title: Analgesia for fracture pain in children: methodological issues surrounding clinical trials and effectiveness of therapy.
abstract: Fractures in childhood are common painful conditions. Suboptimal analgesia has been reported in the emergency department and following discharge. Recently, concern about the safety of narcotics such as codeine has sparked a renewed interest in opioids such as morphine for pediatric fracture pain. Consequently, opioids are being increasingly used in the clinical setting. Despite this, there is ample evidence that clinicians are more willing to offer opioids to adults than children. The existence of limited evidence supporting their use in children is likely a major contributing factor. A closer look at the limitations of designing high-quality analgesic trials in children with fractures is needed to enable investigators to anticipate problems and clinicians to make evidence-based choices.
authors.affiliation: Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.|Division of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada.|Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada.|Paediatric Emergency Department, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Naveen
authors.initials: N
authors.lastname: Poonai
authors.affiliation: Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.|Division of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kilgar
authors.affiliation: Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.|Division of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Shruti
authors.initials: S
authors.lastname: Mehrotra
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002648:Child; D002986:Clinical Trials as Topic / Q000379:methods*; D004636:Emergency Service, Hospital; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid
keywords: analgesia; clinical trial; fracture; morphine; opioid; pediatric