{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:59:48Z","timestamp":1791464388024,"version":"4.3.4"},"reference-count":62,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"\n Importance<\/jats:title>\n Several pharmacologic options exist for the management of acute pediatric pain; however, their comparative effectiveness remains uncertain.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the relative benefits and harms of pharmacotherapy for acute pediatric pain through a network meta-analysis of randomized clinical trials.<\/jats:p>\n <\/jats:sec>\n \n Data Sources<\/jats:title>\n Cochrane Database of Systematic Reviews, Medline, Embase, CINAHL, Web of Science, and Scopus to October 2023.<\/jats:p>\n <\/jats:sec>\n \n Study Selection<\/jats:title>\n Trials that enrolled children (aged &amp;lt;18 years) with acute pain and randomized them to receive a pharmacologic analgesic vs an alternate analgesic or placebo were included.<\/jats:p>\n <\/jats:sec>\n \n Data Extraction and Synthesis<\/jats:title>\n Pairs of reviewers independently reviewed abstracts, extracted data, and assessed risk of bias of eligible trials. A frequentist random-effects model was used for all meta-analyses, and the certainty of evidence was assessed for treatment effects using the Grading of Recommendations Assessment, Development, and Evaluation approach.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes<\/jats:title>\n The primary outcomes were pain severity (range, 0-10 cm using a visual analog scale; minimally important difference [MID], 1 cm), need for rescue medication, symptom relief, and adverse drug events.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 41 trials involving 4935 children were included. High- to moderate-certainty evidence found that compared with placebo, nonsteroidal anti-inflammatory drugs (NSAIDs) (weighted mean difference [WMD], \u22121.29; 95% CI, \u22121.89 to \u22120.70; modeled risk difference [RD] for achieving the MID, 16%), ketamine (WMD, \u22121.12; 95% CI, \u22122.09 to \u22120.14; modeled RD for achieving the MID, 14%), and mid-high potency opioids (WMD, \u22121.19; 95% CI, \u22121.83 to \u22120.55; modeled RD for achieving the MID, 15%) reduced pain. Only NSAIDs reduced the need for rescue medication (relative risk [RR], 0.31; 95% CI, 0.14 to 0.68; modeled RD, 16% fewer patients). Neither NSAIDs (RR, 0.69; 95% CI, 0.31 to 1.55) nor acetaminophen (RR, 0.63; 95% CI, 0.21 to 1.87) increased the risk of short-term gastrointestinal adverse events. All other comparisons showed moderate-certainty evidence of little to no difference from placebo or were supported by low\/very low\u2013certainty evidence.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Compared with placebo, NSAIDs, ketamine, and mid- to high-potency opioids are effective in reducing acute pediatric pain. NSAIDs provide the greatest benefits and least harm, suggesting that they should be the first-line therapy for acute painful conditions in children.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamapediatrics.2024.5920","type":"journal-article","created":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T11:00:43Z","timestamp":1738580443000},"page":"407","source":"Crossref","is-referenced-by-count":22,"title":["Pharmacologic Management of Acute Pain in Children"],"prefix":"10.1001","volume":"179","author":[{"given":"Laura","family":"Olejnik","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, London Health Sciences, London, Ontario, Canada"},{"name":"Department of Pain and Anesthesia, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o Pedro","family":"Lima","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Behnam","family":"Sadeghirad","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason W.","family":"Busse","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada"},{"name":"Michael G. 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