Acute Pain
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Overview
Acute pain often accompanies injury or illness in childhood. When a child or youth has acute pain, their pain should be first managed with physical and psychological strategies, coupled with non-opioid analgesia whenever possible.
For moderate or severe pain, however, the short-term use of opioids may sometimes be necessary. Judicious use of opioids can help reduce children’s discomfort, keep them comfortable during medical examination and diagnostic evaluation, improve their satisfaction with care, and prevent long-term negative consequences of untreated pain.
This toolkit section includes resources for safer and responsible prescribing and administering opioids for acute pain in children and youth.
When opioids are prescribed and administered for acute pain, there are several considerations to ensure safer therapeutic use:
- Physical (e.g., heat, ice, splinting) and psychological (e.g., distraction) treatments should be used for most children and youth with acute pain
- Non-opioid medications (e.g., acetaminophen, ibuprofen, other NSAIDs) should be used as first-line pharmacologic therapies
- Ibuprofen and acetaminophen can be combined for relief of moderate pain; this combination provides relief similar to many oral opioid medications, without opioid side effects, and may alleviate the need to prescribe opioids
- Opioids should be combined with a nonopioid medication to reduce the total amount of opioid needed and lessen the occurrence of adverse events.
- Three days (or 5-10 doses) of an oral opioid medication is almost always enough to manage acute injuries at home
- Children and their families should always be counselled about the potential side effects of opioid medications
- Opioid risk assessment should be performed for all families receiving a prescription for opioids, using a validated risk assessment tool
Also consider risks for opioid use disorder, higher-risk opioid use, child age, and preexisting mental health diagnoses.
However, even when these risks are present, children with severe pain have the right to adequate pain management, which may include the use of opioids. Children and their families should share the decision making about whether opioid analgesia is appropriate for them with their healthcare provider.
Definition of Acute Pain:
Pain that is recent in onset and typically self limiting, with a duration that typically ranges from a few hours to no more than 3 months (depending on the anticipated duration of the healing process) related to tissue injury, a medical procedure, and/or following surgery, acute illness, trauma, or other injuries. Children can experience acute and chronic pain concurrently.
CAN/HSO 13200:2023 Pediatric Pain Management Standard. 2023
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“Opioids have their place and are definitely a very powerful resource in caring for youth with acute and chronic pain. It’s just that there has to be more knowledge, more education for physicians and for patients.” Opioids and Pain in Youth: A toolkit for health professionals / Acute Pain
~ Youth Patient Partner
Have feedback? Visit linktr.ee/youthinpain or kidsinpain.ca/youth-in-pain to learn more about this toolkit. For content suggestions please e-mail contact@kidsinpain.ca
References
Statements and Guidelines
Evidence-Based Guidelines for Prehospital Pain Management: Recommendations
Lindbeck G, et al. Prehospital Emergency Care. 2023
View recommendations
Acute complications in children with sickle cell disease: Prevention and management
Beck CE, et al. Paediatrics & Child Health. Canadian Paediatric Society. 2022
View position statement
Approaching acute pain in emergency settings; European Society for Emergency Medicine (EUSEM) guidelines—part 2: management and recommendations
Hachimi-Idrissi S, et al. Internal and Emergency Medicine. 2020
View recommendations *subscription-based access
Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures
Trottier ED, et al. Paediatrics & Child Health. Canadian Paediatric Society. 2019
View position statement
Practice guideline update summary: Acute treatment of migraine in children and adolescents
Oskoui M, et al. Neurology. 2019
View practice guideline
Opioid prescribing for acute pain: care for people 15 years of age and older
Health Quality Ontario. 2018
View PDF
Review Articles
Responsible and safe use of opioids in children and adolescents in the emergency department
Ali S & Drendel A. Pediatric Emergency Medicine Practice. 2023
Access article *subscription-based access
Health Professional Resources
Assessing and Treating Acute Pain in Children with Sickle Cell Disease
Guidance for emergency department staff, based on a Canadian Paediatric Society Position Statement
CHU Sainte-Justine. 2023.
View PDF
Intranasal Fentanyl
CHU Sainte-Justine. 2020 Guide clinique destiné aux professionnel.le.s de la santé sur l’utilisation du fentanyl intranasal lors des interventions médicales
Visit website
Youth and Family Resources
Analgésiques opioïdes à courte action: informations pour les patients et les familles
CHU Sainte-Justine. 2021 This brochure provides additional information on the use of short-acting opioids to help reduce pain while minimizing associated side effects and risks.
View PDF
Short-acting Opioid Anagesics: information for patients and families
CHU Sainte-Justine. 2021 This brochure provides additional information on how to use prescription opioids to help reduce pain while minimizing associated side effects and risks.
View PDF
Acute pain: How to treat and manage in infants and toddlers
About Kids Health. SickKids. 2019 Learn about the 3P approach to pain management for infant and toddler’s acute pain.
Visit website (multiple languages)
Acute pain: How to treat and manage in young children
About Kids Health. SickKids. 2019 Learn about the 3P approach to pain management for children’s acute pain.
Visit website (multiple languages)
Acute pain: How to treat and manage in older children
About Kids Health. SickKids. 2019 Learn about the 3P approach to pain management for older children’s pain (age six to 12).
Visit website (multiple languages)
Acute pain: How to treat and manage in teens
About Kids Health. SIckKids. 2019 Learn about the 3P approach to pain management for pain in teens.
Visit website (multiple languages)
Additional Resources
The Effectiveness of Ketamine Compared to Opioid Analgesics for management of acute pain in Children in The Emergency Department: systematic Review
Alanazi E. American Journal of Emergency Medicine. 2022
Access article *subscription-based access
The effectiveness and safety of paediatric prehospital pain management: a systematic review
Abebe Y, et al. Scandanavian Journal of Trauma, Resuscitation and Emergency Medicine. 2021
Access article
Influence of ketamine versus fentanyl on pain relief for pediatric orthopedic emergencies: A metaanalysis of randomized controlled studies
Qui J & Xie M. Medicine. 2021.
Access article
Medications containing low-dose codeine for the treatment of pain and coughs
CADTH. 2021
View PDF
Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury
Jones P, et al. Cochrane Database of Systematic Reviews. 2020
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Efficacy of ibuprofen in musculoskeletal post-traumatic pain in children: A systematic review
Parri N & Lazzeri S. PLoS ONE. 2020
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Codeine for Pediatric Patients with Acute Pain: A Review of Clinical Effectiveness
CADTH. 2019
View PDF
Revisiting established medicines: An overview of systematic reviews about ibuprofen and paracetamol for treating pain in children
Radman M, et al. European Journal of Pain. 2019
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Treatment of pain with intranasal fentanyl in pediatric patients in an acute care setting: a systematic review
Setlur A & Friedland H. Pain Management. 2018
Access article *subscription-based access
How Safe Are Common Analgesics for the Treatment of Acute Pain for Children? A Systematic Review
Hartling L, et al. Pain and Research Management. 2016
Access article
Intranasal fentanyl for the management of acute pain in children
Murphy A, et al. Cochrane Database Systematic Reviews. 2014
Access article
Production of this document has been made possible through a financial contribution from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada.
