{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:33:03Z","timestamp":1791959583000,"version":"4.3.4"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2020,4,18]],"date-time":"2020-04-18T00:00:00Z","timestamp":1587168000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Children\u2019s Hospital Center for Research in Outcomes"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Childhood burns are common and distressing for children and their parents. Pain is the most common complaint and often thought to be undertreated, which can negatively influence the child\u2019s care and increase the risk of posttraumatic stress disorder. There is limited literature on the role of opioids and multimodal therapy in the treatment of pediatric outpatient burns. We sought to evaluate the current use of opioids (including the use of multimodal therapies), storage, and disposal of opioids in this patient population. Parents of burn-injured children 8 months to 18 years old, who were seen in an outpatient setting within 2 weeks of their burn injury, were queried from April to December 2019 regarding their child\u2019s pain control, opioid medication use, over-the-counter pain medication use, opioid storage, and disposal. A total of 142 parents of burn-injured children and their parents were surveyed. The median age of the burn-injured children was 2.7 years old and the majority (54.2%; 77\/142) were male. The mean total body surface area (TBSA) was 1.8% and half sustained burn injuries to one or both hands. The most frequently used regimens for constant and\/or breakthrough pain control were acetaminophen (62.7%) and nonsteroidal anti-inflammatory drugs (NSAIDs; 68.3%). Less than one fifth (26\/142;18%) of patients were prescribed opioids and 88% filled their prescription. The median number of doses of opioids prescribed was eight doses, with a median of four doses of opioids unused. Only three patients used all of their prescribed opioids and no patient \u226512 years old used their entire prescription. Burns greater than 3% TBSA, irrespective of burn injury location, were associated with opioid prescription (P = .003). Approximately 40% (10\/26) of parents who filled their child\u2019s opioid prescription stored the opioid in a locked area. Fewer than one third (7\/26) of patients were educated on how to dispose of excess opioid pain medication. Overall, most pediatric outpatient burn injuries can be successfully managed with over-the-counter medications. Providers, who care for burn-injured children \u2264 12 years old with burns that cover \u22653% TBSA in the outpatient setting, should consider no more than four opioid doses for initial pain control. This guideline, coupled with family and provider-centered education on multimodal therapy at the time of initial presentation and safe use of opioids, are important first steps to minimizing the use of opioids in the management of small area burns in children.<\/jats:p>","DOI":"10.1093\/jbcr\/iraa049","type":"journal-article","created":{"date-parts":[[2020,4,18]],"date-time":"2020-04-18T07:45:40Z","timestamp":1587195940000},"page":"814-819","source":"Crossref","is-referenced-by-count":11,"title":["Pain Management for Pediatric Burns in the Outpatient Setting: A Changing Paradigm?"],"prefix":"10.1093","volume":"41","author":[{"given":"Niti","family":"Shahi","sequence":"first","affiliation":[{"name":"Division of Pediatric Surgery, Children\u2019s Hospital Colorado, Aurora, Colorado"},{"name":"University of Colorado School of Medicine, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxene","family":"Meier","sequence":"first","affiliation":[{"name":"The Center for Research in Outcomes for Children\u2019s Surgery, University of Colorado School of Medicine, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Phillips","sequence":"first","affiliation":[{"name":"Division of Pediatric Surgery, Children\u2019s Hospital Colorado, Aurora, Colorado"},{"name":"University of Colorado School of Medicine, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"Shirek","sequence":"first","affiliation":[{"name":"Division of Pediatric Surgery, Children\u2019s Hospital Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Goldsmith","sequence":"first","affiliation":[{"name":"Division of Pediatric Surgery, Children\u2019s Hospital Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Recicar","sequence":"first","affiliation":[{"name":"Division of Pediatric Surgery, Children\u2019s Hospital Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeannie","family":"Zuk","sequence":"first","affiliation":[{"name":"University of Colorado School of Medicine, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Bielsky","sequence":"first","affiliation":[{"name":"University of Colorado School of Medicine, Aurora, Colorado"},{"name":"Department of Anesthesia, Children\u2019s Hospital Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myron","family":"Yaster","sequence":"first","affiliation":[{"name":"University of Colorado School of Medicine, Aurora, Colorado"},{"name":"Department of Anesthesia, Children\u2019s Hospital Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Moulton","sequence":"first","affiliation":[{"name":"Division of Pediatric Surgery, Children\u2019s Hospital Colorado, Aurora, Colorado"},{"name":"University of Colorado School of Medicine, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,4,18]]},"reference":[{"key":"2020070310342652300_CIT0001","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1001\/jama.2011.370","article-title":"Association between opioid prescribing patterns and opioid overdose-related deaths","volume":"305","author":"Bohnert","year":"2011","journal-title":"JAMA"},{"key":"2020070310342652300_CIT0002","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1001\/jamapediatrics.2016.0504","article-title":"The potential impact on children of the CDC guideline for prescribing opioids for chronic pain: above all, do no harm","volume":"170","author":"Schechter","year":"2016","journal-title":"JAMA Pediatr"},{"key":"2020070310342652300_CIT0003","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1001\/jama.2016.1464","article-title":"CDC guideline for prescribing opioids for chronic pain\u2013United States, 2016","volume":"315","author":"Dowell","year":"2016","journal-title":"JAMA"},{"key":"2020070310342652300_CIT0004","doi-asserted-by":"crossref","first-page":"e186558","DOI":"10.1001\/jamanetworkopen.2018.6558","article-title":"US national trends in pediatric deaths from prescription and illicit opioids, 1999\u20132016","volume":"1","author":"Gaither","year":"2018","journal-title":"JAMA Netw Open"},{"key":"2020070310342652300_CIT0005","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1097\/00004630-199709000-00018","article-title":"Development of a pediatric burn pain and anxiety management program","volume":"18","author":"Sheridan","year":"1997","journal-title":"J Burn Care Rehabil"},{"key":"2020070310342652300_CIT0006","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1097\/01.NAJ.0000348604.47231.68","article-title":"Understanding and managing burn pain: part 1","volume":"109","author":"Connor-Ballard","year":"2009","journal-title":"Am J Nurs"},{"key":"2020070310342652300_CIT0007","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1097\/BCR.0000000000000470","article-title":"Pain management in pediatric burn patients: review of recent literature and future directions","volume":"38","author":"Pardesi","year":"2017","journal-title":"J Burn Care Res"},{"key":"2020070310342652300_CIT0008","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.jpain.2007.02.426","article-title":"Burn injury pain: the continuing challenge","volume":"8","author":"Summer","year":"2007","journal-title":"J Pain"},{"key":"2020070310342652300_CIT0009","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1155\/2010\/825657","article-title":"Management of pain in children with burns","volume":"2010","author":"Gandhi","year":"2010","journal-title":"Int J Pediatr"},{"key":"2020070310342652300_CIT0010","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.cps.2017.05.005","article-title":"Principles of burn pain management","volume":"44","author":"James","year":"2017","journal-title":"Clin Plast Surg"},{"key":"2020070310342652300_CIT0011","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1586\/ern.10.158","article-title":"Analgesia and sedation for children undergoing burn wound care","volume":"10","author":"Bayat","year":"2010","journal-title":"Expert Rev Neurother"},{"key":"2020070310342652300_CIT0012","doi-asserted-by":"crossref","first-page":"128","DOI":"10.4103\/2229-5151.100889","article-title":"Pediatric burn injuries","volume":"2","author":"Krishnamoorthy","year":"2012","journal-title":"Int J Crit Illn Inj Sci"},{"key":"2020070310342652300_CIT0013","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1016\/j.burns.2013.04.003","article-title":"Outpatient burn data: an untapped resource","volume":"39","author":"Kahn","year":"2013","journal-title":"Burns"},{"key":"2020070310342652300_CIT0014","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.ccell.2003.09.002","article-title":"Outpatient management of the burn patient","volume":"16","author":"Moss","year":"2004","journal-title":"Crit Care Nurs Clin North Am"},{"key":"2020070310342652300_CIT0015","doi-asserted-by":"crossref","first-page":"522","DOI":"10.3109\/09540260903343844","article-title":"Pain management in patients with burn injuries","volume":"21","author":"Wiechman Askay","year":"2009","journal-title":"Int Rev Psychiatry"},{"key":"2020070310342652300_CIT0016","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/j.cps.2017.02.017","article-title":"Pediatric burn care: unique considerations in management","volume":"44","author":"Shah","year":"2017","journal-title":"Clin Plast Surg"},{"key":"2020070310342652300_CIT0017","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/0304-3959(90)90018-9","article-title":"The Faces Pain Scale for the self-assessment of the severity of pain experienced by children: development, initial validation, and preliminary investigation for ratio scale properties","volume":"41","author":"Bieri","year":"1990","journal-title":"Pain"},{"key":"2020070310342652300_CIT0018","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1016\/j.jpain.2010.02.005","article-title":"PROMIS Pediatric Pain Interference Scale: an item response theory analysis of the pediatric pain item bank","volume":"11","author":"Varni","year":"2010","journal-title":"J Pain"},{"key":"2020070310342652300_CIT0019","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1097\/j.pain.0000000000000914","article-title":"Development and validation of the self-reported PROMIS pediatric pain behavior item bank and short form scale","volume":"158","author":"Cunningham","year":"2017","journal-title":"Pain"},{"key":"2020070310342652300_CIT0020","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1111\/j.1460-9592.2005.01773.x","article-title":"The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment","volume":"16","author":"Malviya","year":"2006","journal-title":"Paediatr Anaesth"},{"key":"2020070310342652300_CIT0021","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/j.surg.2006.07.029","article-title":"The vulnerabilities of age: burns in children and older adults","volume":"140","author":"Bessey","year":"2006","journal-title":"Surgery"},{"key":"2020070310342652300_CIT0022","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/BF02874556","article-title":"Symptoms of depression and anxiety as unique predictors of pain-related outcomes following burn injury","volume":"34","author":"Edwards","year":"2007","journal-title":"Ann Behav Med"},{"key":"2020070310342652300_CIT0023","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1097\/ALN.0b013e31823c1030","article-title":"Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management","volume":"116","author":"American Society of Anesthesiologists Task Force on Acute Pain Management","year":"2012","journal-title":"Anesthesiology"},{"key":"2020070310342652300_CIT0024","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/j.suc.2014.05.009","article-title":"Outpatient burn management","volume":"94","author":"Warner","year":"2014","journal-title":"Surg Clin North Am"},{"key":"2020070310342652300_CIT0025","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1093\/jbcr\/irz164","article-title":"Sedation and analgesia for adult outpatient burn dressing change: a Survey of American Burn Association Centers","volume":"41","author":"Voss","year":"2020","journal-title":"J Burn Care Res"},{"key":"2020070310342652300_CIT0026","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.burns.2019.11.024","article-title":"Impact of the implementation of a therapy dog program on burn center patients and staff","volume":"46","author":"Pruskowski","year":"2020","journal-title":"Burns"},{"key":"2020070310342652300_CIT0027","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1016\/j.burns.2017.11.020","article-title":"Assessing the feasibility of implementing low-cost virtual reality therapy during routine burn care","volume":"44","author":"Ford","year":"2018","journal-title":"Burns"},{"key":"2020070310342652300_CIT0028","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1001\/journalofethics.2018.20.6.cscm1-1806","article-title":"Is it ethical to treat pain differently in children and adults with burns?","volume":"20","author":"Dissanaike","year":"2018","journal-title":"AMA J Ethics"}],"container-title":["Journal of Burn Care &amp; Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jbcr\/advance-article-pdf\/doi\/10.1093\/jbcr\/iraa049\/33099745\/iraa049.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jbcr\/article-pdf\/41\/4\/814\/33460525\/iraa049.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jbcr\/article-pdf\/41\/4\/814\/33460525\/iraa049.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,9]],"date-time":"2021-03-09T15:39:25Z","timestamp":1615304365000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbcr\/article\/41\/4\/814\/5821576"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,18]]},"references-count":28,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,4,18]]},"published-print":{"date-parts":[[2020,7,3]]}},"URL":"https:\/\/doi.org\/10.1093\/jbcr\/iraa049","relation":{},"ISSN":["1559-047X","1559-0488"],"issn-type":[{"value":"1559-047X","type":"print"},{"value":"1559-0488","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,7]]},"published":{"date-parts":[[2020,4,18]]}}}