Recommendations Steer Doctors Away from Opioids in Adolescent Athletes

INDIANAPOLIS — A team physician consensus statement was released on August 27 by the American College of Sports Medicine (ACSM) and five other professional sports medicine organizations sharing guidelines to identify and manage pain in athletes ages 10 to 18. It urges team physicians and pediatricians to use nonpharmacologic treatments before prescribing opioids to manage acute and chronic pain.

“Adolescents are often initially exposed to opioids through prescriptions to treat pain,” said Stanly Herring, M.D., FACSM, the facilitator of the team physician project-based alliance and a clinical professor in the Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery at the University of Washington in Seattle. “This paper gives health care providers, including team physicians, pediatricians and athletic trainers a roadmap to navigate the diagnosis and treatment of chronic and acute pain in adolescent athletes.”

The new statement is titled “Select Issues in Pain Management for the Youth and Adolescent Athlete.”

“This paper specifically focuses on young people because children and adolescents are different than adults,” said Karen Weiss, Ph.D., L.P., a pediatric pain psychologist at Seattle Children’s Hospital and associate professor at the University of Washington School of Medicine. “When assessing and treating pediatric pain, it’s important to consider where young people are from a developmental standpoint and how family behaviors and dynamics may influence the pain experience. It also is imperative to address pediatric pain appropriately to decrease the likelihood of developing persistent or chronic pain issues into adulthood.”

Suggested interventions focus on comprehensive nonpharmacological, pharmacological and psychosocial treatments based on the athlete, the injury and the demands of the sport.

The statement offers preferred actions for team physicians and pediatricians for acute pain including, evaluating the cause of the pain, understanding that opioids should only be used at the lowest effective dose, recognizing the symptoms of problematic opioid use and educating athletes and parents about pain management.

The paper also says team doctors and pediatricians should use a care plan that includes exercise, nutrition, cognitive behavioral techniques, relaxation, improved sleep which are all safer and possibly more effective than pharmaceuticals. The paper also said understanding that opioids should not be used in this age group without specialty consultation and parents and athletes need to be educated about pain management and how pain is relieved.

ACSM collaborated with the American Academy of Family Physicians, the American Academy of Orthopaedic Surgeons, the American Medical Society for Sports Medicine, the American Orthopaedic Society for Sports Medicine and the American Osteopathic Academy of Sports Medicine to develop the statement.

This statement is part of a series published since 2000 that addresses topics for athlete care, such as return-to-play decisions, concussion treatment, injury and illness prevention, sideline preparedness and psychological issues.

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