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Christina Almgren
Department of Anesthesiology Perioperative and Pain Medicine, Stanford University, Palo Alto, CA 94305, USA

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Review
Published: 21 February 2019 in Children
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Opioid therapy is the cornerstone of treatment for acute procedural and postoperative pain and is regularly prescribed for severe and debilitating chronic pain conditions. Although beneficial for many patients, opioid therapy may have side effects, limited efficacy, and potential negative outcomes. Multidisciplinary pain management treatments incorporating pharmacological and integrative non-pharmacological therapies have been shown to be effective in acute and chronic pain management for pediatric populations. A multidisciplinary approach can also benefit psychological functioning and quality of life, and may have the potential to reduce reliance on opioids. The aims of this paper are to: (1) provide a brief overview of a multidisciplinary pain management approach for pediatric patients with acute and chronic pain, (2) highlight the mechanisms of action and evidence base of commonly utilized integrative non-pharmacological therapies in pediatric multidisciplinary pain management, and (3) explore the opioid sparing effects of multidisciplinary treatment for pediatric pain.

ACS Style

Anava Wren; Alexandra Ross; Genevieve D’Souza; Christina Almgren; Amanda Feinstein; Amanda Marshall; Brenda Golianu. Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids. Children 2019, 6, 33 .

AMA Style

Anava Wren, Alexandra Ross, Genevieve D’Souza, Christina Almgren, Amanda Feinstein, Amanda Marshall, Brenda Golianu. Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids. Children. 2019; 6 (2):33.

Chicago/Turabian Style

Anava Wren; Alexandra Ross; Genevieve D’Souza; Christina Almgren; Amanda Feinstein; Amanda Marshall; Brenda Golianu. 2019. "Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids." Children 6, no. 2: 33.

Review
Published: 05 December 2018 in Children
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As awareness increases about the side effects of opioids and risks of misuse, opioid use and appropriate weaning of opioid therapies have become topics of significant clinical relevance among pediatric populations. Critically ill hospitalized neonates, children, and adolescents routinely receive opioids for analgesia and sedation as part of their hospitalization, for both acute and chronic illnesses. Opioids are frequently administered to manage pain symptoms, reduce anxiety and agitation, and diminish physiological stress responses. Opioids are also regularly prescribed to youth with chronic pain. These medications may be prescribed during the initial phase of a diagnostic workup, during an emergency room visit; as an inpatient, or on an outpatient basis. Following treatment for underlying pain conditions, it can be challenging to appropriately wean and discontinue opioid therapies. Weaning opioid therapy requires special expertise and care to avoid symptoms of increased pain, withdrawal, and agitation. To address this challenge, there have been enhanced efforts to implement opioid-reduction during pharmacological therapies for pediatric pain management. Effective pain management therapies and their outcomes in pediatrics are outside the scope of this paper. The aims of this paper were to: 1) Review the current practice of opioid-reduction during pharmacological therapies; and 2) highlight concrete opioid weaning strategies and management of opioid withdrawal.

ACS Style

Genevieve D’Souza; Anava A. Wren; Christina Almgren; Alexandra C. Ross; Amanda Marshall; Brenda Golianu. Pharmacological Strategies for Decreasing Opioid Therapy and Management of Side Effects from Chronic Use. Children 2018, 5, 163 .

AMA Style

Genevieve D’Souza, Anava A. Wren, Christina Almgren, Alexandra C. Ross, Amanda Marshall, Brenda Golianu. Pharmacological Strategies for Decreasing Opioid Therapy and Management of Side Effects from Chronic Use. Children. 2018; 5 (12):163.

Chicago/Turabian Style

Genevieve D’Souza; Anava A. Wren; Christina Almgren; Alexandra C. Ross; Amanda Marshall; Brenda Golianu. 2018. "Pharmacological Strategies for Decreasing Opioid Therapy and Management of Side Effects from Chronic Use." Children 5, no. 12: 163.

Randomized controlled trial
Published: 01 August 2018 in Pediatric Critical Care Medicine
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The purpose of this pilot study was three-fold: 1) to evaluate the safety and feasibility of instituting massage therapy in the immediate postoperative period after congenital heart surgery, 2) to examine the preliminary results on effects of massage therapy versus standard of care plus three reading visits on postoperative pain and anxiety, and 3) to evaluate preliminary effects of opioid and benzodiazepine exposure in patients receiving massage therapy compared with reading controls. Prospective, randomized controlled trial. An academic children’s hospital. Sixty pediatric heart surgery patients between ages 6 and 18 years. Massage therapy and reading. There were no adverse events related to massage or reading interventions in either group. Our investigation found no statistically significant difference in Pain or State-Trait Anxiety scores in the initial 24 hours after heart surgery (T1) and within 48 hours of transfer to the acute care unit (T2) after controlling for age, gender, and Risk Adjustment for Congenital Heart Surgery 1 score. However, children receiving massage therapy had significantly lower State-Trait Anxiety scores after receiving massage therapy at time of discharge (T3; p = 0.0075) than children receiving standard of care plus three reading visits. We found no difference in total opioid exposure during the first 3 postoperative days between groups (median [interquartile range], 0.80 mg/kg morphine equivalents [0.29–10.60] vs 1.13 mg/kg morphine equivalents [0.72–6.14]). In contrast, children receiving massage therapy had significantly lower total benzodiazepine exposure in the immediate 3 days following heart surgery (median [interquartile range], 0.002 mg/kg lorazepam equivalents [0–0.03] vs 0.03 mg/kg lorazepam equivalents [0.02–0.09], p = 0.0253, Wilcoxon rank-sum) and number of benzodiazepine PRN doses (0.5 [0–2.5] PRN vs 2 PRNs (1–4); p = 0.00346, Wilcoxon rank-sum). Our pilot study demonstrated the safety and feasibility of implementing massage therapy in the immediate postoperative period in pediatric heart surgery patients. We found decreased State-Trait Anxiety scores at discharge and lower total exposure to benzodiazepines. Preventing postoperative complications such as delirium through nonpharmacologic interventions warrants further evaluation.

ACS Style

Sandra L. Staveski; Karen Boulanger; Lee Erman; Li Lin; Christina Almgren; Chloe Journel; Stephen J. Roth; Brenda Golianu. The Impact of Massage and Reading on Children’s Pain and Anxiety After Cardiovascular Surgery. Pediatric Critical Care Medicine 2018, 19, 725 -732.

AMA Style

Sandra L. Staveski, Karen Boulanger, Lee Erman, Li Lin, Christina Almgren, Chloe Journel, Stephen J. Roth, Brenda Golianu. The Impact of Massage and Reading on Children’s Pain and Anxiety After Cardiovascular Surgery. Pediatric Critical Care Medicine. 2018; 19 (8):725-732.

Chicago/Turabian Style

Sandra L. Staveski; Karen Boulanger; Lee Erman; Li Lin; Christina Almgren; Chloe Journel; Stephen J. Roth; Brenda Golianu. 2018. "The Impact of Massage and Reading on Children’s Pain and Anxiety After Cardiovascular Surgery." Pediatric Critical Care Medicine 19, no. 8: 725-732.

Journal article
Published: 01 October 2014 in Medical Acupuncture
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ACS Style

Brenda Golianu; Jeannie Seybold; Christina Almgren. Acupuncture Helps Reduce Need for Sedative Medications in Neonates and Infants Undergoing Treatment in the Intensive Care Unit: A Prospective Case Series. Medical Acupuncture 2014, 26, 279 -285.

AMA Style

Brenda Golianu, Jeannie Seybold, Christina Almgren. Acupuncture Helps Reduce Need for Sedative Medications in Neonates and Infants Undergoing Treatment in the Intensive Care Unit: A Prospective Case Series. Medical Acupuncture. 2014; 26 (5):279-285.

Chicago/Turabian Style

Brenda Golianu; Jeannie Seybold; Christina Almgren. 2014. "Acupuncture Helps Reduce Need for Sedative Medications in Neonates and Infants Undergoing Treatment in the Intensive Care Unit: A Prospective Case Series." Medical Acupuncture 26, no. 5: 279-285.