Adolescents, aged 13-15, account for the majority of sports injuries in youth. Tailoring treatment to the patient’s age and life style is important in order to promote prompt healing and decrease the chances of repeat injury.
There are several things to consider when treating pain stemming from a sports injury in a pediatric patient. For example, codeine, previously a mainstay in the treatment of pain, may not be the best choice, especially for children and adolescents. Codeine’s analgesic effects are due to its metabolism or conversion to morphine in the body via the cytochrome P450 enzyme system. In this age group, this system is not fully developed and thus high doses and blood levels of codeine or morphine don’t always correlate with analgesic effects. Another class of drugs used to treat pain in youth is NSAIDS. Drugs in this class (i.e., ibuprofen, ketoprofen) are effective oral analgesics, but their dosing frequency and timing may not be ideal for a busy school-aged patient. Oral NSAIDs should be administered with meals to avoid stomach upset, however, children’s eating habits and meal times aren’t always predictable.
Studies, including a large meta-analysis, have described the advantages of topical vs. oral NSAID therapy. These include high tissue levels of medication at the site of injury, with minimized systemic side effects, such as stomach upset and drowsiness. Odorless and easy-to-apply creams or gels can be compounded using the most appropriate types of medications based on the individual’s specific needs. The use of compounded topical therapy can play an important role in getting adolescents back in the game!
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