Eleven studies were identified that met our inclusion criteria. The range of opioid use among the studies was 12-97%, and among the five studies that reported opioid misuse or aberrant behaviors, 7-90% of patients met criteria. Few studies reported factors associated with opioid misuse but included prior mental health and/or substance use disorders, and prior opioid use. In summary, opioid use is highly variable among children and AYAs with cancer; however, the range of use varies widely depending on the study population, such as survivors or end-of-life cancer patients. Few studies have examined opioid misuse and/or aberrant behaviors, and future research is needed to better understand opioid use and misuse among children and AYAs with cancer, specifically those who will be cured of their cancer and may subsequently experience adverse opioid-related outcomes.PubMedeng/Users/meganridgway/Zotero/storage/WWK3WQ9M/Beauchemin et al. - 2021 - Opioid use and misuse in children, adolescents, an.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/33462726MyLibraryZotero17Ahrari, MalemaAli, SaminaHartling, LisaDong, KathrynDrendel, Amy L.Klassen, Terry P.Schreiner, KurtDyson, Michele P.PediatricsNonmedical Opioid Use After Short-term Therapeutic Exposure in ChildrenPediatricsPediatricse202105192714866AdolescentAnalgesics, OpioidChildFemaleForecastingHumansINCLUDED-MainMaleObservational Studies as TopicOpioid-Related DisordersPain ManagementPrevalenceRisk FactorsTime FactorsYoung Adult20212021-12-011098-427510.1542/peds.2021-051927CONTEXT: Opioid-related harms continue to rise for children and youth. Analgesic prescribing decisions are challenging because the risk for future nonmedical opioid use or disorder is unclear. OBJECTIVE: To synthesize research examining the association between short-term therapeutic opioid exposure and future nonmedical opioid use or opioid use disorder and associated risk factors. DATA SOURCES: We searched 11 electronic databases. STUDY SELECTION: Two reviewers screened studies. Studies were included if: they were published in English or French, participants had short-term (≤14 days) or an unknown duration of therapeutic exposure to opioids before 18 years, and reported opioid use disorder or misuse. DATA EXTRACTION: Data were extracted, and methodologic quality was assessed by 2 reviewers. Data were summarized narratively. RESULTS: We included 21 observational studies (49 944 602 participants). One study demonstrated that short-term therapeutic exposure may be associated with opioid abuse; 4 showed an association between medical and nonmedical opioid use without specifying duration of exposure. Other studies reported on prevalence or incidence of nonmedical use after medical exposure to opioids. Risk factors were contradictory and remain unclear. LIMITATIONS: Most studies did not specify duration of exposure and were of low methodologic quality, and participants might not have been opioid naïve. CONCLUSIONS: Some studies suggest an association between lifetime therapeutic opioid use and nonmedical opioid use. Given the lack of clear evidence regarding short-term therapeutic exposure, health care providers should carefully evaluate pain management options and educate patients and caregivers about safe, judicious, and appropriate use of opioids and potential signs of misuse.PubMedenghttp://www.ncbi.nlm.nih.gov/pubmed/34816280MyLibraryZotero12Canadian Dental AssociationINCLUDED-Additional20232023 Kari to add to main document enhttp://www.cda-adc.ca/en/oral_health/talk/complications/pain_management//Users/meganridgway/Zotero/storage/P37AC48G/pain_management.html2023-07-11 02:49:24MyLibraryZotero27Institute for Safe Medication Practices CanadaINCLUDED-Main20192019Institute for Safe Medication Practices Canadaenhttps://www.ismp-canada.org/download/OpioidStewardship/WisdomTeethRemoval-EN.pdf/Users/meganridgway/Zotero/storage/M8VRGISU/WisdomTeethRemoval-EN.pdf2023-07-11 02:43:53MyLibraryZotero17Bailey, BenoitTrottier, Evelyne D.Pediatric DrugsPediatric DrugsPediatr Drugs287-3011844INCLUDED-Main20168/20161174-5878, 1179-201910.1007/s40272-016-0181-5 GREEN DOI.org (Crossref)enhttp://link.springer.com/10.1007/s40272-016-0181-52023-07-05 02:46:41MyLibraryZotero27Seal, KelseyWright, Mary-Doug1-15INCLUDED-Main20184/16/2018Canadian Agency for Drugs and Technologies in HealthRB1209-000Summary of abstractsenhttps://www.cadth.ca/sites/default/files/pdf/htis/2018/RB1209%20Analgesics%20for%20Oral%20Surgery%20Final.pdf/Users/meganridgway/Zotero/storage/BQVGY7PQ/analgesics-surgical-third-molar-extraction-clinical-effectiveness-and-guidelines.html2023-07-11 02:15:04Summary of abstractsMyLibraryZotero47Ontario Pharmacy Evidence NetworkOPEN Summit 2021INCLUDED-Additional20212021-03-11enhttps://www.youtube.com/watch?v=LVvEnMW3n7M2023-07-11 01:46:37MyLibraryZotero27American Dental AssociationChairside Pain Management DiscussionINCLUDED-Additional20228/1/2022American Dental Associationhttps://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/practice/health-and-wellness/ada_chairside_pain_management_discussion.pdf?rev=b72ea26d3a434bd590a0e321f07e9904&hash=B496A3F1062EFCAE52707FB8E662694A/Users/meganridgway/Zotero/storage/KYWFCLV2/ada_chairside_pain_management_discussion.pdf2023-07-11 01:49:19MyLibraryZotero19Canadian Dental AssociationDonaldson, MarkCDA essentialsCDA essentials21477INCLUDED-Main20172017enhttps://www.cda-adc.ca/en/services/essentials/2017/issue7/20//Users/meganridgway/Zotero/storage/2TNES83I/20.html2023-07-11 01:39:32MyLibraryZotero27Benzel, RHolt, KINCLUDED-Main20222022Washington, DCNational Maternal and Child Oral Health Resource Center, Georgetown Universityhttps://www.mchoralhealth.org/PDFs/opioids_children_adolescents.pdf/Users/meganridgway/Zotero/storage/3WU8RPCN/opioids_children_adolescents.pdf2023-07-11 01:34:03MyLibraryZotero27American Academy of Pediatric DentistryThe Reference Manual of Pediatric Dentistry392.400INCLUDED-Main20222022Chicago, ILAmerican Academy of Pediatric Dentistryenhttps://www.aapd.org/media/Policies_Guidelines/BP_Pain.pdf/Users/meganridgway/Zotero/storage/DL4QNA7E/BP_Pain.pdf2023-07-11 01:23:43MyLibraryZotero27Buffalo, Lyse ArmelleINCLUDED-Main201802/2018CHU Sainte-JustineF -57 GRM : 3000 9963 (Révisé : 02/2018)frhttps://www.chusj.org/getmedia/9a6163dd-0ac3-463e-ad49-1d43f856225e/depliant_F-57_application-timbre-fentanyl.pdf.aspx?ext=.pdf/Users/meganridgway/Zotero/storage/G8QY6LT5/depliant_F-57_application-timbre-fentanyl.pdf.pdf2023-07-11 00:52:44MyLibraryZotero12The Hospital for Sick Children (SickKids)INCLUDED-Main20232023enhttps://www.popyouth.ca/Users/meganridgway/Zotero/storage/ZDQKTJVK/www.popyouth.ca.html2023-09-19 02:38:35MyLibraryZotero27Public Health Agency of CanadaINCLUDED-Main202001/2020OttawaGovernment of CanadaThe purpose of this resource is to facilitate safer, more compassionate and non-stigmatizing language related to substance use within the health system.enhttps://www.canada.ca/en/public-health/services/publications/healthy-living/communicating-about-substance-use-compassionate-safe-non-stigmatizing-ways-2019.html2023-09-19 04:40:25MyLibraryZotero27Tam, TheresaAddressing StigmaINCLUDED-Main201912/2019Public Health Agency of Canada, Government of CanadaThe Chief Public Health Officer’s Report on the State of Public Health in Canada 2019.education and awarenessenhttps://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/addressing-stigma-toward-more-inclusive-health-system.html/Users/meganridgway/Zotero/storage/TXSDMBLK/addressing-stigma-toward-more-inclusive-health-system.html2023-09-19 04:32:53education and awarenessMyLibraryZotero27Health CanadaINCLUDED-Main20222022-05-10OttawaGovernment of CanadaSubstance use can be viewed on a spectrum with varying stages of benefits and harms.education and awarenessenhttps://www.canada.ca/en/health-canada/services/publications/healthy-living/substance-use-spectrum-infographic.html/Users/meganridgway/Zotero/storage/67BIT54D/substance-use-spectrum-infographic.html2023-09-18 19:26:47education and awarenessMyLibraryZotero27IPRO Quality Innovation Network-Quality Improvement OrganizationINCLUDED-Main20202020Centers for Medicare & Medicaid Services, US Department of Health and Human Services12SOW-IPRO-QIN-TA-AA-21-470Zoteroenhttps://qi.ipro.org/wp-content/uploads/Stigma-Implicit-Bias-Toolkit_v1e-508c.pdf/Users/meganridgway/Zotero/storage/AB7U5DGP/Stigma & Implicit Bias Toolkit.pdfMyLibraryZotero27Food and Drug AdministrationINCLUDED-AdditionalUS Department of Health and Human Services, National Institutes of Healthenhttps://www.fda.gov/media/123331/download2023-07-06MyLibraryZotero17Oskoui, MaryamPringsheim, TamaraHoller-Managan, YolandaPotrebic, SonjaBillinghurst, LoriGloss, DavidHershey, Andrew D.Licking, NicoleSowell, MichaelVictorio, M. CristinaGersz, Elaine M.Leininger, EmilyZanitsch, HeatherYonker, MarcyMack, KennethNeurologyPractice guideline update summaryNeurologyNeurology487-499931111Academies and InstitutesAdolescentChildDrug CombinationsHeadacheHumansINCLUDED-MainMigraine DisordersNaproxenNeurologyPractice Guidelines as TopicResearch ReportSocieties, MedicalSumatriptanTreatment OutcomeUnited States20192019-09-101526-632X10.1212/WNL.0000000000008095OBJECTIVE: To provide evidence-based recommendations for the acute symptomatic treatment of children and adolescents with migraine. METHODS: We performed a systematic review of the literature and rated risk of bias of included studies according to the American Academy of Neurology classification of evidence criteria. A multidisciplinary panel developed practice recommendations, integrating findings from the systematic review and following an Institute of Medicine-compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence. RESULTS: There is evidence to support the efficacy of the use of ibuprofen, acetaminophen (in children and adolescents), and triptans (mainly in adolescents) for the relief of migraine pain, although confidence in the evidence varies between agents. There is high confidence that adolescents receiving oral sumatriptan/naproxen and zolmitriptan nasal spray are more likely to be headache-free at 2 hours than those receiving placebo. No acute treatments were effective for migraine-related nausea or vomiting; some triptans were effective for migraine-related phonophobia and photophobia. RECOMMENDATIONS: Recommendations for the treatment of acute migraine in children and adolescents focus on the importance of early treatment, choosing the route of administration best suited to the characteristics of the individual migraine attack, and providing counseling on lifestyle factors that can exacerbate migraine, including trigger avoidance and medication overuse.PubMedeng/Users/meganridgway/Zotero/storage/TC2FZY8F/Oskoui et al. - 2019 - Practice guideline update summary Acute treatment.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/31413171MyLibraryZotero19SickKidsAboutKidsHealthAboutKidsHealthINCLUDED-Main201901/25/2019Trusted information on everyday and complex child health conditions from The Hospital for Sick Children.en-CAhttps://www.aboutkidshealth.ca/article?contentid=3647&language=english2023-07-11 00:21:59MyLibraryZotero17Lindbeck, GeorgeShah, Manish I.Braithwaite, SabinaPowell, Jonathan R.Panchal, Ashish R.Browne, Lorin R.Lang, Eddy S.Burton, BrookeCoughenour, JeffreyCrowe, Remle P.Degn, HannahHedges, MaryGasper, JamesGuild, KyleMattera, ConnieNasca, SandraTaillac, PeterWarth, MarkPrehospital Emergency CareEvidence-Based Guidelines for Prehospital Pain ManagementPrehospital Emergency CarePrehosp Emerg Care144-1532722AcetaminophenAcute PainAnalgesicsAnalgesics, OpioidAnti-Inflammatory Agents, Non-SteroidalChildEmergency Medical ServicesFentanylHumansINCLUDED-MainKetamine202320231545-006610.1080/10903127.2021.2018073This project sought to develop evidence-based guidelines for the administration of analgesics for moderate to severe pain by Emergency Medical Services (EMS) clinicians based on a separate, previously published, systematic review of the comparative effectiveness of analgesics in the prehospital setting prepared by the University of Connecticut Evidence-Based Practice Center for the Agency for Healthcare Research and Quality (AHRQ). A technical expert panel (TEP) was assembled consisting of subject matter experts in prehospital and emergency care, and the development of evidence-based guidelines and patient care guidelines. A series of nine "patient/population-intervention-comparison-outcome" (PICO) questions were developed based on the Key Questions identified in the AHRQ systematic review, and an additional PICO question was developed to specifically address analgesia in pediatric patients. The panel made a strong recommendation for the use of intranasal fentanyl over intravenous (IV) opioids for pediatric patients without intravenous access given the supporting evidence, its effectiveness, ease of administration, and acceptance by patients and providers. The panel made a conditional recommendation for the use of IV non-steroidal anti-inflammatory drugs (NSAIDs) over IV acetaminophen (APAP). The panel made conditional recommendations for the use of either IV ketamine or IV opioids; for either IV NSAIDs or IV opioids; for either IV fentanyl or IV morphine; and for either IV ketamine or IV NSAIDs. A conditional recommendation was made for IV APAP over IV opioids. The panel made a conditional recommendation against the use of weight-based IV ketamine in combination with weight-based IV opioids versus weight-based IV opioids alone. The panel considered the use of oral analgesics and a conditional recommendation was made for either oral APAP or oral NSAIDs when the oral route of administration was preferred. Given the lack of a supporting evidence base, the panel was unable to make recommendations for the use of nitrous oxide versus IV opioids, or for IV ketamine in combination with IV opioids versus IV ketamine alone. Taken together, the recommendations emphasize that EMS medical directors and EMS clinicians have a variety of effective options for the management of moderate to severe pain in addition to opioids when designing patient care guidelines and caring for patients suffering from acute pain.PubMedenghttp://www.ncbi.nlm.nih.gov/pubmed/34928760MyLibraryZotero27TREKKINCLUDED-Main20212021Infographichttp://opioidsclinicians.trekk.ca2023-07-05InfographicMyLibraryZotero27TREKKINCLUDED-Main20212021Infographicenhttp://opioidsparent.trekk.ca2023-07-06InfographicMyLibraryZotero27TREKKINCLUDED-Main20212021Infographichttp://opioidsyouth.trekk.ca2023-07-06InfographicMyLibraryZotero27Heatlh CanadaRecalls, advisories and safety alertsINCLUDED-Main20207/31/2020Government of CanadaRA-73635advisoryEnglishhttps://recalls-rappels.canada.ca/en/alert-recall/non-prescription-pain-relief-products-containing-codeine-are-not-recommended-use/Users/meganridgway/Zotero/storage/AHUSPHAZ/non-prescription-pain-relief-products-containing-codeine-are-not-recommended-use.html2023-06-19 15:06:15advisoryMyLibraryZotero17Young, CalvinLoshak, HannahCanadian Journal of Health TechnologiesCanadian Journal of Health Technologiescjht188INCLUDED-Additional20212021-08-182563-659610.51731/cjht.2021.127Codeine and codeine-containing medicines are used to treat people experiencing pain or cough symptoms. Whereas most products containing codeine require a prescription in Canada, some jurisdictions permit over-the-counter sales of products containing low doses of codeine mixed with other non-narcotic medicinal ingredients. Three overviews of reviews and 13 systematic reviews of variable methodological quality failed to identify studies on the effectiveness of low-dose codeine (i.e., 8 mg of codeine per tablet or 20 mg of codeine per 30 mL in liquid products) for the treatment of pain or coughs. There is a lack of evidence on the clinical effectiveness of oral analgesics and oral antitussives containing low doses of codeine.DOI.org (Crossref)cod/Users/meganridgway/Zotero/storage/DPRYKRLC/Young and Loshak - 2021 - Medications Containing Low-Dose Codeine for the Tr.pdf2023-07-10 03:20:30MyLibraryZotero27Comité de gestion des analgésiques du CHUSJ (GAN))INCLUDED-Main20212021Urgence CHU Sainte-JustineF-848 GRM 30004520 (rév. 01-2021)frhttps://www.chusj.org/getmedia/bab6d4ad-42d2-41d6-8f9a-4559718451ab/depliant_F-848_Analgesiques-opioides-a-courte-action.pdf.aspx?ext=.pdf/Users/meganridgway/Zotero/storage/JQF3QF4I/analgesiques-opioides-a-courte-action-20210308.html2023-07-10 04:51:15MyLibraryZotero17Carrasco-Labra, AlonsoPolk, Deborah E.Urquhart, OliviaAghaloo, TaraClaytor, J. WilliamDhar, VineetDionne, Raymond A.Espinoza, LorenaGordon, Sharon M.Hersh, Elliot V.Law, Alan S.Li, Brian S.-K.Schwartz, Paul J.Suda, Katie J.Turturro, Michael A.Wright, Marjorie L.Dawson, TimMiroshnychenko, AnnaPahlke, SarahPilcher, LaurenShirey, MichelleTampi, MalavikaMoore, Paul A.The Journal of the American Dental AssociationEvidence-based clinical practice guideline for the pharmacologic management of acute dental pain in childrenThe Journal of the American Dental AssociationThe Journal of the American Dental Association814-825.e215499acute dental painanalgesicsClinical practice guidelinecorticosteroidsDevelopment and EvaluationFDAGRADEGrading of Recommendations AssessmentINCLUDED-MainNonsteroidal anti-inflammatory drugNSAIDopioidspediatric dentistryRandomized controlled trialRCTtooth extractionstoothacheUS Food and Drug Administration20232023-09-010002-817710.1016/j.adaj.2023.06.014jada.ada.orgEnglishhttps://jada.ada.org/article/S0002-8177(23)00390-2/fulltext/Users/meganridgway/Zotero/storage/V3KPNMGP/Carrasco-Labra et al. - 2023 - Evidence-based clinical practice guideline for the.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/376349152023-10-13 18:09:46MyLibraryZotero17Spénard, SarahGélinas, CharlesD. Trottier, EvelyneTremblay-Racine, FannieKleiber, NiinaArchives of Disease in ChildhoodMorphine or hydromorphoneArchives of Disease in ChildhoodArch Dis Child1002-10091061010INCLUDED-Main202110/20210003-9888, 1468-204410.1136/archdischild-2020-319059Abstract Objective To systematically review available paediatric literature on comparisons between morphine (Mo) and hydromorphone (Hm), to guide clinicians to rationally use these medications. Design Systematic review within four databases for all studies published from 1963 to July 2019. Setting All paediatric settings. Eligibility All studies comparing Mo to Hm in individuals younger than 21 years. Main outcome measures The primary outcome was to compare clinical efficacy and side effects of Mo and Hm. The secondary outcomes were the comparison of pharmacokinetic profiles and the description of predefined Mo to Hm conversion ratios used across the paediatric literature. Results Among 754 abstracts reviewed, 59 full-text articles met inclusion criteria and 24 studies were included in the analysis: 4 studies compared pharmacodynamics of Mo and Hm and 20 studies reported the use of a predefined Mo to Hm conversion ratio. Most studies had a poor methodological quality. Available evidence suggests that, when given intravenously, the equianalgesic ratio of Mo to Hm is 5:1. Intravenous administration with this ratio results in a similar rate of adverse effects, including pruritus and nausea. The epidural administration with a ratio of 10:1 results in more pruritus and urinary retention with Mo than Hm. Pharmacokinetic data were reported in only one study. A wide range of pre-established ratios for different routes of administration were reported, but few were based on evidence. Conclusion Current literature does not permit a rational choice between Mo and Hm. A ratio of 5:1 seems adequate for intravenous administration and leads to a similar rate of adverse effects.DOI.org (Crossref)enhttps://adc.bmj.com/lookup/doi/10.1136/archdischild-2020-3190592023-07-05 02:45:08MyLibraryZotero17Danovitch, ItaiVanle, BrigitteVan Groningen, NicoleIshak, WaguihNuckols, TerylJournal of Addiction MedicineOpioid Overdose in the Hospital SettingJournal of Addiction Medicine39-471411INCLUDED-Main202001/20201932-0620, 1935-322710.1097/ADM.0000000000000536Objective:  Our objective was to determine the percentage of opioid overdose events among medical and surgical inpatient admissions, and to identify risk factors associated with these events. Methods:  We searched PubMed and CINAHL databases from inception through July 30, 2017 and identified additional studies from reference lists and other reviews. Articles were included if they reported original research on the rate of opioid overdoses or opioid-related adverse events, and the adverse events occurred in a general medical hospital during an inpatient stay. We extracted information on study population, design, results, and risk for bias using the Newcastle-Ottawa Quality Assessment Scale. We performed this review in accordance with recently suggested standards and report our findings as per the Meta-Analyses and Systematic Reviews of Observational Studies guidelines. Results:  Thirteen studies met our eligibility criteria. The percentage of opioid overdoses ranged from 0.06% to 2.50% of hospitalizations. The majority of studies used only 1 method of event detection. Risk factors for overdose included older age, infancy, medical comorbidity, substance use disorder diagnosis, combining opioids with other sedatives, and admission to hospitals with higher opioid-prescribing rates. Conclusions:  Opioid overdose in the inpatient setting is a serious preventable harm and is likely underestimated in much of the current literature. Improved detection methods are needed to more accurately measure the rate of inpatient opioid overdose. Refined estimates of opioid overdose should be used to drive safety and quality improvement initiatives in hospitals.journals.lww.comen-UShttps://journals.lww.com/journaladdictionmedicine/Abstract/2020/02000/Opioid_Overdose_in_the_Hospital_Setting__A.6.aspx/Users/meganridgway/Zotero/storage/VQ9H6YA8/Opioid_Overdose_in_the_Hospital_Setting__A.6.html2023-06-19 16:12:06MyLibraryZotero17Birnie, Kathryn A.Stinson, JenniferIsaac, LisaTyrrell, JenniferCampbell, FionaJordan, Isabel P.Marianayagam, JustinaRichards, DawnRosenbloom, Brittany N.Clement, FionaHubley, PamCanadian Journal of PainCanadian Journal of PainCanadian Journal of Pain108-120622INCLUDED-Additional20222022-06-152474-052710.1080/24740527.2022.2038031Background: Preventing pediatric chronic postsurgical pain is a patient, parent/caregiver, health care professional, and policymaker priority. Poorly managed presurgical and acute postsurgical pain are established risk factors for pediatric chronic postsurgical pain. Effective perioperative pain manage­ ment is essential to prevent the transition from acute to chronic pain after surgery. Aims: The aim of this study was to identify current pediatric surgical pain management practices and assess health system readiness for change at health care institutions conducting pediatric surgery in Canada. Methods: An online survey was completed by 85 multidisciplinary health care professionals (nurses, surgeons, anesthesiologists, allied health) from 20 health institutions in Canada regarding institutional pre- and postsurgical pediatric pain care, specialty pain services, and Organizational Readiness for Implementing Change (ORIC). Results: Of all specialty pain services, acute and chronic/complex pain services were most common, primarily with physician and nursing involvement. Alignment to recommended practices for pediatric pre- and postsurgical pain care varied (38.1%–79.8% reported “yes, for every child”), with tertiary/ quaternary children’s hospitals reporting less alignment than other institutions (community/regional or rehabilitation hospitals, community treatment centers). No significant differences were reported between health care institutions serving pediatric populations only versus those also serving adults. Health care professional experience/practice was the most reported strength in pediatric surgical pain care, with inconsistent standard of care the most common gap. Participants “somewhat agreed” that their institutions were committed and capable of change in pediatric surgical pain care. Conclusions: There is a continued need to improve pediatric pain care during the perioperative period at Canadian health care institutions to effectively prevent the development of pediatric postsurgical pain.DOI.org (Crossref)enhttps://www.tandfonline.com/doi/full/10.1080/24740527.2022.2038031/Users/meganridgway/Zotero/storage/2LLJNJS8/Birnie et al. - 2022 - Mapping the current state of pediatric surgical pa.pdf2023-12-12 14:55:41MyLibraryZotero17Groenewald, Cornelius B.The Clinical Journal of PainThe Clinical Journal of Pain515-5203566INCLUDED-Additional201906/20190749-804710.1097/AJP.0000000000000707The opioid crisis in America affects both adults and children. However, children are often excluded from health care policies and guidelines aimed at curbing the opioid crises. For example, recent guidelines on opioid prescribing authored by the Center for Disease Control and Prevention (CDC), has exclusively focused on adults. Stakeholders such as patients, providers, and public health agencies feel increased pressure to address the opioid crises and thus guidelines intended for adults may inadvertently be generalized to children. Indeed, some health agencies in the United States have advocated for more restrictive opioid prescribing to children as compared to adults. In order to better address the opioid crises we urgently need more evidence to guide decisions. Thus, this topical review aims to provide a brief overview of the opioid crises affecting children, followed by a synopsis of recent research on opioid prescribing patterns and data on the links between legitimate opioid use and risk for problematic opioid use behaviors.DOI.org (Crossref)enhttps://journals.lww.com/00002508-201906000-00010/Users/meganridgway/Zotero/storage/BL7H5CH9/Groenewald - 2019 - Opioid-prescribing Patterns for Pediatric Patients.pdf2023-12-12 15:09:03MyLibraryZotero13SKIPCHU St JustineINCLUDED-Main20232023https://kidsinpain.ca/wp-content/uploads/2023/09/VOEManagement-SCD_EN.pdfMyLibraryZotero17Dyson, Michele P.Dong, KathrynSevcik, WilliamGraham, Samir Z.Saba, SabrinaHartling, LisaAli, SaminaJournal of the American College of Emergency Physicians OpenQuantifying unused opioids following emergency and ambulatory careJournal of the American College of Emergency Physicians OpenJ Am Coll Emerg Physicians Opene12822355INCLUDED-Additional20222022-9-302688-115210.1002/emp2.12822Objective To quantify unused opioids among adult and pediatric patients discharged from the emergency department (ED) or ambulatory care settings with a prescription for acute pain. Methods We searched MEDLINE, Embase, CINHAL, PsycINFO, the Cochrane Library, and the gray literature from inception to April 29, 2021. We included observational studies in which any patient with an acutely painful condition received a prescription for an opioid on discharge from an outpatient care setting, and unused opioids were quantified. Two reviewers screened records for eligibility, extracted data, and conducted the quality assessment. Where possible, we pooled data and otherwise described the results of studies narratively. Total unused prescriptions were synthesized using a weighted average. Random effects models were used, and heterogeneity was measured by the I2 statistic. Our primary outcome was the quantity of unused opioid medication available after receiving a prescription for acute pain. Secondary outcomes were the proportion of patients with unused opioids following a prescription, the proportion of patients using no opioids, morphine equivalents of unused opioids, and factors associated with leftover opioids. Results In this systematic review and meta‐analysis of 9 studies in emergency and ambulatory care settings, 59.6% of prescribed opioids remained unused; pediatric patients had 69.3% of their prescriptions remaining, compared to 54.6% among adult patients. The highest proportion of unused opioids was found following dental extractions (82.6%). Conclusions and Relevance More than 50% of opioids remain unused following prescriptions for acute pain. Responsible prescribing must be accompanied by education on safer use, storage, and disposal.PubMed Centralhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9523453//Users/meganridgway/Zotero/storage/KBTMR79Q/Dyson et al. - 2022 - Quantifying unused opioids following emergency and.pdfhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9523453/2023-12-15 17:28:16MyLibraryZotero17Jun, EstherAli, SaminaYaskina, MarynaDong, KathrynRajagopal, ManasiDrendel, Amy L.Fowler, MeganPoonai, NaveenPediatric Emergency Research CanadaPaediatrics & Child HealthPaediatrics & Child HealthPaediatr Child Health19-262611CaregiverEmergency departmentINCLUDED-AdditionalMusculoskeletal injuryOpioidsPain20212021-021205-708810.1093/pch/pxz162BACKGROUND: Given the current opioid crisis, caregivers have mounting fears regarding the use of opioid medication in their children. We aimed to determine caregivers' a) willingness to accept, b) reasons for refusing, and c) past experiences with opioids. METHODS: A novel electronic survey of caregivers of children aged 4 to 16 years who had an acute musculoskeletal injury and presented to two Canadian paediatric emergency departments (ED) (March to November 2017). Primary outcome was caregiver willingness to accept opioids for moderate pain for their children. RESULTS: Five hundred and seventeen caregivers participated; mean age was 40.9 (SD 7.1) years with 70.0% (362/517) mothers. Children included 62.2% (321/516) males with a mean age of 10.0 (SD 3.6) years. 49.6% of caregivers (254/512) reported willingness to accept opioids for ongoing moderate pain in the ED, while 37.1% (190/512) were 'unsure'; 33.2% (170/512) of caregivers would accept opioids for at-home use, but 45.5% (233/512) were 'unsure'. Caregivers' primary concerns were side effects, overdose, addiction, and masking of diagnosis. Caregiver fear of addiction (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.01 to 1.25) and side effects (OR 1.25, 95% CI 1.11 to 1.42) affected willingness to accept opioids in the emergency department; fears of addiction (OR 1.19, 95% CI 1.07 to 1.32), and overdose (OR 1.15, 95% CI 1.04 to 1.27) affected willingness to accept opioids for at-home use. CONCLUSIONS: Only half of the caregivers would accept opioids for moderate pain, despite ongoing pain following nonopioid analgesics. Caregivers' fears of addiction, side effects, overdose, and masking diagnosis may have influenced their responses. These findings are a first step in understanding caregiver analgesic decision making.PubMedeng/Users/meganridgway/Zotero/storage/Z6VYJPSL/Jun et al. - 2021 - A two-centre survey of caregiver perspectives on o.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/33542771MyLibraryZotero17Hadland, Scott E.Bagley, Sarah M.Gai, Mam JarraEarlywine, Joel J.Schoenberger, Samantha F.Morgan, Jake R.Barocas, Joshua A.Addiction (Abingdon, England)Addiction (Abingdon, England)Addiction2790-28001161010INCLUDED-Additional20212021-100965-214010.1111/add.15487Background and Aims: Some adolescents and young adults (termed ‘youth’) prescribed an opioid will develop opioid use disorder or experience overdose. This study aimed to identify patient and prescription characteristics associated with subsequent risk of opioid use disorder or overdose during the year after an opioid is first dispensed. Design: Retrospective cohort study. Setting: Commercial health insurance claims in a large US database from 2006 to 2016. Participants: Youth aged 11–25 years filling an initial opioid prescription. Exposures: Patient (sociodemographic information, and physical and mental health diagnoses) and prescription characteristics (opioid formulation, dose, and duration). Measurement: The primary outcome was development of an ‘opioid-related complication’ (a diagnosis of opioid use disorder or opioid-related overdose) during the subsequent 12 months. Exposures of interest were patient (sociodemographic information, and physical and mental health diagnoses) and prescription characteristics (opioid formulation, dose, and duration). Findings: Among 3,278,990 youth filling an initial opioid prescription, median age was 18 years (IQR, 16–21) and 56.1% were female. During the subsequent 12 months, 10,405 (0.3%) youth experienced an opioid-related complication. Conditions associated with increased risk included mood/anxiety disorders (aRR, 4.45 [95% CI, 4.25–4.66]) and substance use (aRR, 20.77 [95% CI, 19.74–21.84]). Comorbid substance use disorders were present among 72.8% of youth experiencing an opioid-related complication and included alcohol (33.4%), cannabis (33.0%), nicotine (43.2%), and other substance use disorders (75.5%). Long-acting opioids (aRR, 2.59 [95% CI, 2.18–3.09]) and longer durations were associated with increased risk (7–14 days: aRR, 1.15 [95% CI, 1.08–1.22]; ≥15 days: aRR, 1.96 [95% CI, 1.80–2.12]) compared to short-acting formulations and durations ≤3 days, respectively. Conclusions: Complications after an initial opioid prescription are relatively rare. Screening for mental health conditions and substance use before prescribing might identify youth at risk for OUD and overdose. Clinicians might mitigate the risk by prescribing short-acting opioids for short durations.PubMed Centralhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8429061//Users/meganridgway/Zotero/storage/NF3GNVQF/Hadland et al. - 2021 - Opioid Use Disorder and Overdose Among Youth Follo.pdfhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8429061/2023-12-15 17:42:41MyLibraryZotero27Canadian Centre on Substance Use and AddictionINCLUDED-Main20202020CCSASummarizes data on the use of prescription opioids, including information on associated harms and effects, legal status, costs, hospitalization, emergency department visits and access to treatment. As of the date of the summary (June 2020), opioid pain relievers are used by 11.8% of the population, unchanged from 13% in 2015. Hospitalizations due to opioid poisoning have been increasing and there were 2,913 opioid-related deaths in 2019.enhttps://www.ccsa.ca/prescription-opioids-canadian-drug-summary/Users/meganridgway/Zotero/storage/STC7WG5R/prescription-opioids-canadian-drug-summary.html2023-12-15 17:46:22MyLibraryZotero12Drug Free Kids CanadaINCLUDED-Mainhttps://www.drugfreekidscanada.org/support/supporthub//Users/meganridgway/Zotero/storage/SSD2AZJV/supporthub.html2023-12-15 17:56:51