Doctors are prescribing powerful opium-derived drugs to children as young as 12 who are experiencing chronic pain in what may condemn them to a lifetime of dependency and disadvantage, pain specialists have warned.
One in three children who present to pain specialists have been prescribed opioids and nearly one in five take this medication on a daily or regular basis, according to data released by a national collaboration of pediatric pain clinics.
Pain Australia chief executive Lesley Brydon said the figures were "extremely worrying".
"The use of opioids to manage pain in children carries huge risks and is contra to all clinical guidelines," Ms Brydon said.
"We believe GPs are prescribing medications like opioids rather than referring to non-pharmaceutical therapies, which there's very good evidence to show can be more helpful than drugs in managing chronic pain."
Opioids are a particular class of drugs derived from the opium poppy that act on the central nervous system to reduce pain. They are also highly addictive.
They include heroin, morphine, methadone, pethidine, oxycodone (OxyContin and Endone), also known as "hillbilly heroin".
Data released by the Electronic Persistent Pain Outcomes Collaboration (ePPOC) represents the first national snapshot of chronic pain among children and shows more than half the children referred to pain clinics had been experiencing pain for more than 12 months.
Some of the pain was precipitated by an injury or illness, but for 40 per cent of children there was no known cause.
Opioids had been prescribed to 33 per cent of the children and 19 per cent took this medication daily or often.
The figures covered 628 children with an average age of 12.6 for girls and 12 for boys who had been referred to one of the eight pediatric pain management clinics in the previous six months.
Brooke Peterson, 16, has been taking opioids since she was 12 to manage the chronic pain associated with Freiberg's infraction disease, but her physician is helping wean her off them.
"I've been withdrawing from a couple of them because my body has become immune to them, so they don't work any more," she said.
"In the process of trying to slowly withdraw from them I got bad stomach pains, sweats and chills, really bad withdrawal symptoms.
"My plan now is to focus on techniques that I've learned for when I get these bursts of pain and always thinking in the back of my mind if the techniques don't work I can go on something a bit later but, as opposed to Endone or OxyContin, try Panadol or Nurofen."
Royal Adelaide Hospital pain medicine physician Meredith Craigie said chronic pain was born of a complex set of psychological, environmental and physical factors and while opioids were useful to alleviate acute pain they were not appropriate for long-term pain management.
Doctors often prescribed opioids to patients who kept returning for pain, but the drug did not address the underlying contributing factors contributing to their condition, she said.
"In the chronic, non-cancer setting the evidence for opioids having a role is really quite weak and in fact what we're discovering after having used opioids in this setting for the last 25 years or so is that there are a lot of hidden harms," Dr Craigie said.
Over time, people stopped responding to the analgesic effects of the drugs but developed dependencies upon them, while experiencing side effects including cognitive impairment, sexual dysfunction and constipation, which could develop into bowel prolapse over the long term.
"[Children on opioids] are much more likely to end up as adults with chronic pain, living on social security and it just becomes this downward spiral for them, so it's really important to intervene early," Dr Craigie said.
"By the time we get to see them they've already dropped out of school because the schools don't know how to deal with them.
"If you're still taking an opioid a year after you got on them, your chances of getting off them in your lifetime is very small."
The ePPOC data showed teenagers had missed an average of 12 days of school in the previous term, while children had missed an average of 10 days.
Pain Australia is campaigning for a Medicare payment system that would cover the cost of 15 visits to allied health professionals including physiotherapists, psychologists and occupational therapists so people with chronic pain could be managed in the community.
Ms Brydon said the Faculty of Pain Medicine had developed a free online accredited course for GPs in managing chronic pain, but there had been little uptake.
"We would like to encourage more of them to do it rather than write prescriptions," she said.
But Sydney Children's Hospital clinical director of surgery and anaesthesia Matthew Crawford said his pain clinic only saw two or three children annually who had been prescribed opioids.
Children who experienced chronic pain had an advantage over adults in being more malleable, and 80 per cent of patients seen by the SCH learned psychological techniques that reduced or eliminated their pain, he said.
