Study Questions Pain Management Practice in Children with Abdominal Pain
Contact: Erica Collier (414-266-5420) or Toranj Marphetia (414-456-4700), Children's Hospital of Wisconsin, Milwaukee
Embargo: Monday, May 15, 9 am
For decades, physicians withheld giving pain medicine to children with severe abdominal pain for fear it could mask the symptoms of serious surgical conditions such as appendicitis. This practice prolongs children's suffering in the emergency department while physicians search for the cause of pain.
A study by the Medical College of Wisconsin faculty currently in progress at Children's Hospital of Wisconsin in Milwaukee challenges this non-evidence based practice. Pediatric emergency medicine and surgical specialists are conducting the study after similar research in adult patients showed that pain medicine did not interfere with diagnosis of surgical conditions. The preliminary results were presented at the joint meeting of the Pediatric Academic Society and the American Academy of Pediatrics, May 15 in Boston.
"Abdominal pain is a frequent complaint we see in the emergency department," says Michael K. Kim, M.D., lead researcher and assistant professor of pediatrics at the Medical College. "We feel helpless when we can't ease a child's pain while making a diagnosis, which can take hours."
Preliminary findings from 47 children, ages 5-18, with severe abdominal pain suggest that morphine provides significant pain relief without delaying the diagnosis of serious surgical conditions.
Dr. Kim and his colleagues are encouraged by their findings, but suggest more research is needed before early pain relief for children with severe abdominal pain can be recommended.
The researchers enrolled 47 children with severe abdominal pain of less than five days duration and requiring surgical evaluation. After examination and diagnosis, 26 received morphine and 23 received saline. A follow-up examination and diagnosis completed 15 minutes after the medication was given. There were no significant demographic differences between the two groups. The double blind design of this study ensured that patients, family, and physicians were not aware of the actual agent given as the study medication.
The pain score decreased by four in the morphine group and two in the saline group on a 0 to 10 pain scale. Reduction of pain did not adversely affect the diagnosis. In fact, the accuracy of the diagnosis after morphine was slightly better than saline, although not statistically significant. All 13 surgical conditions in the morphine group were correctly identified by both emergency physicians attending and surgical consultants.
The study was funded by Children's Hospital Foundation.
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