From the Guidelines
For children experiencing pain, oral NSAIDs are the preferred choice due to their effectiveness in providing systemic pain relief, as evidenced by a multicenter randomized double-blind placebo-controlled trial involving 161 children aged 6 to 17 years undergoing tonsillectomy, where patients given intravenous ibuprofen had significantly reduced fentanyl use 1. When considering pain management in children, it's crucial to weigh the benefits and risks of different treatment options. Oral NSAIDs, such as ibuprofen, have been shown to provide adequate analgesia without significant side effects in the posttonsillectomy pediatric patient 1. Some key points to consider when using oral NSAIDs in children include:
- Dosage: Ibuprofen can be given at a dose of 10 mg/kg every 6-8 hours, with a maximum daily dose of 40 mg/kg/day.
- Administration: Oral NSAIDs should be administered with food to reduce stomach irritation.
- Monitoring: Patients should be monitored for potential side effects, such as skin rash, stomach pain, or black stools, and the medication should be discontinued if any of these occur.
- Treatment duration: Limit treatment duration to 3-5 days unless directed by a healthcare provider, as prolonged use increases the risk of gastrointestinal, renal, and cardiovascular side effects. In contrast, topical NSAIDs may be better suited for localized musculoskeletal pain, but their use in children is generally more limited due to the potential for local skin irritation and the availability of fewer pediatric-friendly formulations. Overall, the choice between topical and oral NSAIDs in children should be based on the specific clinical context and the individual child's needs, with a focus on minimizing potential risks and maximizing pain relief.
From the Research
Topical vs Oral NSAIDs in Children for Pain
- The use of topical NSAIDs has been emerging as a treatment option for certain types of acute pain, including soft tissue and musculoskeletal pain 2.
- Topical NSAIDs have been shown to be effective in treating acute, localized, soft tissue injuries or painful conditions, with minimal systemic absorption and risk of related adverse events 2, 3.
- In children, NSAIDs have been used to treat inflammation associated with respiratory tract infections, fever, rheumatic disease, and other chronic inflammatory conditions, as well as peri/post-operative and cancer pain 4.
- Oral NSAIDs, such as ibuprofen, ketoprofen, ketorolac, and diclofenac, have been studied in the context of pediatric pain management, and have been shown to reduce opioid requirements and provide improved or similar pain scores compared to opioids or other controls 5.
- A systematic review and network meta-analysis found that NSAIDs, including topical and oral formulations, are effective in reducing acute pediatric pain, with NSAIDs providing the greatest benefits and least harm compared to other pharmacologic options 6.
- The use of topical NSAIDs in children may be beneficial due to their favorable safety profile, with low serum concentrations and minimal risk of adverse events 2, 3.
- However, more research is needed to fully understand the efficacy and safety of topical NSAIDs in children, particularly in comparison to oral NSAIDs 2, 3.