Pedia Pain Focus

Melatonin use for sleep issues is widespread among all ages despite a lack of recommendation for insomnia by the expert guidelines. Increased stress levels and disrupted routines in the current environment, has many more people turning to melatonin for respite with sleep problems. This episode explores what melatonin is or is not, when and how it should be taken and what caution, if any, is needed wit its use, especially as it relates to children.

Also discussed are the controversies around its use for certain indications, its quality, regulatory issues and how one can ensure getting the right quality products.

Links

AASM Practice Guidelines

Circadian Rhythm Clinical Guidelines

Consumerlab.com

Doctors and other professionals with prescriptive authority can prescribe any medications they deem appropriate for the treatment of their patient's condition, but the liability risk may be weighing on their minds, in the event of adverse outcomes related to use of off label medications. Meanwhile, a vast majority of medications used for pediatric pain have not specifically been labeled for use for that particular indication, age group or dosage. This episode explores the implications of off-label medication use and how to appropriately counsel your patients when using off label medications.

Takeaways in This Episode:

• What constitutes off-label medication use & how prevalent is it?
• What leads to off label use of medications
• What does it mean for a prescriber to use a medication off-label?
• The considerations that a healthcare professional/prescriber should make when evaluating off-label use of a medication.
• Steps in counseling your patient & family when using a medication off-label, that will ensure their safety, build rapport, confidence and minimize your liability risk.

Links:

AAP Statement on Off-Label Use of Drugs

Proactive Pain Solutions

Guest, Ms. Laura Wieck of BodyMind Coaching shares some mind shifts and practical skills to engage, empower and build trust amongst your patients and families to enhance their pain management and wellness.

Takeaways in This Episode

• Impact of your words and how you talk to your patients and the resultant neurocognitive changes in your patients' brain.
• What is the "opposite pain scale" and how you can use it for your patients.

• How you could unconsciously be perpetuating pain instead of treating it.

• What chronic stress might be signaling and how to use it to our advantage.

• How you can assess whether there's congruency between your patient's words and their feelings.

• The #1 job you have as a HCP and the most important factor in establishing your credibility with your patient/family within the first 2 minutes (Hint: it's not your degrees, or expertise!)

• What "Therapeutic or Coaching Triangle" is and how to use it in your pain practice.
• Verbal and nonverbal cue to develop immediate connection with your patients.
• How to conclude your patient visit leaving them more excited, empowered, and engaged creating momentum for positive outcomes.

Links

Therapeutic Triangle

Laura Wieck

Proactive Pain Solutions

Nothing accelerates growth more rapidly than adversity and necessity. The coronavirus pandemic has proved to be a catalyst for rapid adoption of virtual visits in healthcare, bringing some challenges with this rapid change. So we take a look at these issues and explore some strategies for HCPs to adapt to the virtual pain care visits and support their patients during the pandemic and beyond.

Takeaways in This Episode

• Impact of COVID-19 pandemic on pediatric pain care and elective procedures.
• Leveraging technology to promote self management for your pediatric pain patients.
• Telemedicine for virtual clinic visits.
• Selecting patients who may be suitable for virtual pain care visits.
• Technology considerations for virtual pain care and other healthcare visits.
• Dos and Don'ts for conducting seamless virtual pain care visits.

Links

Cultivating Resilience in Times of Stress & Trauma

Resilience Toolkit for HCPs

Improving Access to Pediatric Pain Care via Telemedicine

Self-Management Resource for Patients & Families

Dr. Elliot Krane's article on implementation of telemedicine during COVID-19

American Telehealth Association (ATA)

Proactive Pain Solutions

Narrative Medicine or art of storytelling in healthcare is a unique but essential skill in improving healthcare outcomes. Continuing my conversation with Ms. Beth Turner about the transformative power of storytelling in pediatric pain care.

Takeaways in This Episode

• Particular words and phrases, directives relevant to storytelling/narrative medicine in pediatric pain.
• Guiding a patient to be a hero in their own story.
• Empowering and giving hope even when the exact diagnosis or treatment may be unclear.
• "Closing the gap" when patient and HCP narratives do not align.
• Role of trauma in pain management.
• Role of boundaries (Hint: they are meant to be inclusive)
• Storytelling as an opportunity to grow and transform.
• Checklist for Healthcare Professionals to master the skills in narrative medicine.

Links

Beth Turner

Narrative Medicine Checklist

Peter Levine PHD

Pedia Pain Focus episode #15

Proactive Pain Solutions

This episode uncovers the unique factors which predispose healthcare professionals to an increased risk for trauma and stress during COVID-19 pandemic, early signs of stress & trauma and provides a framework and a toolkit for effectively managing this stress and cultivating resilience.

Takeaways in This Episode

• Reasons why healthcare professionals are at increased risk of trauma and stress during COVID-19 pandemic.
• The subtle (or not so subtle) signs of trauma and stress.
• Ways to effectively and proactively manage trauma and stress and foster resilience.
• Why it is important to manage stress and trauma.
• A resilience & self-care toolkit, and helpful resources.

Links

CDC

Headspace

Proactive Pain Solutions

Resilience & Self care Toolkit

Storytelling is a powerful tool in healthcare especially for pain management and children with their such imaginations are perfect partners for this. This is a healthcare professionals' personal guide to incorporating the art of storytelling in caring of their patients, their teams, loved ones and themselves!

Takeaways in This Episode:

Impact of Storytelling in our lives and in our practice.

Storytelling as a way of being, a relationship to ourselves and to those we influence or interact with.

Incorporating the narrative medicine/storytelling elements in your practice without additional burden.

Influence of quantum physics in storytelling.

Interface of Mindfulness and Storytelling.

Living a bigger life through storytelling and enhancing job satisfaction, performance and stability, personal health & wellness

Harnessing the creative power of children in storytelling regardless of their age.

Links:

Columbia University Narrative Medicine

Code Lavender

Beth Turner

Proactive Pain Solutions

Understanding and proper utilization of QI in healthcare is essential for improved efficiency, safety, patient outcomes and ultimately satisfaction in a clinician's practice, but it can seem like a monumental task. Dr. Thomas Taghon demystifies the concepts of QI and shares how each of us can make it a routine part of our clinical care, that actually works FOR you!

Takeaways In This Episode:

The 6 dimensions of QI and what elements have particularly higher relevance in pain care

How you can standardize care where evidence base does not exist

What considerations must one take into account when setting up QI programs

Tricks to ensure a strong QI practice despite lack of a "fancy database" and high tech resources.

Personnel characteristic important to the success of your QI programs

Running a successful QI program, even if your team doesn't have specific training in QI methodologies

Right sizing a QI team

Appropriate timing for introduction of QI training for healthcare professionals

Leveraging technology beyond databases for the success of your QI program

Number one and most important reason for you as a clinician to be excited about having a QI program

Role of value based purchasing in healthcare

Barriers to effective QI programs and how to overcome them.

Links:

Quality Improvement-HRSA

Dr. Thomas Taghon

The Institute for Healthcare Improvement

QI Training Resources Mentioned in This Episode:

Intermountain Healthcare Delivery

The Institute of Healthcare Improvement

Dayton Children's Hospital Intermediate Quality Improvement training course

Benefits of volunteerism for personal and professional growth are irrefutable. However for a busy clinician finding time and/or resources to create sustainable models of volunteer activities, can be challenging. Dr. Aseem Shukla discusses the challenges, opportunities, unique factors and considerations that led to the success of an international volunteer surgical collaborative, now serving as a prototype globally.

Takeaways in This Episode:

The unique advantage of health care professionals when it comes to volunteering

Factors contributing to the success of volunteer medical work: considerations for organic and local environmental factors, and logistics.

The 3 C's of successful and sustainable volunteer endeavors (Cooperation/Communication, Collaboration, and Commitment of team members)

Discover how vulnerability is essential to create a successful team and endeavor.

Fiscal models that can support sustainability of your (larger)volunteer work initiatives.

Unique elements of the Indo-American Bladder Exstrophy Collaborative, making it so successful for more than a decade.

What does bladder exstrophy collaborative have to do with pain management?

How does pain care play into the success of this initiative or any complex care collaborative?

How your volunteer work away from your institutions benefits in care of patients in your local community, and you.

Links Mentioned:

Aseem Shukla

A model for sustained collaboration- JAMA Article

Ahmedabad-based collaboration considered a model

Civil Hospital Ahmedabad, India

Children's Hospital Philadelphia

Hindu American Foundation

Association for Bladder Exstrophy Community

There's no doubt that mobile health and apps have revolutionized how we live our lives, from our day to day activities, to conducting business, travel and even our health and fitness. Dr. Jennifer Stinson from Hospital for Sick Kids, Toronto, creator of the Pain Squad app talks about how m-health can positively impact pediatric pain care, sharing her own experience developing, researching and using this and other relevant apps with children affected by pain.

If you enjoyed this episode and it inspired you in some way, I'd love to hear about it and know your biggest takeaway, or if you have a question or wish to hear about particular topic, please leave us a comment.

Takeaways in This Episode:

• Why it makes perfect sense to use digital technology and mobile apps for pediatric pain (Hint:Harness their innate ability).
• What elements should be included in a pediatric pain management app
• Validation of a pediatric pain app.
• What is Pain Squad and how it can help your pediatric pain patients?
• What types of pain can this be used for?
• Who's best suited for use of the Pain Squad
• What unique elements help with enhancement of engagement with a pain care app. What they found as optimal number of questions for engagement, and compliance.
• Ways for health care personnel to accomplish tech advances for pain and other health care needs (Hint:There are a winning partnership up for grabs)
• The secret to building and maintaining the apps
• Advice for HCPs interested in mobile health platform for pain or any healthcare
• Jaw dropping stats for how often the healthcare professionals are involved with developing the healthcare apps.
• What future of Pain squad and pediatric pain care apps looks like.

Links Mentioned in this Episode:

Jennifer Stinson, PhD

Pain Squad

Pedia Pain Focus - Epi #3, Epi#4, Epi#6

Your Bonus PDF - FAQs, Apps for pain management and self care

Resources and Apps used by Sick Kids, Toronto:

Stop breathe think Buddhify Calm