It is time for the federal government to proactively address chronic pain and the epidemic of opioid misuse in children and adolescents.

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THE National Institutes of Health has recently issued the National Pain Strategy, aimed at a “cultural transformation in the prevention, care, education, and research of pain by providing a comprehensive population health-level strategy.”

Just days earlier, the Centers for Disease Control and Prevention issued its Guideline for Prescribing Opioids for Chronic Pain in an effort to curb the growing problem of opioid misuse while providing for the needs of patients with chronic pain.

These documents are to be heralded for their efforts to raise awareness and begin inroads to address two huge and related problems in our society: the disease of chronic pain and accidental deaths associated with opioid misuse. However, these documents have something else in common: Both omit nearly one-fourth of the population — people under the age of 18.

Epidemiologic data indicate that about 8 percent of children and adolescents have chronic pain severe enough to interfere with critical activities, such as attending school or socializing with friends. Besides the immediate disruption to their lives and those of their family members, many of these children grow up to become adults with chronic pain.

Similarly, the CDC reports on its own website that nearly 2 million Americans 12 years of age or older either abused or were dependent on opioids in 2013 and that 2.6 of 100,000 people in the United States between the ages of 15 and 24 died of a prescription-opioid overdose. Clearly the opportunity for preventing these disastrous outcomes is lost without attending to the issues early on.

As the director of a pain-medicine program at a major children’s hospital, I see the impact of these challenges regularly. As discussed in the National Pain Strategy, children and adolescents across the country often undergo an array of medical tests and procedures because chronic pain conditions are so poorly understood. Many of these procedures are invasive, expensive and unnecessary. Unfortunately, some of these young people also have had prescriptions for opioids, which not only are ineffective for their pain concerns, but often make the entire clinical situation worse.

For the National Pain Strategy, of the 13 oversight members and about 80 work group members and expert consultants who contributed to the document, not a single pediatric pain expert is to be found. The same was true for the CDC guidelines.

Both of these reports sought public commentary before their publication — there was a groundswell of response from those interested in the well-being of children. The National Pain Strategy is rooted in recommendations from an Institute of Medicine committee co-chaired by a pediatrician, who directly voiced interest in having children’s pain needs addressed.

Future policies, funding initiatives and educational endeavors undoubtedly will be spawned from these statements, and the lack of emphasis on children will have resounding effects for years. It is easy to say that children are included in the population focus of the National Pain Strategy, but such a notion cannot be assessed without those who have the expertise to do so.

The stated objective of the National Pain Strategy is to decrease the prevalence of pain across its continuum from acute to high-impact chronic pain and its associated morbidity and disability across the life span. The life span does not begin at 18 years.

The state of Washington insightfully included pediatrics in the most recent version of the Interagency Guideline on Prescribing Opioids for Pain. Now it is time for the federal government to proactively invoke parallel efforts to address chronic pain and the epidemic of opioid misuse in children and adolescents.

Those who lack voice to advocate for themselves must not be ignored or included as a mere afterthought.