Pharmacologic Management of Acute Pain in Children: A Systematic Review and Network Meta-Analysis

Review Author: Megan Cox, DO 

 Study Highlights 

- Systematic review and network meta-analysis of 41 randomized clinical trials, involving 4935 patients < 18 years. 

- Compared use of NSAIDs, acetaminophen, opioids, and ketamine, versus placebo, in management of acute pediatric pain. 

- Evaluated effect on pain relief, need for rescue analgesia, and gastrointestinal, neurologic, and dermatologic adverse drug events. 

 Key Findings 

- Moderate- to high-certainty evidence suggested NSAIDs, ketamine, and opioids reduced pain severity. Low-certainty evidence suggested acetaminophen may reduce pain. 

- Only NSAIDs decreased the need for rescue analgesia. 

- NSAIDs showed no significant difference in adverse drug events, as compared to placebo. - Neither acetaminophen nor NSAIDs increased the risk of short-term gastrointestinal adverse events. Ketamine may increase gastrointestinal adverse events. 

- Low-certainty evidence suggested neither NSAIDS nor acetaminophen nor opioids nor ketamine were more harmful than placebo. 

 Conclusions 

- NSAIDs offer the greatest benefits and least risks of gastrointestinal, neurologic, and dermatologic adverse drug events. 

Reference:

Olejnik L, Lima JP, Sadeghirad B, et al. Pharmacologic Management of Acute Pain in Children: A Systematic Review and Network Meta-Analysis. JAMA Pediatr. 2025;179(4):407–417. doi:10.1001/jamapediatrics.2024.5920

 Read the full article here.