Routine head and neck procedures, such as removal of tonsils and adenoids and the placement of ear tubes, may cause moderate to severe pain in pediatric patients. Over-the-counter analgesics (aspirin and acetaminophen) and pain management can mitigate this discomfort and are typically recommended after surgery to manage pain.

Since most of these kinds of procedures are either done as an outpatient, or require only a short hospital stay, post-operative pain management often is the responsibility of the child’s caregiver. Despite not wanting their child to be in pain, a new study has found the majority of caregivers are unsure about or do not feel comfortable giving their child opioids post-operatively. Most, they found, are specifically concerned about the risk of addiction.

“Given the current opioid epidemic and the fact that children continue to be undertreated for pain following surgeries, it is important to understand caregivers’ attitudes toward post-operative opioid use,” said corresponding author Jessica R. Levi, MD, associate professor of otolaryngology-head & neck surgery at Boston University School of Medicine. “Understanding caregivers’ views is essential, so surgeons can counsel caregivers and provide appropriate post-operative pain management in their patients.”

An anonymous, 11-item questionnaire survey that assessed demographic information and attitudes toward post-operative opioid use for pediatric pain management survey was distributed to caregivers of pediatric patients undergoing routine head and neck procedures at an academic medical center in Boston. Thirty-eight percent of parents said they would feel comfortable giving their child opioids post-operatively, 30.2 percent would not feel comfortable while 31.7 percent were unsure. For every increase in one year of age of the child, there was an increase in the odds of a parent being comfortable giving opioids. Caregivers who had taken opioids in the past were more likely to feel comfortable. The comfort level did not differ based on the caregivers’ education level, income, race, or language. “Pain management in children after surgery can be challenging, and is something that requires conversation between parents and providers,” says co-author Michael Cohen, MD, assistant professor of otolaryngology at BUSM and an otolaryngologist at Boston Medical Center.

According to the researchers, the most common barrier to use opioids for pain management was concern about addiction potential. “However, it is surprising that only 11 caregivers cited addiction potential as the reason behind their opinion on post-operative opioid use. This could be because parents control the distribution of post-operative medications and, therefore, believe they can prevent this risk,” added Levi, who also is a pediatric otolaryngologist at BMC.

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