Treatment of pain in juvenile idiopathic arthritis: A survey of pediatric rheumatologists

Authors

  • Yukiko Kimura,

    Corresponding author
    1. Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, and University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark
    • Pediatric Rheumatology, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601
    Search for more papers by this author
  • Gary A. Walco,

    1. Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, and University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark
    Search for more papers by this author
  • Etan Sugarman,

    1. Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey
    Search for more papers by this author
  • Paola M. Conte,

    1. Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey
    Search for more papers by this author
  • Laura E. Schanberg

    1. Duke University Medical Center, Durham, North Carolina
    Search for more papers by this author

Abstract

Objective

To assess the opinions and current practice of pediatric rheumatologists regarding treatment of chronic pain in children with juvenile idiopathic arthritis (JIA).

Methods

Standardized questionnaires were distributed to pediatric rheumatologists who are members of the Children's Arthritis and Rheumatology Research Alliance. Demographic data, opinions, and attitudes were solicited about pain assessment, current treatment of JIA with residual pain, and actual use of opioids to treat pain in children with JIA.

Results

Of 99 rheumatologists who were contacted, 53 responses were received (53.5%). No significant demographic differences were found in attitudes about pain management and use of opioids. A total of 77.3% of respondents agreed that there are patients who continue to have significant pain despite adequate treatment. However, 59.6% disagreed with the use of opioid analgesics for treatment of those patients. Cross tabulations showed significant relationships between attitudes about opioid use and concerns for side effects, including drowsiness, fatigue, and constipation (χ2 = 1.16, P > 0.05), as well as addiction (χ2 = 5.51, P = 0.019). Thirty percent of those who strongly disagreed with opioid use and 52.4% of those who disagreed had in fact prescribed opioids in the past year. The most commonly prescribed opioids were codeine and oxycodone. Practitioners' perceived knowledge of the drugs significantly affected their likelihood to prescribe them.

Conclusion

Pediatric rheumatologists are divided in their attitudes regarding treatment of residual pain in children with JIA. Concern for side effects appears to be a major factor in the decision to prescribe these analgesics. More data are needed to facilitate clearer cost-benefit analyses in the decision to prescribe opioids to this clinical population.

Ancillary