Safely Managing Your Child's Pain After Surgery

There are unique risks that children and teens face if they are taking opioids. It’s important to monitor your child's or teen’s opioid use, and to educate them about using opioids safely. There are also other pain management techniques and medicines that we will review in the article below.

Why is my child’s pain worse a day or two after surgery?

Sometimes pain becomes worse a day or two after leaving the hospital. It could be because a nerve block is subsiding, medications given in the hospital are no longer in effect, or because your body is healing, and you are instructed to do physical therapy or resume daily activities. Be sure to have pain medicines ready for if or when this occurs. Ask your medical care team when to expect the pain relief given in the hospital to wear off and start giving your child pain-relief medicine around that time.

How long should my child take opioids for pain relief after surgery?

Each surgery and each individual is different, and the surgeon should give you guidance on the length of time opioids will be required in the post-operative period. The length of time varies depending on the type of surgery and individual pain levels. Often, non-opioid pain medicine will be needed for longer periods of time after the opioid prescription runs out.

How can I ensure that my child receives the appropriate dose of opioids without the risk of overdose?

Always follow the instructions on the label, and before you leave the hospital, review the instructions and doses with the nurse who does your discharge instructions. If you have any questions or concerns about the dose, do not hesitate to ask them to double check with the prescribing physician.

Are there other medications that can be used alongside or instead of opioids to manage my child's pain?

In general, whenever possible, it is better to try treating pain with other methods first, such as ice, distraction, and non-opioid pain medicines approved by your surgeon.

Then, if these other pain-relief methods are not enough, give your child opioids as needed at the prescribed dose and timing. While some pain is expected after surgery, your child’s pain should be managed well enough that they can participate in activities that help them recover, such as attending physical therapy and sleeping comfortably.

Often, in children who have had surgery, lower doses of opioids will be prescribed and intended to use alongside non-opioid pain relievers like acetaminophen and ibuprofen. Be sure to ask your surgeon which over-the-counter (OTC) pain medicines your child can take, as this is unique to each patient’s health, comorbidities, and other medicines they may be taking. For example: some patients should not take ibuprofen because it increases their risk of bleeding; others should not take acetaminophen if they have already been prescribed Percocet, which is oxycodone and acetaminophen combined. These are just some of the many examples of situations in which some OTC pain medicines are safe while others are not, so be sure to ask your surgeon.

If the prescribed dose isn’t managing the pain, or if pain worsens in intensity, contact your child’s surgeon.

What are the potential risks of using opioids to manage my child's pain?

Adolescents often have a higher risk of addiction than adults. This is because:

• Their brains are still developing.
• Some face peer pressure or experiment with drugs or alcohol.
• Many experience mental health issues, such as anxiety or depression. In the United States, teens are experiencing mental health issues now more than ever, and having surgery can be stressful.

According to CDC data, one in seven high school students admitted to misusing prescription opioids at least once.1 But despite the risks, opioids are often necessary for managing postsurgical pain in children and teenagers when other pain-relieving techniques are not enough.

What are the possible side effects of opioids in children and teenagers?

Side effects of opioids can include constipation, nausea, vomiting, and dizziness. In addition, children or teens may be at heightened risk for certain side effects including itching, or feeling “loopy” or “fuzzy.” If your child experiences side effects, contact their surgeon. There may be methods of relieving these side effects, or a different type of opioid might work better for them.

Learn more about using opioids safely and tapering off of opioids after surgery.

What signs should I watch out for to determine if my child is experiencing adverse effects from opioids?

Signs of an opioid overdose include:

• pale or clammy face
• small, constricted "pin-point" pupils
• limp body
• blue or purple fingernails or lips
• gurgling noises or vomiting
• difficult to wake or unable to speak
• breathing or heartbeat slows or stops

If your child is experiencing an overdose, call 911 immediately and administer naloxone.

How can I help my child or teen understand the importance of using opioids safely?

Educate your child or teen about opioid safety. Kids usually believe that taking this medication is safe because it was prescribed by a doctor. Explain that while taking medication as prescribed by a doctor is safe, taking more than the doctor prescribed can be dangerous or addictive. Never coax children to take medicine by calling it candy. Instead, teach that medicine can make them feel better, but only when taken with a caregiver supervising.

Adolescents may incorrectly believe that prescription opioids are safer to abuse than recreational drugs. Explain that opioids are not necessarily safer or less addictive than street drugs, and that they are especially dangerous when taken with other substances, such as alcohol, marijuana, or other legal or illegal drugs.

My child ran out of opioids but is still experiencing pain. Should I ask for a refill?

In this situation, it is best to call your surgeon. Every situation is different, and there are multiple reasons for continued pain after surgery, which may include situations such as surgical complications, infection, incorrect dosing of medicines, stopping use of pain medicine too early because of underestimating pain, or complications because of comorbidities. Your surgeon can help assess the cause of continued pain and whether a refill is appropriate. They can also help assess for signs of opioid dependence.

What are some signs of dependence or addiction to watch out for?

It is important to understand the difference between dependence and addiction.

Physical dependence occurs when the body experiences withdrawal symptoms when it doesn’t receive a specific dose of a particular drug, such as a prescription opioid.

If the body becomes dependent on opioids, withdrawal symptoms may begin when the amount of opioid medicine in the body is reduced or gone.

Withdrawal symptoms of opioids may include:

• flu-like symptoms, such as sweating, chills or aches
• fatigue, anxiety, or trouble sleeping
• rapid heart rate or headache
• nausea, vomiting, or diarrhea

Addiction, also called substance use disorder (SUD), is classified as abnormal and is defined by the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) as a chronic, treatable illness. Addiction results in compulsive behaviors such as cravings, an inability to control use, and continued use of the drug despite its harmful consequences. The brain is directed primarily by an overwhelming need to acquire more of the drug, and the part of the brain that guides self-control and decision-making is impaired.

If your child is requesting more medicine when their prescription runs out, this doesn’t necessarily mean they are dependent on the drug – it could simply mean that they are still experiencing pain. But the possibility of dependence is something to keep in mind. Talk to your child about what sensations they are experiencing and reach out to your child’s surgeon to determine if they need a refill for their pain.

If your child requests multiple refills, or if they are starting to use other substances to compensate for reduced doses of opioid medicine, these are also signs to watch out for. Contact your child’s medical care team if you have any questions or concerns.

How can I safely store opioid medicines?

Be sure to store the medication where your child cannot access it and follow the dosing and schedule your doctor provides. Adolescents may be tempted to try leftover pills to “get high.” Even if you trust your child, keep in mind that it may not be your own child who is at risk. Friends or other visitors may steal the pills or pressure your child to steal pills for them.

Data suggests that over 70% of people who abuse opioids get them from a family member or a friend.2

There are several things you can do to keep medicines out of reach of children, or to prevent teens from taking more pills than you realize. Store medicines in a lock box or on a high shelf. Count pills to ensure they are taken on the correct schedule, and to make sure no pills go missing.

How can I safely dispose of any unused opioids?

When your child no longer needs opioids, use a safe disposal method to avoid theft or water contamination.

If you have surgery at HSS, you will receive a disposal product stapled to instructions in your discharge packet. To learn about the disposal product HSS provides, watch our video “How to Safely Dispose of Opioids.”

You can also ask about safe disposal products at your pharmacy, or search for public disposal locations on the DEA website. You can also read more about safely disposing of opioids.

As always, ask your medical care team if you have any questions or concerns about opioids.

Video: Managing Your Child’s Pain After Surgery: Safe Opioid Use

Posted: 8/24/2023

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References

1. Jones CM, Clayton HB, Deputy NP, et al. Prescription Opioid Misuse and Use of Alcohol and Other Substances Among High School Students – Youth Risk Behavior Survey, United States, 2019. MMWR Suppl 2020;69(Suppl-1):38-46. DOI: http://dx.doi.org/10.15585/mmwr.su6901a5.
2. Policy Impact: Prescription Painkiller Overdoses. Centers for Disease Control and Prevention: National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention. 2011 Nov. Retrieved from 
   https://www.cdc.gov/drugoverdose/pdf/policyimpact-prescriptionpainkillerod-a.pdf.

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