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Pain management for children with musculoskeletal injuries is suboptimal and, in the absence of clear evidence-based guidelines, varies significantly.
The usefulness of
nonpharmacological interventions in the pediatric population and the ideal
analgesic agent(s) for moderate-to-severe pain is yet to be found. This is the
first review of its kind which explains the most effective interventions for
pain reduction related to acute musculoskeletal injury.
Pain management
for children with musculoskeletal injuries is suboptimal and, in the absence of
clear evidence-based guidelines, varies significantly. To systematically review
the most effective pain management for children presenting to the emergency
department with musculoskeletal injuries.
Electronic
databases were searched systematically for randomized controlled trials of
pharmacological and nonpharmacological interventions for children aged 0–18
years, with musculoskeletal injury, in the emergency department. The primary
outcome was the risk ratio for successful reduction in pain scores.
Of 34 studies
reviewed, 8 met inclusion criteria and provided data on 1169 children from 3 to
18 years old. Analgesics used greatly varied, making comparisons difficult.
Only two studies compared the same analgesics with similar routes of
administration. Two serious adverse events occurred without fatalities. All
studies showed similar pain reduction between groups except one study that
favored ibuprofen when compared to acetaminophen.
Due to heterogeneity of medications and routes
of administration in the articles reviewed, an optimal analgesic cannot be
recommended for all pain categories. Larger trials are required for further
evaluation of analgesics, especially trials combining a nonopioid with an
opioid agent or with a nonpharmacological intervention.
Pain Research and Management
Pain Management of Pediatric Musculoskeletal Injury in the Emergency Department: A Systematic Review
Sylvie Le May et al.
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