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Children 2018, 5(12), 163;

Pharmacological Strategies for Decreasing Opioid Therapy and Management of Side Effects from Chronic Use

Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA 94304, USA
Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Stanford University, Palo Alto, CA 94304, USA
Author to whom correspondence should be addressed.
Received: 24 August 2018 / Revised: 27 November 2018 / Accepted: 3 December 2018 / Published: 5 December 2018
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
PDF [245 KB, uploaded 13 December 2018]


As awareness increases about the side effects of opioids and risks of misuse, opioid use and appropriate weaning of opioid therapies have become topics of significant clinical relevance among pediatric populations. Critically ill hospitalized neonates, children, and adolescents routinely receive opioids for analgesia and sedation as part of their hospitalization, for both acute and chronic illnesses. Opioids are frequently administered to manage pain symptoms, reduce anxiety and agitation, and diminish physiological stress responses. Opioids are also regularly prescribed to youth with chronic pain. These medications may be prescribed during the initial phase of a diagnostic workup, during an emergency room visit; as an inpatient, or on an outpatient basis. Following treatment for underlying pain conditions, it can be challenging to appropriately wean and discontinue opioid therapies. Weaning opioid therapy requires special expertise and care to avoid symptoms of increased pain, withdrawal, and agitation. To address this challenge, there have been enhanced efforts to implement opioid-reduction during pharmacological therapies for pediatric pain management. Effective pain management therapies and their outcomes in pediatrics are outside the scope of this paper. The aims of this paper were to: (1) Review the current practice of opioid-reduction during pharmacological therapies; and (2) highlight concrete opioid weaning strategies and management of opioid withdrawal. View Full-Text
Keywords: opioid therapy; weaning of opioids; withdrawal; assessment of withdrawal opioid therapy; weaning of opioids; withdrawal; assessment of withdrawal
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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D’Souza, G.; Wren, A.A.; Almgren, C.; Ross, A.C.; Marshall, A.; Golianu, B. Pharmacological Strategies for Decreasing Opioid Therapy and Management of Side Effects from Chronic Use. Children 2018, 5, 163.

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