Pedia Pain Focus

With 15% of all healthcare encounters classified as "challenging", it is likely that you will or have already experienced one. It's easy to pin that on a "difficult" patient or family. Listen to find out why there's no such thing as "difficult" patients or families.

Takeaways in This Episode

• Dr. Groves' classification for"Hateful" patients
• Why there are no difficult patients
• Contributing factors to challenging or difficult patient-clinician encounters
• Why root cause analysis is necessary to have a smooth patient care visit and positive outcomes
• Clinicians role in the challenging patient encounters
• How to effectively manage these difficult clinician-patient encounters

Links

Managing Disagreements and Misalignment of Opinions in Pediatric Pain Care

Taking Care of the Hateful Patient

You Might be Perpetuating Your Patients Pain instead of Treating it

Owning your role as a Physician leader in Today's Healthcare

Storytelling in Pediatric Pain Medicine (Part 1 and Part 2)

Proactive Pain Solutions Physicians Academy

Proactive Pain Solutions

Therapeutic Triangle

Differences in opinions can be real roadblocks in our patient's progress and reasons for Misalignment in pediatric pain care are manifold and multilayered.

To address them effectively, we must be tactful, because opinions are often closely tied/rooted in with people's emotions rather than objective information or knowledge.

In this episode of Pedia Pain Focus, we explore what situations may lead to a difference of opinion between, patients/families and healthcare professionals or even between different HCPs involved in a patient's care, and how to address those situations.

Takeaways In This Episode:

• Various players that make pediatric pain management susceptible to misalignment of opinions
• Reasons and situations that contribute to differences of opinion and misalignment in pediatric pain care
• Why a parent may feel that they/their child is not believed
• What a healthcare professional can do to create alignment and engage patients and families
• Code of ethics for physicians/healthcare professionals and the Hippocratic oath to address the differences of opinion on health care
• Therapeutic interaction
• Alliance Consultation
• Managing differences of opinion with other healthcare professionals

Links

Pedia Pain Focus Episode #40

AMA Code of Medical Ethics

Proactive Pain Solutions Physicians Academy

Proactive Pain Solutions

Critical Role of Primary Care in Pediatric Pain Management

Caring for Ehlers-Danlos Syndrome

As influential citizens in society marked by our extensive medical education, we as pediatric pain physicians need to astutely assess the landscape of healthcare in the 21st century situation and adapt as professionals to embrace our true role and improve our service to our patients, institutions and the society.

We can do this by first acknowledging the situation and taking it as it is-- The changing expectations from HCPs with evolving definition of efficiency and efficacy with evolution of technology, and of how we relate or communicate with each other. We must integrate and adapt to create a more inclusive, compassionate, yet value-packed process of healthcare delivery in pediatric pain medicine. It is only by acknowledging and embracing these changes that we can make progress as well.

Information is more readily available to our patients now, eliminating the status of physicians as the "the" source of medical care. We must remain as the most credible source of information and carefully guide them through this onslaught of unrefereed health information with kindness and compassion, helping them understand why what we prescribe for their situation is the optimal course.

I will share how there has been an evolution of the modern physicians' role and why we must step up and claim the leadership role in pediatric healthcare-- particularly as a pediatric pain physician.

Takeaways in This Episode:

• The roles a physician plays (or expected to play)
• Navigating situations that involve pediatric patients' pain
• The delicate balance of standardized vs. personalized care
• Understanding and evaluating the influences of pain and its impact on healthcare
• Health information availability online and how they affect us as physicians
• How we deal with these new trends
• Our role as a pediatric pain physician in the context of non direct patient care.
• A recap of our new bigger roles in patient care

Links:

• 3 Areas every healthcare provider can influence
• Kids Are Not Small Adults
• Proactive Pain Solutions
• Pediatric Pain Physician's Academy Waitlist
• International Association for the Study of Pain (IASP)
• ChildKind International
• Society for Pediatric Pain Medicine

For the complete list of our podcasts:

• Podcast | PediaPainFocus

The pandemic has forced the healthcare industry to leverage its resources in order to better adapt and combat the new challenges it has brought. This also inspired us in healthcare to take a closer look at how we can utilize the available technology more effectively and efficiently.

In this episode, Dr. Rashmi Bhandari, PhD, a pediatric pain psychologist at Stanford University, shares the instrumental role of learning health systems for improved outcomes when treating children's pain. Dr. Bhandari believes that decisions about appropriate treatments are dependent on accurate data.

She'll talk about how big data plays in the management of children's pain and for improving treatment outcomes for all involved. We will also compare and contrast some of the aspects of CHOIR with other databases and registries.

Listen to this episode as we explore the patient outcomes based database and data registries as well as the highlights of some of Dr. Rashmi's work and contribution in the area of utilizing databases registries for improving health outcomes for children's pain!

Takeaways In This Episode:

• How Dr. Rashmi Bhandari became a pediatric pain psychologist
• Patient outcomes based databases and data registries
• Dr. Bhandari expound her specific database and data registry
• Dr. Bhandari sheds light on the learning health systems that she's involved with
• Important components needed for CHOIR to capture the unique aspects of pediatric pain
• The difference between the parent or caregiver date versus the children's data
• The cost of implementing a learning health system
• How one can access or participate in Peds-CHOIR

Links:

• Rashmi Bhandari, PhD
• • LinkedIn
  • Stanford Profile
• Peds-CHOIR
• RedCap
• PROMIS tool
• EPOC
• Proactive Pain Solutions Physicians Academy
• Kids Are Not Small Adults: Need for Pediatric Pain Care

About Our Guest:

Dr. Rashmi Bhandari

Dr. Rashmi Bhandari joined the Pediatric Pain Management Clinic and Stanford faculty in 2005 and has since been working with children who have complex chronic pain conditions and their families. She is the Director of Psychology Services for the Pediatric Pain Clinic and oversees all aspects of clinical pain psychology services. In addition to practicing behavioral pain medicine, Dr. Bhandari is the director of the pediatric pain psychology fellowship training. The education curriculum created for the pain psychology fellowship is now the leading standard in the field, educating future pediatric psychologists who want to specialize in pain medicine. Dr. Bhandari has extensive training in bio behavioral interventions for chronic pain such as biofeedback and is certified by the American Society of Clinical Hypnosis.

Dr. Bhandari is a committed clinician, educator, and researcher with a focus on assessment and development of treatment interventions to improve the lives of youth with chronic pain. Decisions about the appropriate treatments, however, are dependent on accurate and useful data—data that have been lacking for adults and children who experience chronic pain. This lack of information inspired the creation of a health registry called CHOIR. Dr. Bhandari helped lead the pediatric adoption of CHOIR, called Peds-CHOIR (Pediatric Collaborative Health Outcomes Information Registry) which is a novel, open-source outcome-dual tracking vehicle for youth with chronic pain and their caregivers. This registry is utilized by clinicians to offer patient tailored interventions in real time while creating opportunities to study important predictors and consequences of treatment factors.

Dr. Bhandari, has successfully led the Pediatric Pain Clinic in multiple clinical innovations including tele-medicine, canine-assisted therapy, and sleep treatment interventions to continue offering evidence based treatments and improving access to care.

Pediatric pain education and training is very limited and there are several barriers contributing to this failure, but there is one fatal flaw that has been long overlooked. In this episode Dr Anjana Kundu, MD, ABIHM, FAAP discusses the current state of pediatric pain medicine, specifically as it related to training, including one fatal flaw and how that can be addressed.

Takeaways in this episode

• The multidimensional impact of pediatric pain.
• Current state of pediatric pain.
• Current state of training in pain medicine, especially in pediatric pain medicine.
• Barriers to training in pediatric pain management.
• Timing and amount of pediatric pain management training.
• How lack of pediatric pain medicine training can lead to burnout.
• Available resources for additional education and training in pediatric pain management.
• The fatal flaw in pediatric pain medicine training.
• Knowledge-to-action gap and how to address it.
• Unique contributions of Proactive Pain Solutions to pediatric pain medicine training.
• Bottomline on pediatric pain education and training.
• What the clinicians and administrators should prioritize when it comes to pediatric pain management.

Links

Pediatric pain; a team sport in need of transformation

Kids Are Not Small Adults

Why Investing in Pediatric Pain Management is the Cost-efficient Answer to a Public Health Crisis

IASP Pain Education Curricula

Proactive Pain Solutions Physicians Academy

IASP Special Interest Group on Pain in Childhood

OPENPediatrics - Boston Children's Hospital

The Online Pediatric Pain Curriculum (The Hospital for Sick Children [SickKids] – OPPC)

The Pediatric Pain Master Class (Children's Minnesota)

Authenticity is highly valued: On the whole, we don't like or trust people who come across as phony and false. With major emphasis on patient and family centered care, Healthcare Professionals are asked to be "more relatable, approachable and more authentic", but is that really consistent with the definition of being authentic?

Authenticity in healthcare has qualifiers and in this episode I dissect the anatomy of authenticity, examine what those qualifiers are and how you can differentiate effective from ineffective authenticity.

Takeaways in This Episode

• Definition of authenticity
• Core qualities that contribute to authenticity
• What are the qualifies to authenticity for a healthcare professional?
• How does one show measurable vulnerability?
• What is a provisional self and how does one create it?
• What is "emotional labor" and how to avoid it?
• Do authenticity and conformity go together?
• "Idiosyncrasy credit" and why does one need it?
• Effective Vs. ineffective authenticity.

Links

What is Unique about Managing Pediatric Pain During a Pandemic for Patients, Parents and HCPs

Proactive Pain Solutions Academy Waitlist

Historically children's pain has been poorly understood and treated, replete with misconceptions that though improving, still persist. Children deserve to be tended to with proper treatment and care. In order for them to grow healthy, responsible and happy citizens of the world, they need to be in an environment that fosters growth, learning and protects them from unnecessary suffering and illness.

Children are not small adults. In this episode, I'm joined with Dr. Finley, a pediatric anesthesiologist and pain physician, to discuss what's unique about pediatric pain and why we can't just treat children as small adults especially when it comes to pain management.

Dr. Finley is a trailblazer in pediatric pain medicine. He is the co-leader of the ChildKind International Initiative, and has worked for over 20 years in pain research and management. He has published over 100 papers in peer-reviewed journals and has lectured widely, with more than 230 invited presentations on six continents. Dr. Finley is passionate about pain service development and how to spread awareness and better improve pain care for children.

Listen to this episode as we talk about what we can do as healthcare professionals to advance pediatric pain medicine and serve more children!

Takeaways In This Episode

• The role Canadian healthcare professionals have played in the development of pediatric pain research
• What's unique about the environment in Canada that allows pediatric pain research to flourish
• What's unique about children and their pain
• The biggest reason (and other barriers) for failure to treat pain
• How we can achieve pain treatment for kids more responsibly
• The skills that pediatric practitioners need for appropriate management of pediatric pain
• The four components of a comprehensive pain management program
• Dr. Finley's advice to aspiring clinicians wanting to pursue a career in pediatric pain management

Links

• Allen Finley, MD FRCPC, FAAP
• • LinkedIn
  • Email: [email protected]
• Cultivating Resilience During Times of Stress and Trauma
• Pediatric Pain: a team sport in need of transformation
• 3 Areas every healthcare provider can influence to improve children's pain care
• PEDIATRIC-PAIN Listserve
• ChildKind International
• IASP Virtual Series
• Solutions for Kids in Pain (SKIP)
• Proactive Pain Solutions Physicians Academy

About Our Guest

Dr. Allen Finley

Dr. Allen Finley is a pediatric anesthesiologist who has worked for 25 years in pain research and management. He is Professor of Anesthesia and Psychology at Dalhousie University, and holds the inaugural Dr. Stewart Wenning Chair in Pediatric Pain Management at the IWK Health Centre in Halifax. He has published over 120 papers in peer-reviewed journals and has lectured widely, with more than 250 invited presentations on six continents.

He started the PEDIATRIC-PAIN e-mail discussion list in 1993, bringing together pain researchers and clinicians from over 40 countries. His own research and educational projects have recently taken him to Jordan, Thailand, China, Brazil, and elsewhere.

His main interest is pain service development and advocacy for improved pain care for children around the world, and he is co-leader of the ChildKind International Initiative.

Overdose related deaths have continually increased in the United States over the past 2 decades. Substance abuse and mental health disorders are the NUMBER ONE contributor to adverse health effects among young people. Though it is so prevalent its impact on children is rarely mentioned. The added complexities of pain management in the setting of substance abuse and addiction, require a clear understanding of the issue, due diligence and coordination of care.

In this episode, we discuss substance abuse among youths, its prevention, treatment options, resources for clinicians, and management of pain in the setting of substance abuse and addiction, with two pediatric pain experts from UCSF Benioff Children's Hospital;

Dr. Amber Borucki MD, a Board Certified pediatric anesthesiologist and pain physician, and Dr. Veronika Mesheriakova MD, an adolescent medicine physician with specialization in pediatric substance use disorders and addiction.

Takeaways in This Episode

• How Dr. Amber Borucki and Dr. Veronica Mesheriakova got interested in addiction and pediatric pain management and how they created opportunities for specialization.
• The scope of the problem of substance use disorder amongst children, teens, and youth.
• Why substance abuse, as well as mental health disorders is the top contributor for health burdens amongst young people and what the TOP offender is (Hint: It's normalized in our society!)
• The most vulnerable age group(s) when it comes to addiction
• Perception of alcohol and nicotine use. How alcohol use in households and social context impacts children and young people.
• Importance of basic pain management and addiction education for all healthcare professionals especially those who are prescribers.
• Validated screening tools that can be easily implement in a clinical practice
• The dual and challenging issues of substance use and chronic pain
• How to manage patients with substance use disorder or at risk patients, when they come for a major or minor procedure requiring analgesics?
• Common health conditions and substances used amongst youth that HCPs need to be aware of and regularly screening for.
• Common treatment options for substance use disorder.
• What you can do when someone presents with an opioid overdose or overdose from other substance.
• Resources for HCPs to assist with managing patients with addiction and substance abuse issues.

Links

• Dr. Amber Borucki, MD
• Email Dr. Borucki
• Dr. Veronica Mesheriakova, MD
• Email Dr. Mesheriakova
• Youth Outpatient Substance Use Program Division of Adolescent & Young Adult Medicine
• California Bridge Project:
• The CCC Warmline: Substance Use Consultation for Providers Is Just a Phone Call Away
• Ensuring Opioid Safety for Children and Teens
• Opioid Stewardship: Responsible Pediatric Pain Care
• Proactive Pain Solutions Physicians Academy
• CRAFFT
• SOAP-R

About Our Guest:

Dr. Veronika Mesheriakova

Dr. Veronika Mesheriakova is board-certified in pediatrics, adolescent medicine, and is working toward board certification in addiction medicine. She cares for adolescent and young adult patients, and specializes in the treatment of substance use disorders and addiction in youth. She is the director of the UCSF Youth Outpatient Substance Use Program (YoSUP) and the UCSF Youth Addiction Management Training Program. She also specializes in eating disorders, sexual and reproductive health, menstrual disorders, depression, and anxiety in youth.

Dr. Amber Borucki

Dr. Amber Borucki is fellowship trained, board-certified pediatric anesthesiologist and pain physician whose focus is treating acute and chronic pain conditions in children and adolescents. She is the Director of UCSF Benioff Children's Hospital Pediatric Anesthesia Pain Service. In her spare time, Dr. Borucki enjoys spending time with her 3 children, hiking and exploring the Northern California coast, and she is an avid equestrian.

"In 2030, there will be 21 million children who will be turning 18, and approximately half a million of those will have chronic disabling pain that will last, oftentimes throughout the majority of their adulthood." This statement is quite alarming, and also shows how important it is to improve pediatric pain care services NOW or risk the future. We not only discuss this issue, but Dr. McClain also gives us a peek on how a HCP can leverage the needs and resources within their hospitals to continually work with the patients and its workforce to establish superior and fiscally responsible services.

Whether you are a caregiver, a nursing staff, a pediatrician, pain physician, any clinician or an institutional leader. The future needs your service to ensure a healthier society, NOW!

Takeaways In This Episode

• How one pivotal experience determined the trajectory of Dr. McClain's career and how she was led to choose pediatric pain medicine
• Pediatric pain medicine as a business model, the importance of a business plan, and several viable sources for financial support for the services.
• Effectively working with institutional administrators and decision makers to gain support for pediatric pain medicine program(s)
• Whether/how providing pain management as a hospital service line makes sense
• The Institute of Medicine 2030 Mission grounded in pain management
• Seeking or training exceptional staff despite the different demographics amongst them
• Importance of patient satisfaction with focus on outcomes
• An Ideal vs. functional pediatric pain service models
• What makes a successful pediatric pain management specialist
• The importance of having a clear vision of what to accomplish

Links:

Linkedin @Brenda McClain MD

Brenda McClain MD Email International Association for the Study of Pain (IASP) Society for Pediatric Pain Medicine (SPPM) Proactive Pain Solutions Physicians Academy

Handbook of Pediatric Chronic Pain

About Dr. Brenda McClain:

Dr. McClain has developed and directed several pediatric pain programs at institutions such as the Yale University, Vanderbilt University, St. Louis University and finally serving as the Medical Director for Pediatric Anesthesia at Cardinal Glennon Children's Medical Center. She is a pioneer in the field of pediatric pain medicine and paved the path for many to follow. 30 years ago, she left her practicing faculty position to pursue additional training in pediatric pain medicine and holds dual board certifications in Pain Management (American Board of Pain Medicine) and Pain Medicine (American Board of Anesthesiology). In 2011, she also co-authored the "Handbook of Pediatric Chronic Pain".

When a child with pain does not get timely or appropriate treatment, it makes pain more refractory to treat and often makes the patients and their families feel hopeless, underserved, or mistrusted by the healthcare system.

Pediatricians as the first point of contact (and defense) for all healthcare, with trusted and longitudinal relationships with their patients and their families play a critical role in the success of treatment outcomes, and keeping them engaged and hopeful as they go through their treatment.

As a pediatric pain specialist, I often see patients after patients who have undergone an extensive workup; seen an impressive lineup of specialists, and have waited many months to years before they get to the appropriate care they need and deserve.

I'm bringing in someone who sees patients at an entry-level to share the challenges of pain care in a primary care setting and the strategies she employs to address them as a pediatrician, Dr. Dhanu Sant, MD!

Dr. Sant is the founder of WholeKids Pediatrics, an online service for providing virtual consultation and educational content to keep your family healthier through nutritional, herbal, and lifestyle remedies. She also co-founded ThiveWell Pediatrics, Northeast Florida's first direct care, personalized, integrative pediatric practice that even offers home visits.

A physician who is also a certified yoga teacher, and a certified herbalist, she beautifully incorporates both these practices in the care of her patients and families.

Takeaways in This Episode

• What pediatric pain care looks like when addressed upstream
• The challenges and opportunities that present in primary care when they take care of children's pain
• The unique and special role a pediatrician plays in improving the outcomes of pediatric pain care.
• Challenges related to kids that Dr. Sant is currently faced with
• How Dr. Sant deals with pediatric pain care concerns
• Dr. Sant discusses colic and its relation to chronic pain, headaches and common musculoskeletal pains among children.
• Understanding how the family responds to their child's pain
• Dr. Sant's thoughts on - when it's okay for a pediatrician to continue with specialty care for pain patients?
• Dr. Sant's advice to physicians and young physicians when it comes to holistic patient care
• Common things that Dr. Sant hears from some of the children and family with pain
• Common struggles as a pediatrician
• Pain-related education in pediatric training
• Dr. Sant talks about health and diet for patients and healthcare professionals

  Links:

  • WholeKids Pediatrics
  • Dr. Sant's Twitter
  • Dr. Sant's LinkedIn
  • Facebook
  • ThriveWell Pediatrics
  • Proactive Pain Solutions

About Our Guest:

Dr. Sant completed medical school at The Ohio State University. She completed her residency at Nationwide Children's Hospital. Prior to starting WholeKids Pediatrics in 2008, Dr. Sant was in a private practice for 10 years with a large pediatric group.

Dr. Sant is a primary care pediatrician who has sought out additional training in integrative medicine. Her interest in establishing an integrative practice was spurred by her concern about the increased use and side effects of many medications and her deepening respect for the body's natural healing capabilities.

Continuing education in complementary therapies has allowed Dr. Sant to broaden her treatment options for both preventative and illness care. Dr. Sant is a yoga teacher having finished yoga and prenatal yoga teacher training. In addition, she loves teaching infant massage.

Dr. Sant now lives in Jacksonville, FL with her husband, John and her parents. Dr. Sant's mother has Alzheimer's dementia and while challenging, she is honored to be able to care for her parents as they age. She is the parent to three adult daughters who still live up north but love to visit sunny Florida!

Dr. Sant is a Columbus native and is a huge fan of Buckeye football. Dr. Sant loves to travel and her bucket list includes a safari in Africa and a trip to New Zealand. In addition, she loves reading, especially about food, eating great food, cooking and yoga.