Acute pediatric musculoskeletal pain management in North America: a practice variation survey

Clin Pediatr (Phila). 2014 Dec;53(14):1326-35. doi: 10.1177/0009922814555972.


Children's musculoskeletal (MSK) injury pain remains poorly managed. This survey of pediatric emergency physicians and orthopedic surgeons assessed analgesia administration practices and discharge advice for children with acute MSK pain; 683 responses were received. Ibuprofen was the most commonly reported analgesic used in the emergency department (52%) and at discharge (68%). Most (85%) reported using oral opioids in the previous 6 months. Codeine use was the most commonly reported opioid used in the emergency department (38%) and at home (51%). For equal levels of pain, younger children received less opioids than older children. Younger physicians and recent graduates chose acetaminophen and codeine more than older and more experienced colleagues, who preferred ibuprofen and non-codeine containing opioid compounds (P < .001 and .006, respectively). Orthopedic surgeons reported less ibuprofen use than pediatric emergency physicians (P < .001). Choice of analgesic agents is heterogeneous among physicians and is influenced by pain severity, child's age, and physician characteristics.

Keywords: analgesia; emergency; fracture; musculoskeletal; opioids; orthopedic; pain.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Pain / diagnosis*
  • Acute Pain / drug therapy*
  • Adolescent
  • Adult
  • Analgesics / therapeutic use*
  • Canada
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Emergency Service, Hospital
  • Female
  • Health Care Surveys
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Musculoskeletal Pain / diagnosis*
  • Musculoskeletal Pain / drug therapy*
  • Pain Measurement
  • Patient Discharge
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Self Care
  • United States


  • Analgesics