Saving pediatric pain patients from the opioid epidemic

Practice Management

A spotlight on opioid abuse is burning brighter as opioid-related deaths continue to plague the nation. In October 2017, President Donald Trump declared the opioid crisis a public health emergency. More than 350,000 people died from overdoses involving opioids between 1999 and 2016, according to the CDC.

With keen focus on curbing adult opioid dependency, Baltimore-based Kennedy Krieger Institute is ensuring children with chronic pain don't suffer the same fate.

"We want kids to be regular kids, even if they have chronic pain. A regular kid is never on opioids," says pediatrician Suzanne Venoski Rybczynski, MD. "At Kennedy Krieger Institute, our goal is to treat children and adolescents with chronic pain without the use of opioids." Dr. Rybczynski serves as medical director of the Pediatric Rehabilitation Unit at Kennedy Krieger Institute and as an assistant professor of pediatrics at Baltimore-based Johns Hopkins School of Medicine.

Kennedy Krieger's pediatric pain rehabilitation program offers outpatient, intensive day treatment and intensive inpatient rehabilitation. The Institute takes a holistic treatment approach, bringing pediatric anesthesiologists, pediatric rehabilitation physicians and pediatricians together with physical therapists, occupational therapist and a host of other team members to solve patients' pain problems. Additionally, Kennedy Krieger sets up patients with behavioral psychologists to teach skills and coping methods for children with chronic pain.

Dr. Rybczynski says they often treat pediatric patients recovering from spine procedures for idiopathic scoliosis or neuromuscular scoliosis, with the goal of weaning them off opioids as quickly as possible.

Complex regional pain syndrome is another common condition among patients at Kennedy Krieger. "These kids that are at risk for ending up on opioids if a physician isn't aware of that condition," says Dr. Rybczynski. "We think the interdisciplinary group treatment helps a lot for that subgroup of orthopedic chronic pain."

The institute offers a variety of treatment options that don't include opioids, helping both the patients and their families cope with the burden of chronic pain:

  • Biofeedback
  • Sleep hygiene
  • Behavioral psychology
  • Exercise: yoga, riding bikes, walking on treadmills
  • Massage and acupuncture
  • Aquatic therapy
  • Animal-assisted therapy

"Typically four weeks, the inpatient treatment gives the child and family new skills to cope with pain," adds Dr. Rybczynski. "We never promise the pain will go away 100 percent." Dr. Rybczynski says the key is to get children on a routine and to distract them from the pain.

"I think that children want to just be kids," says Dr. Rybczynski. "We want to get them back to doing their regular things without having to rely on [opioids]." She notes that children are often motivated to get better and dislike being on medication, so removing opioids from their treatment plans is usually easier than it is for adults.

And it helps that pediatricians are generally more reluctant to prescribe any medications, Dr. Rybczynski adds.

"We are more comfortable saying no because we are used to having parents coming in asking for antibiotics inappropriately," she explains. "In that respect, pediatrics is in a better place than adult medicine."

Dr. Rybczynski is hopeful the opioid epidemic will slow, due to the heightened awareness in the media and Congress prioritizing it.

"People are more aware and hopefully physicians won't be swept up in the prescribing of opioids," she concludes.

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