Codeine Overused in Children: Alternatives Exist for Hard-to-Manage Pain

By Jacob Molyneux, senior editor

According to a story at MedlinePlus, a study in Pediatrics has found that codeine is still prescribed too often to children during ER visits, though it’s known that a small but significant subset of children metabolize the painkiller far more rapidly than do other children, leading to potentially dangerous results. As AJN‘s February CE article on treating the often severe and stubborn posttonsillectomy pain in children noted, there are other effective and safer options for children in pain, such as hydrocodone in combination with acetaminophen, as well as some non-opioid analgesics. Here’s a brief overview of the article:

Tonsillectomy, used to treat a variety of pediatric disorders, including obstructive sleep apnea, peritonsillar cellulitis or abscesses, and very frequent throat infection, is known to produce nausea, vomiting, and prolonged, moderate-to-severe pain. The authors review the causes of posttonsillectomy pain, current findings on the efficacy of various pharmacologic and nonpharmacologic interventions in pain management, recommendations for patient and family teaching regarding pain management, and best practices for improving medication adherence.

There’s often no perfect answer in pain management, but it helps to know the full range of available strategies, their safety, and how well they work. As with all CE articles, this one is free.

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Posttonsillectomy Pain in Children: Safer, More Effective Treatment Strategies

By Shawn Kennedy, editor-in-chief

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One of the CE articles in the February issue is “Posttonsillectomy Pain in Children.” It might seem like a no-brainer—ice-collar, cold fluids, and acetaminophen with codeine, right? WRONG. As the article indicates, there’s a lot more to managing this stubborn, sometimes severe pain.

For one thing, there’s been a big reversal in choice of pain medication. Acetaminophen with codeine, long a mainstay in managing children’s pain, is no longer recommended—in fact, the FDA issued a black box warning last year saying that codeine should not be used because its metabolism rate in one subset of children can cause excessive sedation. Reports of three deaths and a case of nonfatal respiratory depression in children who received appropriate doses prompted the warning. […]

AJN’s February Issue: New Nurses, Children’s Posttonsillectomy Pain, Medication Errors, More

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AJN’s February issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles, which you can access for free.

With high hospital turnover rates, keeping newly licensed RNs (NLRNs) continues to be a priority for hospitals. This month’s original research article, “Changing Trends in Newly Licensed RNs,” found that new nurses considered themselves to have fewer job opportunities and to be less likely to work in hospitals and more likely to have a second job than new nurses who were surveyed six years earlier. Earn 2.5 CE credits by reading this article and taking the test that follows.

Tonsillectomy is effective at treating a variety of pediatric disorders, such as sleep apnea and frequent throat infection. But it often results in prolonged, moderate-to-severe pain. “Posttonsillectomy Pain in Children” reviews the causes of posttonsillectomy pain, the efficacy of various treatment interventions, and the recommendations for patient and family teaching regarding pain management. Earn 2.3 CE credits by reading this article and taking the test that follows. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by tapping on the podcast icon on the first page. The podcast is also available on our Web site.

According to an Institute of Medicine report, at least 1.5 million preventable medication-related adverse events occur in the U.S […]

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