Pedia Pain Focus

Rare diseases are...well rare, but pain and suffering associated with them is not! It requires early recognition or even preempting the pain inoder to prevent development of chronic an drefractory pain.

In commemoration of the International Rare Diseases Day, I bring you an episode focused on promptly identifying and managing the pain associated with pediatric rare diseases and the challenges associated with that.

Takeaways in This Episode

• Why we should talk about rare diseases.
• What makes a disease rare and what is an orphan disease
• Which rare diseases are commonly encountered amongst children
• How big an issue is pain management for these children
• Common causes leading to pain experiences in a rare disease
• Common challenges to managing pain in a rare disease
• What should a healthcare professional know and do about managing pain for these children

Links

Pedia Pain Focus #51. Digital Interventions for Self Management of Pediatric Pain

National Organization for Rare Disorders

American Syringomyelia and Chiari Alliance Project

The Ehlers-Danlos Society

Society for Pediatric Pain Medicine

IASP - Pain in Childhood

Pediatric Pain Listserve

Proactive Pain Solutions

Since the COVID-19 pandemic, use of digital technology in healthcare has become commonplace, but Dr. Tonya Palermo, PhD has spent more than 2 decades researching and developing digital interventions for management of children's pain.

In this episode she discusses the origin and development of her free app for self management of pediatric pain, WebMAP, its components, who its applicable for and how healthcare professionals can use it in their clinical practice to empower and equip their patients and families with self management strategies.

Takeaways in This Episode

• How serendipity got Dr. Palermo on the path to becoming the most prolific researcher in pediatric pain
• Dr. Palermo's first foray into digital interventions for accurate measurement of pediatric pain using a palm pilot, for patterns of pain and patterns of activity limitation.
• Use of website to collect data and offer simple interventions for kids and families living in remote areas.
• Surprising finding she saw in relation to acceptance and outcomes from these interventions
• The platform to deliver interventions designed to improve pain care and lifestyle interventions that promote wellness and change in behaviors (Hint: Psychology based interventions).
• Precursor to the WebMAP program and its progression
• What WebMAP is, who it is for, and how HCPs can integrate it in clinical care. (Tips Sheet included in the links link)
• What they did to ensure and drive patient/parent engagement
• Uniques feature and opportunities for improvement of WebMAP
• Challenges associated with use of m-health and digital interventions in healthcare
• Whats working and what she's focused on now and in future
• How she manages to do it all and what advice she has for the aspiring professionals

Links

Tonya Palermo, PhD

Contact Dr. Tonya Palermo

Pediatric Pain and Sleep Innovations Lab

WebMAP Mobile App

Tip Sheet for Healthcare Professionals

Solutions for Kids in Pain (SKIP)

Proactive Pain Solutions Physicians Academy

Cognitive Behavioral Therapy for Chronic Pain In Children and Adolescents

Managing your Child's Chronic Pain

About the Speaker

Tonya Palermo, PhD

Dr. Tonya Palermo is a professor of anesthesiology, pediatrics and psychiatry at the University of Washington School of Medicine. She serves as associate director for the Center for Child Health, Behavior and Development. Palermo's longstanding NIH-funded research program has focused on assessment and treatment of chronic pain in children and adolescents. She is specifically interested in cognitive-behavioral interventions; delivery of psychological treatment via eHealth and mHealth interventions; sleep disturbances; and parent/family factors as they relate to pain treatment. Through her work as program director for the University of Washington Anesthesiology T32 program and for the Psychology Postdoctoral Fellowship Program in Pain Research, Palermo is active in training clinician–scientists at the postdoctoral and junior faculty level.

Palermo serves on the executive boards of the Society of Pediatric Psychology and the American Pain Society, serves as editor of the Journal of Pediatric Psychology and has been elected a fellow of the American Psychological Association. She also serves as a member of the advisory council for the Center for Scientific Review at NIH.

Up to 50 percent of medical professionals, like the lay people, believe there are biological differences between the Caucasian and African-American patients' bodies when it comes to pain perception. How much of that is truth and how much is myths and misconceptions is debunked in this episode.

I also explore the factors contributing to the well documented disparities in assessment and management of pain amongst the African-American and black populations. More importantly, I recommend solutions at the individual and broader systems level to improve the pain care for these patients.

Takeaways in This Episode

• Factors that may determine the quality and quantity of care a black patient may receive.
• Racial disparities in pain care and how they show up
• Historic perspective on pain perception, threshold and tolerance of pain among African American and black population
• Factors contributing to pain care disparities for African American and black patients
• In-group bias and how it impacts pain care
• Why everyone in healthcare should take the Implicit Association Test and what that means
• Ways to address pain care disparities at individual and systems level

Links

Pedia Pain Focus Episode # 47. Reliving or Relieving Children's Pain

Pedia Pain Focus Episode # 48. Making Best Pain Care Everywhere Achievable

Enroll in Proactive Pain Solutions Physicians Academy

CDC Guidelines for Prescribing Opioids

Implicit Association Test

IASP

Proactive Pain Solutions

Treatment interventions based in psychology form the mainstay of pain management, particularly for children's pain. Yet, these may not receive the due priority and/or many not be easily accessible for patients and families. Use of psychological based treatments for pain may inadvertently create stigma around the nature of the child's pain diagnosis, for patients, families and even the healthcare professionals who may not be familiar with pain management. The end result being, inadequate pain care, mistrust, and frustration for all involved.

Dr. Rachael Coakley, PhD. of the Boston Children's Hospital shares the role of, challenges to and her innovative solution, the Comfort Ability Program, to address this gap.

Takeaways in This Episode

• The reasons for a gap in access to psychological based pain care interventions
• Stigma around psychological treatments and what might propagate it.
• Things healthcare professionals do and implement to change the perception around role of psychological treatments
• Use of metaphors for explanation of the pain conditions, and role of various treatments.
• The real hurdle in healthcare right now
• The message that healthcare professionals can and should be giving the pain patients and their families
• Why Dr. Coakley chose to pursue pediatric pain management and the formative experience that lead her career path.
• The tight rope that parents walk with their children's pain
• The driving force behind creation of the Comfort Ability program
• Elements of the Comfort Ability program, who it's for and how healthcare professionals can access and utilize it for their patients and families
• The mission and goal of the Comfort Ability program
• Dr Coakley's message for healthcare professionals

Links

Rachael Coakley, PhD.

Connect with Dr. Rachael Coakley on twitter

The Comfort Ability Program

Contact the Comfortability Program

When Your Child Hurts

Pedia Pain Focus Episode # 27

Join the Proactive Pain Solutions Academy

Proactive Pain Solutions

About the Guest Speaker

Rachael Coakley, PhD.

Dr. Rachael Coakley is pediatric pain psychologist in the Department of Anesthesia, Critical Care and Pain Medicine at Boston Children's Hospital, where she serves as the Director of Clinical Innovation and Outreach in Pain Medicine and the Associate Director of Psychological Services. Additionally, she is Founder and Director of The Comfort Ability Program, an internationally disseminated program that teaches evidence-based pain management skills to adolescents with chronic pain and their parents. Dr. Coakley is an Assistant Professor of Psychology, Harvard Medical School and holds national and international leadership positions.

Dr. Coakley completed her undergraduate work at The University of Pennsylvania and her doctoral studies at Loyola University in Chicago. She completed fellowship at Boston Children's Hospital and joined the Pain Treatment Service in 2006.

Dr. Coakley's career focuses on translational research of evidence-based psychological intervention for pediatric pain management. For her work in program development and for enhancing access to clinical care for patients with chronic pain, she was honored with the 2016 David Weiner Award for Leadership and Innovation in Child Health and with the American Psychological Association's 2020 Carolyn Schroeder Award for outstanding clinical practice.

Outside her work in program development, Dr. Coakley enjoys writing and lecturing to help educate parents and providers about chronic pain. Her 2016 book, "When Your Child Hurts: Effective Strategies to Increase Comfort, Reduce Stress and Break the Cycle of Chronic Pain"(Yale University Press), won a national book award for best parenting book (NAPPA). Her writing is also featured in her ongoing Psychology Today column, the Washington Post, and numerous other publications.

Appropriate and timely pain care, especially for children, is a necessity and every clinician's responsibility. Yet our training system fails to provide the clinicians with those necessary skills and tools. In this episode, Dr Tracy Harrison, MD from the Mayo Clinic, discusses the importance, knowhow of necessary skills and leaves you with practical skills you can put into practice right away!

Takeaways in This Episode

• Dr. Harrison's interest and work in pediatric pain medicine
• Reasons for the discrepancy in pediatric pain care across institutions and geographical locations
• Implications and impact for pain care discrepancy in pediatric pain
• Whose responsibility is it to ensure "best pain care everywhere"
• Barriers to best pain care everywhere
• What can you as a clinician do to contribute to best pain care for children under your care
• Dr. Harrison's advice to all clinicians caring for children's health.
• Dr. Harrison's advice for pediatric pain specialist and what our responsibility is in achieving this goal.

Links

Tracy Harrison, MD

Connect with Dr. Harrison on Twitter

Pedia Pain Focus Episode # 38. Why Pediatric Pain Education is Failing and How to Fix It

Pedia Pain Focus Episode # 26. Manage Memory Manage Pain!

Join the Proactive Pain Solutions Physicians Academy

Proactive Pain Solutions

About the Speaker

Tracy Harrison, MD

Tracy Harrison, MD is a board certified pediatric anesthesiologist, pain medicine, palliative care and hospice care physician. She's an Assistant Professor, Dept of Anesthesiology and Perioperative Medicine at the Mayo Clinic in Rochester, MN. She is the co-director of the Pediatric Pain Rehabilitation Center that treats some of the most complex chronic patients who are significantly disabled by their pain, from all over the globe. She has many publications to her credit and is an invited speaker at national and international pediatric pain meetings. She chairs the Patient and Family Advocacy Council at the Mayo Clinic's Children's Center.

For most clinicians thinking about policy conjures up images of legislative or regulatory work that goes on "over there", but the truth is that our daily work is the very foundation of the policies. How we conduct the business of our daily work drives the quality, safety, evidence and ultimately the policy and guidelines for appropriate pediatric pain care.

Dr. Fiona Campbell, MD, FRCA, the co-chair of the Canadian Pain Task Force, shared her experience and advice around policy work to improve pediatric pain care.

Takeaways in This Episode

• How Dr Fiona Campbell, MD, FRCA got engaged in pediatric pain management and then on to chairing the Canadian Pain Task Force.
• What Policy work entails and how you may already be doing it.
• How you can get started and influence the quality of pediatric pain care
• How to drive engagement from decision makers
• Determining what is the purpose of your work
• The 5 pillars of the Canadian Pain Task Force and its implications globally
• Dr. Campbell's advice to pediatric pain care professionals
• How Dr. Campbell is a complete rockstar both in her personal and professional lives (ok, that's my assessment of the situation, but I'm sure you'll agree with me too!)

Links

Fiona Campbell, MD, FRCA

Connect with Dr Campbell on Twitter

Canadian Pain Society

Canadian Pain Task Force

Solutions for Kids in Pain (SKIP)

Childkind International

Working together to better understand, prevent and, manage chronic pain: What We Heard

Chronic pain in Canada, laying a foundation for action.

Proactive Pain Solutions Physicians Academy

Proactive Pain Solutions

About the Author

Fiona Campbell, MD FRCA

Dr. Fiona Campbell is a Professor at the University of Toronto, and Medical Director of the Chronic Pain Program in the Department of Anesthesia & Pain Medicine at the Hospital for Sick Children. She is the Co-Director of the SickKids Pain Centre, co-chair of the Ontario Chronic Pain Network in partnership with the Ministry of Health and Long-term Care. Dr. Campbell served as the President of the Canadian Pain Society and has been appointed by Health Canada as Co-chair of the Canadian Pain Task Force - a national strategy for pain for all Canadians of all ages.

Dr. Campbell's research contributions involve utilizing quality improvement methodology to improve pain outcomes for hospitalized children, and identifying risk factors involved in the transition from acute to chronic pain. Dr. Campbell has also won a SickKids Centre for Innovation competition, and developing an app for tracking chronic pain in kids.

She is involved in pain education initiatives for both Health Professionals, and children and families. Fiona is Senior Editor on the Pain Editorial Board of www.Aboutkidshealth.ca/pain a SickKIds website for children and families that contains a wealth of information about pain. She is also the medical lead on the development of an online pediatric pain curriculum for prelicensure students and entry level health professionals, based on the International Association for the Study of Pain (IASP) Curriculum.

Appropriate pain management is a key driver for both the patient's and healthcare professional's satisfaction. With the recent healthcare crisis and changes to how outcomes and patient satisfaction is evaluated, pain care skills have become paramount.

Pediatric pain management impacts every healthcare professional's practice and IS everyone's responsibility. Yet pain care skills and pain education is sparse and inconsistent.

In this episode we discuss the scope of pediatric pain issues, why it is important to address them and why and how each healthcare professional plays a key role in children's pain management and therefore must consider honing, at a bare minimum, their basic pain management skills.

Takeaways in This Episode

• Changes in in the healthcare practice and role pain management plays
• Scope of pediatric pain
• Impact of children's pain
• How pediatric pain care affects delivery of healthcare
• How healthcare costs, reimbursement and productivity are related to pain management
• What does healthcare professionals' satisfaction have to do with appropriate pain management or honing pain care skills?
• Drivers of healthcare professionals' satisfaction
• Drivers of patient satisfaction
• How pediatric pain management skills will ensure job satisfaction, and job security?

Links

Proactive Pain Solutions Physicians Academy

Proactive Pain Solutions

HCAHPS

Press Ganey Scores

Undertreatment of children's pain is pervasive despite scientific advances, and national guidelines. Some of that is a result of common mistakes healthcare professional are making, often unknowingly.

This episode explores the 5 of the most common and what I call the most nefarious but easy to address mistakes when dealing with pediatric pain management.

Takeaways in This Episode

• A common challenge faced by most healthcare professionals
• A conceptual fallacy around pain
• How even acute presentation of pain may not simply be a symptom of another disease or cause and how that impacts its management
• Multiple benefits of prioritizing pediatric pain management (Hint: Benefits for the HCPs)
• Role played by regulatory bodies like JCAHO, CMS in negatively impacting pediatric pain management
• Role of diagnostic tests, and parents involvement
• The widespread impact of pediatric pain

Links

IASP Wait Times Guidelines

Pedia Pain Focus Episode #41

Pedia Pain Focus Episode #42. There are No "Difficult" Patients

Pedia Pain Focus Episode #38. Why Pediatric Pain Education is Failing and How to Fix It.

Proactive Pain Solutions Physicians Academy

FREE Pediatric Pain Management Masterclass

Proactive Pain Solutions

Most people start the new year with new resolutions, but 80% of them fail by February. That's not to say that one shouldn't cross the threshold into the next year with some goals and intentions. On the contrary, that is exactly what one must do. However, like intenstions, goals too fail if not considered carefully.

In this episode, we provide a sound framework to help you not just set meaningful and effective goals, but also strategies to ensur ethat you knock them out of the park over the next 12 months.

Takeaways in This Episode

• Why it is important to create goals
• Benefits of goal setting
• What should you include and consider when you set goals
• What makes your goals effective and appropriate
• The "Purge" and "Prune" strategy for goal setting
• How to refine your goals
• How to ensure you stay on track and turn your year into a resounding success

Links

Pedia Pain Focus Episode 40. Owning Your Role as a Physician Leader in Today's Healthcare.

Proactive Pain Solutions Physicians Academy

Proactive Pain Solutions

Goal Setting with Confidence

What an incredible year 2020 has been. We've seen the lowest of lows, "once in a life time" experiences and hardships. Yet there have been glimmers of positivity and progress all along and it seems to be concluding with the triumph of science and hope over a pandemic that had brought the world to its knees.

Despite the challenges of this year, we have had amazing pediatric pain experts sharing their expertise here and it's been an incredible pleasure to compile some of the highlights from some of our most popular and episodes!

Takeaways in This Episode

• The reason behind the creation of this "Best of" episode.
• What is a "opposite pain scale" and why that is a better way to assess your patients pain issues and treatment outcomes?
• How shifting your mindset can completely alter the treatment outcomes for your patients?
• Addressing the opioids and substance abuse/addiction issues amongst children and youth.
• Elements of opioid stewardship and responsible pain management
• How spinal analgesia helps health outcomes for children and elements for developing a spinal analgesia program.
• Impact of memory, language and reframing in the pain experience of children, persistence of pain and how to reframe it for optimal outcomes.
• Metaphors for explanation of pain to children and families and a highly effective framework you can use in your practice today.
• Creating engagement and empowerment of patients and families in multidisciplinary treatment of their pain.

Links

Pedia Pain focus Episode #20. You may be Perpetuating your patients' pain instead of treating it

Pedia Pain focus Episode #35. Managing Pain in Children and Youth with Addiction and Substance Use Disorder

Pedia Pain focus Episode #29. Opioid Stewardship: Responsible Pediatric Pain Care!

Pedia Pain focus Episode #31. Spinal Analgesia for Babies: What's All That Fuss About?

Pedia Pain focus Episode #26. Manage Memory, Manage Pain!

Pedia Pain focus Episode #27. Interdisciplinary Pain Education is Necessary to Change the Face of Pediatric Pain Management

Proactive Pain Solutions Physicians Academy

Proactive Pain Solutions