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My clinical experience and observations with pediatric pain and tolerance.
If you’ve ever been around a child or an adolescent that is truly sick or in significant pain, you can attest to how difficult it is to handle.
As a medical student, I am not ashamed to say that I was not adequately prepared for my inpatient pediatrics rotation and the emotional toll that seeing sick children and their grieving families would have.
Outpatient carried a different acuity while the nursery was nothing but joy. Thus, I had no idea that what was coming would be so taxing when I switched to my three concurrent weeks of inpatient service.
Given the current opioid epidemic that exists in our country, one must ask themselves how early a patient should be first exposed to such drugs for pain management purposes.
Obviously, there are instances in pediatric care when it is necessary to climb another rung on the pharmaceutical ladder.
However, to my amazement, young patients were tolerating immense amounts of pain with simple NSAIDs such as Tylenol or ibuprofen. Given my limited range of exposure, it was fascinating to see that in similar situations but with adults, there would almost always be opioids involved with the treatment.
With this newfound knowledge in mind, it really was refreshing to sit back and appreciate both the resolve and demeanor of pediatric patients. I kept harkening back to the aforementioned question:
At what age should a patient be first exposed to narcotic painkillers?
Also, could a future opioid addiction be prevented if we maintained the same standards of care for both pediatric and adult patients? What causes that shift in patient expectations?
At what age does pain tolerance decrease?
Is it even a decrease in pain tolerance at all or simply that the patient has gotten a “taste” of the power of narcotics?
My first experience with opioid medication as a patient was when I got my wisdom teeth removed, and I believe this probably holds true for a decent amount of the population. I know I was borderline awestruck at the feeling I got.
Later, and this is just my honest personal experience, I did notice that in future situations of moderate to severe pain (such as a broken finger or nose), I began to feel that my physician “didn’t take my pain seriously” if they didn’t prescribe something stronger than a simple NSAID.
Yet again, those very same NSAIDs work perfectly fine in most circumstances for most of the pediatric population.
Are children just less likely to complain?
Think about that though — the pain threshold argument might be invalid considering how many times I’ve seen a child cry just from stubbing their toe.
Granted, this entire post is written from a non-research perspective and is merely observational in nature.
Or is it?
Publications and Resources
There are numerous publications on the topic of age-dependent pain tolerance. Studies even stratify the data to show differences in gender.
Posted below are some links to a few of these publications and resources:
The question that burns within me still begs an answer.
How can we still maintain a standard of care with regard to pain mitigation, while at the same time not introducing children to opioids earlier than need be?
Will it have an effect on their pain tolerance or treatment expectations in the future?
Is there something different within the minds of our pediatric patients?
If so, how can we extrapolate that and confer it to our older populations, curbing some of the addictions that are so rampant in our society?
Preparing for their careers as future physicians, medical students need to constantly be asking themselves what kind of doctor they want to become.
We must remember that the easy path is often not the best route to long term outcomes for our patients. Until then, I think we should all be cognizant of the heart and soul that our pediatric patients have, continuing all the while to ask ourselves when exactly our patients’ expectations change.