Opioid Prescribing and Polypharmacy in Children with Chronic Musculoskeletal Pain
Abstract Objective Thirty percent of adults with fibromyalgia receive an opioid, but the prevalence of opioid prescribing in pediatric chronic musculoskeletal pain is unknown. The aims of this study were to determine the prevalence of and factors associated with opioid exposure and polypharmacy amon...
Gespeichert in:
| Veröffentlicht in: | Pain medicine (Malden, Mass.) Mass.), 2019-03, Vol.20 (3), p.495-503 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 503 |
|---|---|
| container_issue | 3 |
| container_start_page | 495 |
| container_title | Pain medicine (Malden, Mass.) |
| container_volume | 20 |
| creator | Gmuca, Sabrina Xiao, Rui Weiss, Pamela F Sherry, David D Knight, Andrea M Gerber, Jeffrey S |
| description | Abstract
Objective
Thirty percent of adults with fibromyalgia receive an opioid, but the prevalence of opioid prescribing in pediatric chronic musculoskeletal pain is unknown. The aims of this study were to determine the prevalence of and factors associated with opioid exposure and polypharmacy among children with chronic musculoskeletal pain.
Methods
In this retrospective cohort study using health care claims data from 2000 to 2013, the index date was the first ICD-9 code 729.1. Included subjects were ≥ 2 and < 18 years old at the index date with two or more codes within 12 months and 18 months of continuous enrollment. Subjects with burns, sickle cell disease, or malignancy were excluded. Opioid exposure was defined as one or more prescriptions within six months before or any time after the index date. Polypharmacy was considered minor (2–4 medications) or major (≥5 medications).
Results
Of 25,321 included subjects, 20% received an opioid and 26% experienced minor polypharmacy. Opioid exposure was associated with female sex (odds ratio [OR] = 1.27, P |
| doi_str_mv | 10.1093/pm/pny116 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6387982</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A659812173</galeid><oup_id>10.1093/pm/pny116</oup_id><sourcerecordid>A659812173</sourcerecordid><originalsourceid>FETCH-LOGICAL-c525t-dc6623b94f8cb2f244426d8b7dbf411931cead2f320a6b46777721f9a7b0f7443</originalsourceid><addsrcrecordid>eNp9kU1LxDAQhoMofh_8A1LQi4dd89WkvQiy-AWKK-g5pGmyG22TmrTK_nsju4qCmDlkJnnmZYYXgAMExwiW5LRrTzu3QIitgW2UYzaijPD1VY4Jz7fATozPECJGC7IJtnBZwrygeBs83HfW2zqbBh1VsJV1s0y6VPtm0c1laKVaZNZlk7lt6qBd9m77eaqCd1Zld0NUQ-Pji250L5tsKq3bAxtGNlHvr-5d8HR58Ti5Ht3eX91Mzm9HKsd5P6oVY5hUJTWFqrDBlFLM6qLidWUoQiVBSssaG4KhZBVlPB2MTCl5BQ2nlOyCs6VuN1StrpV2fZCN6IJtZVgIL634_ePsXMz8m2Ck4GWBk8DRSiD410HHXjz7Ibg0s8AEEk4QYT-omWy0sM74JKZaG5U4Z3lZIIw4SdT4DypFrVurvNPGpvdfDSfLBhV8jEGb78ERFJ-miq4VS1MTe_hz02_yy8UEHC8BP3T_6HwAjNWpkQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2303731362</pqid></control><display><type>article</type><title>Opioid Prescribing and Polypharmacy in Children with Chronic Musculoskeletal Pain</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><creator>Gmuca, Sabrina ; Xiao, Rui ; Weiss, Pamela F ; Sherry, David D ; Knight, Andrea M ; Gerber, Jeffrey S</creator><creatorcontrib>Gmuca, Sabrina ; Xiao, Rui ; Weiss, Pamela F ; Sherry, David D ; Knight, Andrea M ; Gerber, Jeffrey S</creatorcontrib><description><![CDATA[Abstract
Objective
Thirty percent of adults with fibromyalgia receive an opioid, but the prevalence of opioid prescribing in pediatric chronic musculoskeletal pain is unknown. The aims of this study were to determine the prevalence of and factors associated with opioid exposure and polypharmacy among children with chronic musculoskeletal pain.
Methods
In this retrospective cohort study using health care claims data from 2000 to 2013, the index date was the first ICD-9 code 729.1. Included subjects were ≥ 2 and < 18 years old at the index date with two or more codes within 12 months and 18 months of continuous enrollment. Subjects with burns, sickle cell disease, or malignancy were excluded. Opioid exposure was defined as one or more prescriptions within six months before or any time after the index date. Polypharmacy was considered minor (2–4 medications) or major (≥5 medications).
Results
Of 25,321 included subjects, 20% received an opioid and 26% experienced minor polypharmacy. Opioid exposure was associated with female sex (odds ratio [OR] = 1.27, P < 0.01), Caucasian race (OR = 1.27, P < 0.01), hospitalization (OR = 1.20, P < 0.01), and visit with anesthesiology (OR = 1.97, P < 0.01) or orthopedics (OR = 1.09, P < 0.05). Mental health codes were associated with decreased odds of opioid exposure (all P < 0.05). Children seen by a chiropractor or physiatrist had a reduced odds of receipt of an opioid (OR = 0.42 and 0.84, respectively, both P < 0.01).
Conclusions
Twenty percent of children with chronic musculoskeletal pain received an opioid. Twenty-six percent experienced polypharmacy, with the majority receiving 2–4 medications. Increased availability of psychological and nonpharmacologic services are potential strategies to reduce opioid exposure.]]></description><identifier>ISSN: 1526-2375</identifier><identifier>EISSN: 1526-4637</identifier><identifier>DOI: 10.1093/pm/pny116</identifier><identifier>PMID: 29905842</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Adolescent ; Analgesics, Opioid - therapeutic use ; Child ; Children ; Childrens health ; Chronic pain ; Chronic Pain - drug therapy ; Cohort Studies ; Comorbidity ; Drug therapy ; Drugs ; Female ; Fibromyalgia ; Health risk assessment ; Humans ; Male ; Malignancy ; Mental disorders ; Musculoskeletal diseases ; Musculoskeletal Pain - drug therapy ; Musculoskeletal Pain - epidemiology ; Musculoskeletal Pain - psychology ; Narcotics ; Neurodevelopmental Disorders - epidemiology ; Opioids ; OPIOIDS & SUBSTANCE USE DISORDERS SECTION ; Pain ; Pain in children ; Pain management ; Pain Management - methods ; Pediatric research ; Pediatrics ; Polypharmacy ; Practice Patterns, Physicians' - statistics & numerical data ; Prescribing ; Retrospective Studies ; Sex ratio ; Sickle cell disease ; Statistics</subject><ispartof>Pain medicine (Malden, Mass.), 2019-03, Vol.20 (3), p.495-503</ispartof><rights>2018 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2018</rights><rights>2018 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><rights>COPYRIGHT 2019 Oxford University Press</rights><rights>2018 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c525t-dc6623b94f8cb2f244426d8b7dbf411931cead2f320a6b46777721f9a7b0f7443</citedby><cites>FETCH-LOGICAL-c525t-dc6623b94f8cb2f244426d8b7dbf411931cead2f320a6b46777721f9a7b0f7443</cites><orcidid>0000-0003-3533-5698</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29905842$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gmuca, Sabrina</creatorcontrib><creatorcontrib>Xiao, Rui</creatorcontrib><creatorcontrib>Weiss, Pamela F</creatorcontrib><creatorcontrib>Sherry, David D</creatorcontrib><creatorcontrib>Knight, Andrea M</creatorcontrib><creatorcontrib>Gerber, Jeffrey S</creatorcontrib><title>Opioid Prescribing and Polypharmacy in Children with Chronic Musculoskeletal Pain</title><title>Pain medicine (Malden, Mass.)</title><addtitle>Pain Med</addtitle><description><![CDATA[Abstract
Objective
Thirty percent of adults with fibromyalgia receive an opioid, but the prevalence of opioid prescribing in pediatric chronic musculoskeletal pain is unknown. The aims of this study were to determine the prevalence of and factors associated with opioid exposure and polypharmacy among children with chronic musculoskeletal pain.
Methods
In this retrospective cohort study using health care claims data from 2000 to 2013, the index date was the first ICD-9 code 729.1. Included subjects were ≥ 2 and < 18 years old at the index date with two or more codes within 12 months and 18 months of continuous enrollment. Subjects with burns, sickle cell disease, or malignancy were excluded. Opioid exposure was defined as one or more prescriptions within six months before or any time after the index date. Polypharmacy was considered minor (2–4 medications) or major (≥5 medications).
Results
Of 25,321 included subjects, 20% received an opioid and 26% experienced minor polypharmacy. Opioid exposure was associated with female sex (odds ratio [OR] = 1.27, P < 0.01), Caucasian race (OR = 1.27, P < 0.01), hospitalization (OR = 1.20, P < 0.01), and visit with anesthesiology (OR = 1.97, P < 0.01) or orthopedics (OR = 1.09, P < 0.05). Mental health codes were associated with decreased odds of opioid exposure (all P < 0.05). Children seen by a chiropractor or physiatrist had a reduced odds of receipt of an opioid (OR = 0.42 and 0.84, respectively, both P < 0.01).
Conclusions
Twenty percent of children with chronic musculoskeletal pain received an opioid. Twenty-six percent experienced polypharmacy, with the majority receiving 2–4 medications. Increased availability of psychological and nonpharmacologic services are potential strategies to reduce opioid exposure.]]></description><subject>Adolescent</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Child</subject><subject>Children</subject><subject>Childrens health</subject><subject>Chronic pain</subject><subject>Chronic Pain - drug therapy</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Drug therapy</subject><subject>Drugs</subject><subject>Female</subject><subject>Fibromyalgia</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Male</subject><subject>Malignancy</subject><subject>Mental disorders</subject><subject>Musculoskeletal diseases</subject><subject>Musculoskeletal Pain - drug therapy</subject><subject>Musculoskeletal Pain - epidemiology</subject><subject>Musculoskeletal Pain - psychology</subject><subject>Narcotics</subject><subject>Neurodevelopmental Disorders - epidemiology</subject><subject>Opioids</subject><subject>OPIOIDS & SUBSTANCE USE DISORDERS SECTION</subject><subject>Pain</subject><subject>Pain in children</subject><subject>Pain management</subject><subject>Pain Management - methods</subject><subject>Pediatric research</subject><subject>Pediatrics</subject><subject>Polypharmacy</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Prescribing</subject><subject>Retrospective Studies</subject><subject>Sex ratio</subject><subject>Sickle cell disease</subject><subject>Statistics</subject><issn>1526-2375</issn><issn>1526-4637</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kU1LxDAQhoMofh_8A1LQi4dd89WkvQiy-AWKK-g5pGmyG22TmrTK_nsju4qCmDlkJnnmZYYXgAMExwiW5LRrTzu3QIitgW2UYzaijPD1VY4Jz7fATozPECJGC7IJtnBZwrygeBs83HfW2zqbBh1VsJV1s0y6VPtm0c1laKVaZNZlk7lt6qBd9m77eaqCd1Zld0NUQ-Pji250L5tsKq3bAxtGNlHvr-5d8HR58Ti5Ht3eX91Mzm9HKsd5P6oVY5hUJTWFqrDBlFLM6qLidWUoQiVBSssaG4KhZBVlPB2MTCl5BQ2nlOyCs6VuN1StrpV2fZCN6IJtZVgIL634_ePsXMz8m2Ck4GWBk8DRSiD410HHXjz7Ibg0s8AEEk4QYT-omWy0sM74JKZaG5U4Z3lZIIw4SdT4DypFrVurvNPGpvdfDSfLBhV8jEGb78ERFJ-miq4VS1MTe_hz02_yy8UEHC8BP3T_6HwAjNWpkQ</recordid><startdate>20190301</startdate><enddate>20190301</enddate><creator>Gmuca, Sabrina</creator><creator>Xiao, Rui</creator><creator>Weiss, Pamela F</creator><creator>Sherry, David D</creator><creator>Knight, Andrea M</creator><creator>Gerber, Jeffrey S</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-3533-5698</orcidid></search><sort><creationdate>20190301</creationdate><title>Opioid Prescribing and Polypharmacy in Children with Chronic Musculoskeletal Pain</title><author>Gmuca, Sabrina ; Xiao, Rui ; Weiss, Pamela F ; Sherry, David D ; Knight, Andrea M ; Gerber, Jeffrey S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c525t-dc6623b94f8cb2f244426d8b7dbf411931cead2f320a6b46777721f9a7b0f7443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Analgesics, Opioid - therapeutic use</topic><topic>Child</topic><topic>Children</topic><topic>Childrens health</topic><topic>Chronic pain</topic><topic>Chronic Pain - drug therapy</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Drug therapy</topic><topic>Drugs</topic><topic>Female</topic><topic>Fibromyalgia</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Male</topic><topic>Malignancy</topic><topic>Mental disorders</topic><topic>Musculoskeletal diseases</topic><topic>Musculoskeletal Pain - drug therapy</topic><topic>Musculoskeletal Pain - epidemiology</topic><topic>Musculoskeletal Pain - psychology</topic><topic>Narcotics</topic><topic>Neurodevelopmental Disorders - epidemiology</topic><topic>Opioids</topic><topic>OPIOIDS & SUBSTANCE USE DISORDERS SECTION</topic><topic>Pain</topic><topic>Pain in children</topic><topic>Pain management</topic><topic>Pain Management - methods</topic><topic>Pediatric research</topic><topic>Pediatrics</topic><topic>Polypharmacy</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Prescribing</topic><topic>Retrospective Studies</topic><topic>Sex ratio</topic><topic>Sickle cell disease</topic><topic>Statistics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gmuca, Sabrina</creatorcontrib><creatorcontrib>Xiao, Rui</creatorcontrib><creatorcontrib>Weiss, Pamela F</creatorcontrib><creatorcontrib>Sherry, David D</creatorcontrib><creatorcontrib>Knight, Andrea M</creatorcontrib><creatorcontrib>Gerber, Jeffrey S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pain medicine (Malden, Mass.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gmuca, Sabrina</au><au>Xiao, Rui</au><au>Weiss, Pamela F</au><au>Sherry, David D</au><au>Knight, Andrea M</au><au>Gerber, Jeffrey S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Opioid Prescribing and Polypharmacy in Children with Chronic Musculoskeletal Pain</atitle><jtitle>Pain medicine (Malden, Mass.)</jtitle><addtitle>Pain Med</addtitle><date>2019-03-01</date><risdate>2019</risdate><volume>20</volume><issue>3</issue><spage>495</spage><epage>503</epage><pages>495-503</pages><issn>1526-2375</issn><eissn>1526-4637</eissn><abstract><![CDATA[Abstract
Objective
Thirty percent of adults with fibromyalgia receive an opioid, but the prevalence of opioid prescribing in pediatric chronic musculoskeletal pain is unknown. The aims of this study were to determine the prevalence of and factors associated with opioid exposure and polypharmacy among children with chronic musculoskeletal pain.
Methods
In this retrospective cohort study using health care claims data from 2000 to 2013, the index date was the first ICD-9 code 729.1. Included subjects were ≥ 2 and < 18 years old at the index date with two or more codes within 12 months and 18 months of continuous enrollment. Subjects with burns, sickle cell disease, or malignancy were excluded. Opioid exposure was defined as one or more prescriptions within six months before or any time after the index date. Polypharmacy was considered minor (2–4 medications) or major (≥5 medications).
Results
Of 25,321 included subjects, 20% received an opioid and 26% experienced minor polypharmacy. Opioid exposure was associated with female sex (odds ratio [OR] = 1.27, P < 0.01), Caucasian race (OR = 1.27, P < 0.01), hospitalization (OR = 1.20, P < 0.01), and visit with anesthesiology (OR = 1.97, P < 0.01) or orthopedics (OR = 1.09, P < 0.05). Mental health codes were associated with decreased odds of opioid exposure (all P < 0.05). Children seen by a chiropractor or physiatrist had a reduced odds of receipt of an opioid (OR = 0.42 and 0.84, respectively, both P < 0.01).
Conclusions
Twenty percent of children with chronic musculoskeletal pain received an opioid. Twenty-six percent experienced polypharmacy, with the majority receiving 2–4 medications. Increased availability of psychological and nonpharmacologic services are potential strategies to reduce opioid exposure.]]></abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>29905842</pmid><doi>10.1093/pm/pny116</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-3533-5698</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1526-2375 |
| ispartof | Pain medicine (Malden, Mass.), 2019-03, Vol.20 (3), p.495-503 |
| issn | 1526-2375 1526-4637 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6387982 |
| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Adolescent Analgesics, Opioid - therapeutic use Child Children Childrens health Chronic pain Chronic Pain - drug therapy Cohort Studies Comorbidity Drug therapy Drugs Female Fibromyalgia Health risk assessment Humans Male Malignancy Mental disorders Musculoskeletal diseases Musculoskeletal Pain - drug therapy Musculoskeletal Pain - epidemiology Musculoskeletal Pain - psychology Narcotics Neurodevelopmental Disorders - epidemiology Opioids OPIOIDS & SUBSTANCE USE DISORDERS SECTION Pain Pain in children Pain management Pain Management - methods Pediatric research Pediatrics Polypharmacy Practice Patterns, Physicians' - statistics & numerical data Prescribing Retrospective Studies Sex ratio Sickle cell disease Statistics |
| title | Opioid Prescribing and Polypharmacy in Children with Chronic Musculoskeletal Pain |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-22T19%3A57%3A05IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Opioid%20Prescribing%20and%20Polypharmacy%20in%20Children%20with%20Chronic%20Musculoskeletal%20Pain&rft.jtitle=Pain%20medicine%20(Malden,%20Mass.)&rft.au=Gmuca,%20Sabrina&rft.date=2019-03-01&rft.volume=20&rft.issue=3&rft.spage=495&rft.epage=503&rft.pages=495-503&rft.issn=1526-2375&rft.eissn=1526-4637&rft_id=info:doi/10.1093/pm/pny116&rft_dat=%3Cgale_pubme%3EA659812173%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2303731362&rft_id=info:pmid/29905842&rft_galeid=A659812173&rft_oup_id=10.1093/pm/pny116&rfr_iscdi=true |