Drugs Log

Giving your child medications, even over-the-counter medicines, should always be carefully monitored by your doctor.

The American Academy of Family Physicians offers these suggestions before you give any pain medication to your child:

• If a person younger than age 18 has the flu or chickenpox, never give the person aspirin, which could lead to a rare but deadly condition called Reye’s Syndrome.
• Acetaminophen (the active ingredient in Tylenol) is a generally safe painkiller for young children.
• Be careful about giving ibuprofen to children who are allergic to aspirin, as they may also be allergic to ibuprofen.
• Pain relievers may be dangerous for children with asthma, so don’t administer them without a doctor’s consent.
• Be careful not to give your child too much of the same medication. Sometimes the same active ingredient can be found in more than one medication.

Pain Medication in Young Children: How Are We Doing?

Not very well, especially for children younger than 2 years.

Doctors are known to do a poor job of treating pain. How do we do in treating pain in preverbal and very young children? To answer this question, these authors performed a retrospective chart review of patients 6 months to 10 years old who presented to a pediatric emergency department between 1999 and 2000 with isolated long-bone fractures or second- or third-degree burns.

Patients were excluded if they had closed head injury, chest or abdominal trauma, or a history of developmental delay or other neurologic impairment; 180 children were enrolled. The use of analgesics was assessed in 2 age groups: very young (6 to 24 months) and school-aged (6 to 10 years) children. More very young children than school-aged children did not receive analgesic agents (64.6% vs. 47.6%). When analgesics were used, very young patients were less likely to receive opioids (16.7% vs. 44.0%, respectively) and more likely to receive over-the-counter products (18.8% vs. 8.3%, respectively). Injury patterns differed significantly in the 2 age groups: Second-degree burns were more common in the very young group, and displaced fractures were more common in the school-aged group. Among children with nondisplaced fractures and among those with third-degree burns, there was no difference in analgesic treatment between the very young and school-aged groups.

Pain Medications

Over-the-Counter Pain Relievers

Over-the-counter (OTC) pain relievers include:

• Acetaminophen (Tylenol, Aspirin Free Excedrin)
• Nonsteroidal anti-inflammatory drugs (NSAIDs; aspirin, Motrin, Aleve and Orudis KT)
• Topical Corticosteroids (Cortaid and Cortizone)

Both acetaminophen and NSAIDs reduce fever and relieve pain caused by muscle aches and stiffness, but only NSAIDs can also reduce inflammation (swelling and irritation). Acetaminophen and NSAIDs also work differently. NSAIDs relieve pain by reducing the production of prostaglandins, which are hormone-like substances that cause pain. Acetaminophen works on the parts of the brain that receive the “pain messages.” NSAIDs are also available in a prescription strength that can be prescribed by your physician.

Topical pain relievers are also available without a doctor’s prescription. These products include creams, lotions, or sprays that are applied to the skin in order to relieve pain from sore muscles and arthritis. Some examples of topical pain relievers include Aspercreme, Ben-Gay, Icy Hot and Capzasin-P. Corticosteroid creams are also available.

Prescription Pain Relievers

Prescription pain relievers include:

• Corticosteroids
• Opioids
• Antidepressants
• Anticonvulsants (antiseizure medications)

What Are Corticosteroids?

Prescription corticosteroids provide relief for inflamed areas of the body by easing swelling, redness, itching and allergic reactions. Corticosteroids can be used to treat allergies, asthma and arthritis. When used to control pain they are generally given in the form of pills or injections. Examples include: Deltasone, Hydeltrasol and Solu-Medrol.

Prescription corticosteroids are strong medicines and may have serious side effects, including:

• Weight gain
• Upset stomach
• Headache
• Mood changes
• Trouble sleeping
• Weakened immune system

To minimize these potential side effects, corticosteroids are prescribed in the lowest dose possible for as short of a length of time as needed to relieve the pain. Efforts are underway to develop safer corticosteroids.

What Are Opioids?

Opioids are narcotic pain medications that contain natural, synthetic or semi-synthetic opiates. Opioids are often used for acute pain, such as short-term pain after surgery. Some examples of opioids include:

• Morphine
• Fentanyl
• Oxycodone
• Codeine

Opioids are effective for severe pain and do not cause bleeding in the stomach or other parts of the body as can other types of pain relievers. It is rare for people to become addicted to opioids if the drugs are used to treat pain for a short period of time.

Side effects of opioids may include:

• Drowsiness
• Nausea
• Constipation
• Itching
• Breathing problems
• Addiction

What Are Antidepressants?

Antidepressants are drugs that can treat pain and/or emotional conditions by adjusting levels of neurotransmitters (natural chemicals) in the brain. These medications can increase the availability of the body’s signals for well-being and relaxation, enabling pain control for people with chronic pain conditions that do not completely respond to usual treatments.

Chronic pain conditions treated by low-dose antidepressants include some types of headaches (like migraines) and menstrual pain. Some antidepressant medications include:

• Selective Serotonin Reuptake Inhibitors (SSRIs) such as Celexa, Prozac, Paxil, and Zoloft
• Tricyclic antidepressants such as Elavil, Norpramin Sinequan, Tofranil, and Pamelor
• Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRIs) such as Effexor and Cymbalta

These drugs require a steady dose of the medicine build up in the body over a period of time to work. The doses needed to treat pain are often lower than those needed to treat depression.

In general, antidepressants have fewer long-term side effects than frequent, ongoing use of other pain medicines. Generally, SSRIs and SSNRIs have fewer side effects than tricyclic antidepressants. The most common side effects with antidepressants include:

• Blurry vision
• Constipation
• Difficulty urinating
• Dry mouth
• Fatigue
• Nausea
• Headache

What Are Anticonvulsants?

Anticonvulsants are drugs typically used to treat seizure disorders. Some of these medications are shown to be effective in treating pain as well. The exact way in which these medicines control pain is unclear but it is thought that they minimize the effects of nerves that cause pain. Some examples include Tegretol, Neurontin and Lyrica.

In general they are well tolerated. The most common side effects include:

• Drowsiness
• Dizziness
• Fatigue
• Nausea

Other Pain Treatments

Another means of topical pain relief comes in the form of a Lidoderm patch, which is a prescription medication.

If your pain is not relieved by the usual treatments, your doctor may refer you to a pain management specialist. Doctors who specialize in pain management may try other treatments such as certain types of physical therapy or other kinds of medicine. They may also recommend TENS, a procedure that uses patches placed on the skin to send signals that stop pain.

Patient-controlled analgesia (PCA) is a method of pain control that allows the patient to control the amount of pain medication administered. This is often used in the hospital to treat pain. By pushing a button on a computerized pump, the patient receives a pre-measured dose of pain medicine. The pump is connected to a small tube that allows medicine to be injected intravenously (into a vein), subcutaneously (just under the skin), or into the spinal area.