Opioids for Chronic Noncancer Pain in Children and Youth
A previously healthy, 16-year-old boy presents to the chronic pain program 1 year after a speed skating accident that resulted in an extensive laceration from a skate blade and required surgical repair of all layers of the latissimus dorsi at the level of T12-L1. He suffered excruciating pain and, after many medical consultations, presented to the pain clinic. At that time, his pain was continuous with variable intensity, and his pain score was 6-8 on a 10-point numerical rating scale (average 6 of 10 with a goal of 3-4 of 10). He described the pain as sharp, burning, stabbing, and numb. He admitted to a marked impact on mood, sleep, and function (school attendance, job, socializing, competitive sports). He had been taking acetaminophen, ibuprofen, and codeine with only minimal benefit, and was not using any physical or psychological strategies. He lives with his parents and siblings, all of whom are supportive. His mother was tearful throughout the assessment, reporting that her son, who previously was very social and involved in school and sport activities, was becoming withdrawn and moody and often declined social invitations due to pain. Physical examination revealed an otherwise healthy adolescent boy with a well-healed 22-cm low thoracic scar from the left side of midline extending laterally and inferiorly. There was marked allodynia. A diagnosis of moderate-to-severe neuropathic pain with significant impact on mood, sleep, and function was made.
The Case: A Teen With Chronic Pain
A previously healthy, 16-year-old boy presents to the chronic pain program 1 year after a speed skating accident that resulted in an extensive laceration from a skate blade and required surgical repair of all layers of the latissimus dorsi at the level of T12-L1. He suffered excruciating pain and, after many medical consultations, presented to the pain clinic. At that time, his pain was continuous with variable intensity, and his pain score was 6-8 on a 10-point numerical rating scale (average 6 of 10 with a goal of 3-4 of 10). He described the pain as sharp, burning, stabbing, and numb. He admitted to a marked impact on mood, sleep, and function (school attendance, job, socializing, competitive sports). He had been taking acetaminophen, ibuprofen, and codeine with only minimal benefit, and was not using any physical or psychological strategies. He lives with his parents and siblings, all of whom are supportive. His mother was tearful throughout the assessment, reporting that her son, who previously was very social and involved in school and sport activities, was becoming withdrawn and moody and often declined social invitations due to pain. Physical examination revealed an otherwise healthy adolescent boy with a well-healed 22-cm low thoracic scar from the left side of midline extending laterally and inferiorly. There was marked allodynia. A diagnosis of moderate-to-severe neuropathic pain with significant impact on mood, sleep, and function was made.