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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2016-11-21T13:04:56-05:00April 23rd, 2014|Ethics, nursing perspective, pain management|1 Comment
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AJN’s April Issue: Sickle Cell Anemia, Telehealth, Systematic Reviews, FOAMed, More

AJN0414.Cover.OnlineAJN‘s April issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles that you can access for free.

Coping with pain in sickle cell anemia. Our April cover features a painting of red flowers in a vase. But on closer inspection, you might notice that the flowers are actually red blood cells, painted by a young girl who suffers from sickle cell anemia. Afflicting about 90,000 to 100,000 people in the United States, sickle cell disease often causes acute and chronic pain syndromes described as being on par with cancer-related pain. Cognitive behavioral therapies, such as the use of guided imagery, have shown promise in changing pain perception and coping patterns in people with chronic illnesses. April’s original research CE article, “Using Guided Imagery to Manage Pain in Young Children with Sickle Cell Disease,” suggests that this technique can be effective for managing pain in school-age children with the disease.

Implementing advances in telehealth. New technologies such as remote monitoring and videoconferencing often emerge before a facility is ready to efficiently integrate them. Sometimes referred to as disruptive innovations, these technologies, while convenient and easy to use, may not be readily accepted. “Telehealth: A Case Study in Disruptive Innovation” discusses the many applications of telehealth, a means of delivering care that is […]

2016-11-21T13:05:06-05:00March 28th, 2014|nursing perspective, nursing research|0 Comments
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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. […]

2016-11-21T13:05:19-05:00February 26th, 2014|nursing perspective, pain management|0 Comments
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Toward a Less Painful Death: ICD Deactivation at End of Life

By Sylvia Foley, AJN senior editor

A few years ago, in a letter to the editor of another journal, an NP described how one of her patients, a man on home hospice care, had suffered 33 shocks as he lay dying in his wife’s arms. The source of those shocks, his implantable cardioverter-defibrillator (ICD), reportedly “got so hot that it burned through his skin.” The device that had been implanted to save his life caused this man and his wife great distress in his final hours. Device deactivation at the end of life is an option; but in this case, apparently, it had never been discussed.

Stories like this one helped to inspire the research reported in this month’s CE feature, “Deactivation of ICDs at the End of Life: A Systematic Review of Clinical Practices and Provider and Patient Attitudes,” by James Russo.

ICDs, standard treatment for people at risk for life-threatening cardiac arrhythmias, work to restore normal rhythm by delivering a high-energy, painful electrical shock. The devices are so effective that people with ICDs often die from causes other than heart disease. But once a person with an ICD begins actively dying, as in the case above, the device may cause needless pain and prolonged suffering. So […]

2016-11-21T13:11:44-05:00October 14th, 2011|nursing research|0 Comments
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Choosing AJN’s Med-Surg Nursing Books of the Year


By Julie Zerwic, PhD, RN, interim executive associate dean, College of Nursing, University of Illinois at Chicago

The faculty in the department of biobehavioral health science at the University of Illinois College of Nursing looked forward with enthusiasm this fall to our opportunity to pick the AJN medical—surgical book of the year. The range of books that are submitted is outstanding and it was a challenge to find the book that we felt was deserving of the title. In fact, we selected two books. Both selections fill a need, covering material neglected in other works. 

How to Manage Pain in the Elderly, by Yvonne D’Arcy, will be useful for any nurse working with older adults in pain. The book begins by dispelling myths about the experience and treatment of pain in the elderly. The material in each chapter is brought together by text boxes, figures, and rich case studies. The book includes material on the physiology of pain in the elderly, pharmacologic and nonpharmacologic approaches to pain management, issues of multidrug therapy, and palliative care.

I recently watched as my 75-year-old mother experienced a long episode of pain after knee replacement surgery. An infection and then problems with a degenerative spine left her searching for some type of therapy that would relieve the debilitating pain. Many of the concepts that D’Arcy covers in her book were relevent to the situation my mother found herself in. This book will provide a resource as health care providers […]

2016-11-21T13:14:25-05:00January 6th, 2011|nursing perspective|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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