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The use of oral opioids to control children's pain in the post-codeine era

Michael J Rieder1, Geert 't Jong1

  • 1Canadian Paediatric Society, Drug Therapy and Hazardous Substances Committee, Ottawa, Ontario.

Paediatrics & Child Health
|March 22, 2021
PubMed

Insights

Oral opioids are used for moderate to severe pain in children, but codeine use has declined. Oral morphine shows the most safety and efficacy, but more research on other opioids and non-opioid options is needed.

Area of Science:

  • Pediatric Pain Management
  • Pharmacology
  • Evidence-Based Medicine

Background:

  • Pain is a prevalent issue in pediatric care, requiring effective pharmacologic and nonpharmacologic management strategies.
  • Oral opioids have been widely used for moderate to severe pediatric pain, with codeine historically being a common choice.
  • Declining availability and safety concerns associated with codeine have necessitated the exploration of alternative analgesics for children.

Purpose of the Study:

  • To review the current evidence on the safety and efficacy of various oral opioids used for moderate to severe pain management in children.
  • To identify gaps in knowledge regarding the use of alternative opioids such as oxycodone, hydromorphone, and tramadol in pediatric populations.
  • To highlight oral morphine as an alternative with substantial evidence for pediatric use and to emphasize the need for further research.

Main Methods:

  • Literature review and synthesis of existing studies on oral opioid analgesics in pediatric pain management.
  • Analysis of pharmacokinetic and pharmacodynamic data for commonly used opioids in children.
  • Evaluation of safety and efficacy data from clinical trials and observational studies.

Main Results:

  • Codeine use in children has significantly decreased due to safety concerns.
  • Limited data exist on the efficacy and safety of oxycodone, hydromorphone, and tramadol in pediatric patients.
  • Oral morphine demonstrates the most robust evidence for safety and efficacy as a codeine alternative in children.

Conclusions:

  • Oral morphine is a viable alternative to codeine for moderate to severe pain in children, supported by the most extensive evidence.
  • Further research is crucial to establish the safety and efficacy profiles of other opioid analgesics and non-opioid therapies for pediatric pain.
  • Evidence-based guidelines are needed to optimize analgesic therapy for children experiencing moderate to severe pain.

Keywords:
HydromorphoneMorphineOxycodoneTramadol

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