Rick van Uum
Pain management in childhood acute otitis media
Ear pain remains central to children’s and parents’ experience of AOM and contributes significantly to AOM’s burden of disease. Our studies highlight that there is room for improvement of pain management in children with AOM, and that this requires more than issuing guidance. Our multifaceted intervention aimed at educating GPs about pain management in children with AOM led to an increase in analgesic use, ibuprofen in particular, but this did not lead to lower parent-reported ear pain scores, fewer antibiotic prescriptions, nor lower costs. There was an increase in GP reconsultations. Considering the absence of evidence of a benefit of ibuprofen as add-on to paracetamol, and a potentially negative effect on disease course, we suggest to not routinely use ibuprofen in children with AOM. It is tempting to believe that complex interventions (based on existing evidence and/or guidelines) are useful by definition, and do not introduce harm. Our study suggests how that may not be the case. We therefore emphasise that complex interventions need careful planning and assessment of effectiveness and adverse effects before considering its introduction. Regarding pain management in children with AOM, we need to further strengthen the evidence base and improve our practice. GPs, and other clinicians involved in the care of children with AOM, should be aware of parents’ uncertainties in recognising AOM and their lack of understanding of the role of pain medication as drivers for consultation. They should address this during the consultation, to better align with parents’ views and expectations. Future research should focus on elucidating parental barriers to administering paracetamol in age- or weight-appropriate dosing, the added benefit of such dosing, and the effectiveness of analgesic ear drops for children with AOM.