To relieve pain or avoid opioid‐related risk? A comparison of parents’ analgesic trade‐off preferences and decision‐making in 2019 versus 2013 in a single U.S. pediatric hospital

Abstract

Background: Analgesic trade-off preferences, or the relative preference for pain relief vs. risk aversion, shape parents' decisions to give prescription opioids to their children.These preferences may be influenced by personal experiences and societal factors.Aim: To examine whether parental analgesic trade-off preferences and opioid decisionmaking have shifted toward risk aversion during the opioid crisis in the United States. Methods:We conducted a secondary analysis of the preoperative survey data of parents from a single U.S. pediatric hospital whose children aged 5-17 years were to undergo painful surgery in 2013 (Time 1) or 2017/2019 (Time 2). Surveys assessed parents' analgesic trade-off preference (−12 or risk-averse to +12 or pain relief preferent, scores around 0=ambivalent) and their hypothetical decisions to give a prescribed opioid to a child in pain.Results: Data from 847 parents were included (Time 1, n = 361; Time 2, n = 486).Parents at Time 2 were significantly more risk-averse compared with Time 1 (adj.β: −0.84 [95% CI: −1.09, −0.60]). Parents at Time 2 were more than twice as likely to be risk-averse or ambivalent (OR: 2.17 [95% CI: 1.62, 2.91]). There was a significant interaction effect of Time*Preference on parents' decision to give the opioid (adj. OR:1.09 [95% CI: 1.03, 1.16]). At Time 2, parents who were ambivalent or risk-averse were less likely than those who preferred to relieve pain to administer the prescribed opioid (OR: 0.57 [95% CI: 0.37, 0.89]). In contrast, there was no association between the preference group and the opioid decision at Time 1. Conclusion:Findings suggest that parents of children scheduled for painful surgery at our pediatric hospital have become more analgesic risk-averse during the past decade.Parents' analgesic trade-off preferences may influence their decisions to administer prescribed opioids after surgery, which may contribute to children's pain outcomes. K E Y W O R D Schildren, decision-making, opioid analgesics, opioid epidemic, pain management, parents What is already knownParents' decisions to administer prescribed opioids to children are influenced, in part, by their risk perceptions and analgesic preferences. | 879 LENKO aNd VOEPEL-LEWIS What new information this study addsParents' analgesic preferences have shifted toward risk aversion during the opioid crisis, which may influence them to withhold prescription opioids for a child in pain.How to cite this article: Lenko R, Voepel-Lewis T. To relieve pain or avoid opioid-related risk? A comparison of parents' analgesic trade-off preferences and decision-making in 2019 versus 2013 in a single U.S. pediatric hospital.

Prescription Opioid Decision-Making and Use Behaviors in Adolescents with Acute Pain

“…On the opposite side of the spectrum of analgesic trade-off preferences, some adolescents in our study (and/or their caregivers) expressed extremely high opioid risk avoidance despite severe pain—perceptions that have likely become more common due to opioid epidemic messaging 32 . However, potential risks of undertreating pain were usually omitted from accounts of decision-making among those more analgesic risk-averse participants.…”

“…On the opposite side of the spectrum of analgesic tradeoff preferences, some adolescents in our study (and/or their caregivers) expressed extremely high opioid risk avoidance despite severe pain-perceptions that have likely become more common due to opioid epidemic messaging. 32 However, potential risks of undertreating pain were usually omitted from accounts of decision-making among those more analgesic risk-averse participants. As signaled by recent changes in adult opioid clinical guidelines, 33 the consequences of inadequate pain management (eg, persistent pain and other substance misuse 19 ) should not be overlooked in shared decision-making about opioids prescribed for acute pain in youth.…”

Enhanced recovery after cleft palate repair: A quality improvement project

“…In the era of the opioid epidemic, postoperative opioid consumption is an important issue for physicians and parents, 21 given the association between opioid consumption and adverse events 22 . Risk factors of opioid induced respiratory depression, which typically occurs within the first 24 hours postoperatively, include airway surgeries and patients under 1 year of age 23 .…”