From the Guidelines
Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) are the recommended first-line medication options for a 13-year-old patient with acute back pain.
Key Considerations
- The choice between acetaminophen and NSAIDs should be based on the patient's individual risk factors, such as gastrointestinal and cardiovascular risks 1.
- Acetaminophen is a reasonable first-line option due to its more favorable safety profile and low cost, although it may be slightly less effective for pain relief than NSAIDs 1.
- NSAIDs are more effective for pain relief but are associated with well-known gastrointestinal and renovascular risks, and an increased risk of myocardial infarction 1.
- Opioid analgesics or tramadol may be considered for patients with severe, disabling pain that is not controlled with acetaminophen and NSAIDs, but their use should be carefully weighed due to the risks of abuse, addiction, and other adverse events 1.
Non-Pharmacologic Options
- Spinal manipulation is associated with small to moderate short-term benefits for acute low back pain and may be considered as a non-pharmacologic therapy 1.
- Other non-pharmacologic options, such as exercise therapy, acupuncture, massage therapy, yoga, cognitive-behavioral therapy, or progressive relaxation, may also be considered for patients who do not improve with self-care options 1.
From the Research
Pain Management Options for a 13-year-old Patient with Acute Back Pain
- The approach to managing acute back pain in a 13-year-old patient involves identifying the underlying cause and using a disease-specific treatment 2, 3.
- For mild to moderate pain, first-line pharmacologic agents include acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), with the choice depending on the type of pain and patient risk factors 2, 3.
- In pediatric settings, an adequate assessment is the initial stage in a proper clinical approach to pain, and a wide range of analgesic agents are available for pain management, tailored according to the patient's age and the intensity of pain 4.
- Non-pharmacological techniques should also be considered to alleviate anxiety and distress in pediatric patients 4.
- For severe acute pain, treatment can be briefly escalated with the use of medications that work on opioid and monoamine receptors or with the use of acetaminophen/opioid or NSAID/opioid combinations, with caution due to the risks associated with opioid medications 2, 3.
Considerations for Pediatric Patients
- Pain is often underreported and undertreated in children, and a multidisciplinary approach is recommended for pain management in pediatric settings 4.
- A treatment algorithm based on a ladder approach can be used to facilitate the choice of the appropriate drug for pain management in children 4.
- The American Academy of Pediatrics and the American Pain Society emphasize the importance of a multidisciplinary approach to eliminate pain in children 4.
General Principles of Pain Management
- A biopsychosocial approach to back pain provides the best clinical framework, and a detailed history and physical examination with a thorough workup are required to exclude emergent or nonoperative etiologies of back pain 5.
- Conventional therapies, including lifestyle modifications, nonsteroidal anti-inflammatory drugs, physical therapy, and cognitive behavioral therapy, are typically used first to treat back pain 5.