A team physician consensus statement released by the American College of Sports Medicine (ACSM) and five other professional sports medicine organizations advises doctors to avoid prescribing opioids when treating athletes between the ages of 10 and 18.
The experts say that nonpharmacologic options should be used for treatment first.
“Adolescents are often initially exposed to opioids through prescriptions to treat pain” said Stanley A. Herring, M.D., FACSM, the facilitator of the team physician project-based alliance and a clinical professor in the Department 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 statement, “Select Issues in Pain Management for the Youth and Adolescent Athlete,” published in the September 2020 issue of Medicine & Science in Sports & Exercise offers suggested interventions that focus on a comprehensive treatment approach based on the athlete, the injury and the demands of the sport.
The recommendations for treating acute pain in adolescent athletes include:
- Understand that the diagnostic process must evaluate all aspects (anatomical and psychosocial) of pain causation
- Understand that nonpharmacological treatments are fundamental to treat acute and post-acute pain from injuries
- Understand that medications, in particular opioids if prescribed, should be utilized at the lowest effective dose for the shortest duration
- Recognize the signs and symptoms of potential problematic opioid use
- Understand the role of exercise to improve pain and function from acute injury
- Educate athletes and parents so pain management goals are understood and realistic.
The recommendations for chronic pain include:
- Understand that treatment is best offered as part of an interdisciplinary approach
- Understand that a multimodal care plan (e.g., exercise, nutrition, cognitive behavioral techniques, relaxation, improved sleep) is safer, possibly more effective and probably more durable than pharmaceuticals
- Understand that opioids should not be used in this age population without specialty consultation
- Educate student athletes and parents regarding what pain is and how it is relieved because expectations and misunderstanding affect response to treatment.
“This paper specifically focuses on young people because children and adolescents are different than adults,” said Karen W. 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 at 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.”
For the consensus statement, ACSM collaborated with the American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine and the American Osteopathic Academy of Sports Medicine.
