Ok to Treat Severe Stomach Pain in Kids, Docs Say

NEW YORK (Reuters Health) - When a child has acute abdominal pain severe enough for surgery to be considered, the rule has been to not give painkillers -- because doing so might obscure the diagnosis.

That rule can be discarded, a new study shows. The prompt administration of morphine relieves the pain without masking the physical signs of appendicitis.

To see if morphine does in fact make it harder to reach a diagnosis, investigators in the US and Canada randomly assigned 108 children who were seen in the emergency department with acute abdominal pain to IV morphine or normal saline.

"In our study," Dr. Milton Tenenbein from Children's Hospital in Winnipeg, Manitoba, and colleagues report in the journal Pediatrics, "there was no difference between groups in diagnostic accuracy or confidence in diagnoses by emergency physicians or surgeons."

Specifically, there were no differences between morphine- and saline-treated children in the diagnoses of appendicitis or perforated appendicitis, or in the number of children who were observed and then underwent surgery, according to the team.

Not surprisingly, children treated with morphine had significantly greater reductions in average pain scores.

Tenenbein and colleagues point out that it is now "standard care to provide pain relief to adults with acute abdominal pain, before definitive diagnosis and before surgical assessment."

Their study, they add, suggests that morphine effectively relieves pain in children with acute abdominal pain and does not seem to impede diagnosis of the cause of the pain.

SOURCE: Pediatrics, October 2005.