{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:38:16Z","timestamp":1760236696581,"version":"build-2065373602"},"reference-count":35,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T00:00:00Z","timestamp":1640131200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: To evaluate trends in national emergency department (ED) adolescent opioid use in relation to reported pain scores. Methods: A retrospective, cross-sectional analysis on National Hospital Ambulatory Medical Care Survey (NHAMCS) data was conducted on ED visits involving patients aged 11\u201321 from 2008\u20132017. Crude observational counts were extrapolated to weighted estimates matching total population counts. Multivariate models were used to evaluate the role of a pain score in the reported use of opioids. Anchors for pain scores were 0 (no pain) and 10 (worst pain imaginable). Results: 31,355 observations were captured, which were extrapolated by the NHAMCS to represent 162,515,943 visits nationwide. Overall, patients with a score of 10 were 1.35 times more likely to receive an opioid than patients scoring a 9, 41.7% (CI95 39.7\u201343.8%) and 31.0% (CI95 28.8\u201333.3%), respectively. Opioid use was significantly different between traditional pain score cutoffs of mild (1\u20133) and moderate pain (4\u20136), where scores of 4 were 1.76 times more likely to receive an opioid than scores of 3, 15.5% (CI95 13.7\u201317.3%) and 8.8% (CI95 7.1\u201310.6%), respectively. Scores of 7 were 1.33 times more likely to receive opioids than scores of 6, 24.7% (CI95 23.0\u201326.3%) and 18.5% (CI95 16.9\u201320.0%), respectively. Fractures had the highest likelihood of receiving an opioid, as 49.2% of adolescents with a fracture received an opioid (CI95 46.4\u201351.9%). Within this subgroup, only adolescents reporting a fracture pain score of 10 had significantly higher opioid use than adjacent pain scores, where fracture patients scoring a 10 were 1.4 times more likely to use opioids than those scoring 9, 82.2% (CI95 76.1\u201388.4%) and 59.8% (CI95 49.0\u201370.5%), respectively. Conclusions: While some guidelines in the adult population have revised cut-offs and groupings of the traditional tiers on a 0\u201310 point pain scale, the adolescent population may also require further examination to potentially warrant a similar adjustment.<\/jats:p>","DOI":"10.3390\/jcm11010038","type":"journal-article","created":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T02:01:19Z","timestamp":1640224879000},"page":"38","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Evaluating the 0\u201310 Point Pain Scale on Adolescent Opioid Use in US Emergency Departments"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4671-0513","authenticated-orcid":false,"given":"Michael T.","family":"Phan","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA 92618, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel M.","family":"Tomaszewski","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical and Health Economics, University of Southern California, Los Angeles, CA 90007, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6903-2746","authenticated-orcid":false,"given":"Cody","family":"Arbuckle","sequence":"additional","affiliation":[{"name":"Schmid College of Science and Technology, Chapman University, Orange, CA 92866, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8463-7468","authenticated-orcid":false,"given":"Sun","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA 92618, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brooke","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Department of Psychology, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA"},{"name":"Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA 92697, USA"},{"name":"UCI Center on Stress and Health, School of Medicine, University of California Irvine, Irvine, CA 92697, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle A.","family":"Fortier","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA 92697, USA"},{"name":"UCI Center on Stress and Health, School of Medicine, University of California Irvine, Irvine, CA 92697, USA"},{"name":"Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, CA 92697, USA"},{"name":"Department of Psychology, Children\u2019s Hospital of Orange County, Orange, CA 92868, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theodore","family":"Heyming","sequence":"additional","affiliation":[{"name":"Department of Pediatric Emergency Medicine, Children\u2019s Hospital of Orange County, Orange, CA 92868, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0174-7002","authenticated-orcid":false,"given":"Erik","family":"Linstead","sequence":"additional","affiliation":[{"name":"Fowler School of Engineering, Chapman University, Orange, CA 92866, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Candice","family":"Donaldson","sequence":"additional","affiliation":[{"name":"Department of Psychology, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA"},{"name":"UCI Center on Stress and Health, School of Medicine, University of California Irvine, Irvine, CA 92697, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeev","family":"Kain","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA 92697, USA"},{"name":"UCI Center on Stress and Health, School of Medicine, University of California Irvine, Irvine, CA 92697, USA"},{"name":"Department of Pediatrics, Children\u2019s Hospital of Orange County, Orange, CA 92868, USA"},{"name":"Yale Child Study Center, Yale University, New Haven, CT 06519, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,22]]},"reference":[{"key":"ref_1","unstructured":"CDC (2021, December 02). National Hospital Ambulatory Medical Care Survey: 2015 Emergency Department Summary Tables, Available online: https:\/\/www.cdc.gov\/nchs\/data\/nhamcs\/web_tables\/2015_ed_web_tables.pdf."},{"key":"ref_2","unstructured":"CDC (2021, December 02). National Center for Health Statistics\u2014Health, United States, 2019\u2014Data Finder, Available online: https:\/\/www.cdc.gov\/nchs\/hus\/contents2019.htm?search=Emergency_department_visits."},{"key":"ref_3","unstructured":"California, M.B.O. (2014). Guidelines for Prescribing Controlled Substances for Pain."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr6501e1","article-title":"CDC Guideline for Prescribing Opioids for Chronic Pain\u2014United States, 2016","volume":"65","author":"Dowell","year":"2016","journal-title":"MMWR Recomm. Rep."},{"key":"ref_5","unstructured":"World Health Organization (2012). WHO Guidelines on the Pharmacological Treatment of Persisting Pain in Children with Medical Illnesses, WHO."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1111\/pan.13639","article-title":"The Society for Pediatric Anesthesia recommendations for the use of opioids in children during the perioperative period","volume":"29","author":"Cravero","year":"2019","journal-title":"Paediatr. Anaesth."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1093\/pm\/pny307","article-title":"Challenges with Implementing the Centers for Disease Control and Prevention Opioid Guideline: A Consensus Panel Report","volume":"20","author":"Kroenke","year":"2019","journal-title":"Pain Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1097\/AJP.0000000000000165","article-title":"A debate on the proposition that self-report is the gold standard in assessment of pediatric pain intensity","volume":"31","author":"Twycross","year":"2015","journal-title":"Clin. J. Pain"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.pain.2005.10.004","article-title":"The role of developmental factors in predicting young children\u2019s use of a self-report scale for pain","volume":"120","author":"Stanford","year":"2006","journal-title":"Pain"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1093\/jpepsy\/16.6.783","article-title":"Assessment of sex differences in children\u2019s and adolescents\u2019 self-reported pain from venipuncture","volume":"16","author":"Lander","year":"1991","journal-title":"J. Pediatr. Psychol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1542\/peds.2008-3332","article-title":"Ethnicity matters in the assessment and treatment of children\u2019s pain","volume":"124","author":"Fortier","year":"2009","journal-title":"Pediatrics"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e1169","DOI":"10.1542\/peds.2015-1364","article-title":"Prescription Opioids in Adolescence and Future Opioid Misuse","volume":"136","author":"Miech","year":"2015","journal-title":"Pediatrics"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1001\/jamainternmed.2018.5419","article-title":"Association of Opioid Prescriptions From Dental Clinicians for US Adolescents and Young Adults With Subsequent Opioid Use and Abuse","volume":"179","author":"Schroeder","year":"2019","journal-title":"JAMA Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"344","DOI":"10.15585\/mmwr.mm6711a8","article-title":"QuickStats: Percentage of Emergency Department Visits that Had an Opioid Ordered or Prescribed, by Age Group\u2014National Hospital Ambulatory Medical Care Survey, United States, 2006\u20132015","volume":"67","author":"Yacisin","year":"2018","journal-title":"MMWR Morb. Mortal Wkly Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"422","DOI":"10.5811\/westjem.2012.7.12936","article-title":"Prescription drug monitoring programs and other interventions to combat prescription opioid abuse","volume":"13","author":"Chakravarthy","year":"2012","journal-title":"West J. Emerg. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.annemergmed.2003.10.043","article-title":"Variability in emergency physician decision making about prescribing opioid analgesics","volume":"43","author":"Dawson","year":"2004","journal-title":"Ann. Emerg. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.annemergmed.2015.03.026","article-title":"Opioid Prescribing in a Cross Section of US Emergency Departments","volume":"66","author":"Hoppe","year":"2015","journal-title":"Ann. Emerg. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Menchine, M., Lam, C.N., and Arora, S. (2019). Prescription Opioid Use in General and Pediatric Emergency Departments. Pediatrics, 144.","DOI":"10.1542\/peds.2019-0302"},{"key":"ref_19","unstructured":"Johnson Yackey, K. (2013). Ouch! Factors that contribute to emergency department pediatric pain control. AAP Experience, AAP."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1542\/peds.2005-2046","article-title":"Pain Assessment for Pediatric Patients in the Emergency Department","volume":"117","author":"Drendel","year":"2006","journal-title":"Pediatrics"},{"key":"ref_21","unstructured":"US Emergency Department (2010). Nhamcs Micro-Data File Documentation, The National Bureau of Economic Research."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e20172151","DOI":"10.1542\/peds.2017-2151","article-title":"Age Limit of Pediatrics","volume":"140","author":"Hardin","year":"2017","journal-title":"Pediatrics"},{"key":"ref_23","unstructured":"National Center for Health Statistics (US) (2018, July 05). The Ambulatory Care Drug Database System, Available online: https:\/\/www2.cdc.gov\/drugs\/applicationnav1.asp."},{"key":"ref_24","unstructured":"US Emergency Department (2006). 2006 Nhamcs Micro-Data File Documentation, The National Bureau of Economic Research."},{"key":"ref_25","unstructured":"National Center for Health Statistics (US) (2020, June 10). Ambulatory Health Care Data: NAMCS and NHAMCS Description, Available online: http:\/\/www.cdc.gov\/nchs\/ahcd\/ahcd_questionnaires.htm."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/0304-3959(94)00178-H","article-title":"When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function","volume":"61","author":"Serlin","year":"1995","journal-title":"Pain"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1097\/PEC.0000000000000791","article-title":"Defining No Pain, Mild, Moderate, and Severe Pain Based on the Faces Pain Scale\u2013Revised and Color Analog Scale in Children With Acute Pain","volume":"34","author":"Tsze","year":"2018","journal-title":"Pediatric Emerg. Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1197\/j.aem.2005.09.010","article-title":"Defining mild, moderate, and severe pain by using the color analogue scale with children presenting to a pediatric emergency department","volume":"13","author":"McConahay","year":"2006","journal-title":"Acad. Emerg. Med."},{"key":"ref_29","unstructured":"NHAMCS (2020, May 29). Micro-Data File Documentation. Available online: https:\/\/data.nber.org\/nhamcs\/docs\/nhamcsed2015.pdf."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/j.ajem.2008.12.035","article-title":"Triage pain scales cannot predict analgesia provision to pediatric patients with long-bone fracture","volume":"28","author":"Weng","year":"2010","journal-title":"Am. J. Emerg. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1097\/PEC.0b013e3181850c1c","article-title":"Does a pain scale improve pain assessment in the pediatric emergency department?","volume":"24","author":"Kaplan","year":"2008","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1136\/emj.2008.065193","article-title":"Routine pain scoring does not improve analgesia provision for children in the emergency department","volume":"26","author":"Jadav","year":"2009","journal-title":"Emerg. Med. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1067\/mem.2003.138","article-title":"Underuse of analgesia in very young pediatric patients with isolated painful injuries","volume":"41","author":"Alexander","year":"2003","journal-title":"Ann. Emerg. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1177\/0009922814555972","article-title":"Acute pediatric musculoskeletal pain management in North America: A practice variation survey","volume":"53","author":"Kircher","year":"2014","journal-title":"Clin. Pediatr."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Committee on Psychosocial Aspects of Child and Family Health (2001). The assessment and management of acute pain in infants, children, and adolescents. Pediatrics, 108, 793\u2013797.","DOI":"10.1542\/peds.108.3.793"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/1\/38\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:51:27Z","timestamp":1760169087000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/1\/38"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,22]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["jcm11010038"],"URL":"https:\/\/doi.org\/10.3390\/jcm11010038","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2021,12,22]]}}}