Pedia Pain Focus - SoundSage

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Have you ever had any of your patients say that they don't think physical therapy helps their pain? Or that the physical therapy made their pain worse?

It would certainly not surprise me, if you said yes. And in that case, this is definitely is the episode you want to listen to carefully. And if your answer to my question was no, this is an episode for you too, my friend. Because sooner or later you too will join this elite club with rest of us. However, this episode will give you the framework and tools to change that in your practice. Learn it from our guest who magically rehabilitates patients debilitated by pain .

Kathleen Lynch, DPT joins us to share how she motivates her patients to do physical therapy and be fully engaged with it. She also shares strategies and tools that can be used in assessing patients if they are in need of physical therapy. Kathleen’s goal is to discharge physiotherapist patients to self care by educating more healthcare professionals and patients.

Worry no more about patients who do not go to their physical therapy session, as you will learn so much from Kathleen that will make your patients fully engaged. Listen now!

Takeaways In This Episode:

How Kathleen become interested in physiotherapy.
Her guide to approaching, assuring, and educating patients who are afraid to do physiotherapy.
How any healthcare professionals can convey the value of including physical therapy in their treatment plan.
When to incorporate physiotherapy for pain management.
Physical activity and therapy strategies pertinent to different diagnoses.
Engaging a child and their family in self management of their pain using physical activity and therapy.
what type(s) of physiotherapy or occupational therapy is optimal for different conditions
Role(s) a physiotherapist plays in pain management and how it may be different than an occupational therapist.
The optimal duration for physiotherapy
How to overcome the barriers to access as it relates to physiotherapy.

Links

Clinicians Pain Evaluation Toolkit

Proactive Pain Solutions Physicians Academy

About the Guest Speaker:

Kathleen Lynch, DPT

Kathleen Lynch completed her Master's of Science in Physiotherapy in 2009 at the Dalhousie University and her Bachelors of Arts with Honors at McGill University in 2005. She's fluently bilingual both in French and English and has worked in a variety of pediatric environments including acute care, rehabilitation settings, school and home based settings. She's a physiotherapist at the Thames Valley Children's Center and Children's Hospital (TVCC) at London Health Science Centre

Kathleen is a doctor specialized in physical treatment of children to help reduce pain, restore mobility, rehabilitate an injury, or increase movement and overall function. As a physical therapist, Dr. Lynch can treat multiple conditions with exercises, ultrasound, electrical stimulation, joint mobilization, heat, ice, massage, laser or light therapy and more. Dr. Lynch will create a treatment plan based on the child's specific injury, disease or condition, and might target a specific body part or body system based on the individual.

She is also the pediatric lead in the Ontario chronic pain network as Operations Manager for the executive committee representing all the publicly funded chronic pain programs in Ontario, Canada.

Pedia Pain Focus Podcast is hosted by Dr. Anjana Kundu, it's the 1st podcast dedicated to pediatric pain, providing education and tools for all healthcare professionals dealing with children's pain issues. If you're a pediatric healthcare provider, this one's for YOU! The podcast brings you renowned experts from the field of pediatric pain, healthcare technology and business, policy makers, healthcare advocates and more to share their innovations, expertise, and experience in the field.

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Pain and mental illnesses coexist, often more than any of other illnesses. Both of them have a profound effect on a child's child’s quality of life, individually. Now imagine the magnitude of impact when they co-exist.

In this episode, Dr. Anjana Kundu, with guest speaker Dr. Mirabelle Mattar, a child, and adolescent psychiatrist, discusses the intricate and dynamic relationship between pediatric pain and mental health, likely cause or affect and prognosis for a child with pain in the setting of mental health issues or vice-versa. They also discussed the factors which may predispose a child to a higher risk of chronic pain and mental problems, role of trauma, PTSD and other adverse events on pediatric pain.

Takeaways In This Episode:

How Dr. Mattar became interested and her journey to the intersection of pediatric mental health and pain
Some unexpected discovery during this journey among children with chronic pain
Importance of understanding the effects of chronic pain on mental health in children.
What is the sequence of occurrence when pain and mental health issues co-exist and how does it matter.
What should the focus of treatment entail
Impact of regaining function and improving mental health
Common chronic pain conditions associated with mental illnesses and vice versa
Influence of trauma, ACES and PTSD on children's pain
When to consult a mental health professional for a child with pain issues
Diagnosing conversion disorder
Ways to work with the entire family unit especially when mental health and physical health issues are tangled.
A Message to YOU from Dr. Mattar

Links

Mirabelle Mattar, MD

Clinicians’ Pain Evaluation Toolkit

Proactive Pain Solutions

About the Guest Speaker

Mirabelle Mattar, MD

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Acute pain may be a protective and adaptive phenomenon, but chronic pain is nothing but damaging and a burden in every way possible and for all involved directly or indirectly. So how do we reduce or can we reduce burden?

Join me in this episode to learn the factors that contribute to chronicity of pain and whether we can prevent it.

Takeaways in This Episode

Complexities of pain and its impact for the individuals and the society
What differentiates acute from chronic pain and why that is important
Various factors contributing to pain and its chronicity
Modifiable vs. Non-modifiable factors
How demographic factors contribute to chronic pain and what if anything can be done to stop their contribution to chronic pain
Which lifestyle factors might have the most impact on chronicity of pain
Genetic and epigenetic factors involved with chronic pain
Family, social and cultural factors influencing pain and progression to chronic pain
Clinical and biological factors involved with chronic of pain
Your role in reducing the burden of pain

Links

Other Related and Helpful Episode to Listen to:

Episode #80. Stop treating pain like a symptom.

Episode #10. Disparities in pediatric pain

Episode #50. Stepping up pain care efforts for African American patients

Episode# 85. Pain amongst children with Autism Spectrum Disorder

Episodes #76 and #77. Impact of pediatric pain rehabilitation program Part 1 and 2.

Episode # 27. Interdisciplinary pain education is necessary to change the face of pediatric pain management.

Episode #60. Influence of sleep on peri-operative pain among children.

Episode #25. Role of epigenetics in chronic post surgical pain

Episode #89. The pain of being a Redhead

Proactive Pain Solutions

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Did you know that redheads can tolerate more spicy foods than those with dark hair?

This is supported by biology and genetics.

Ask any anesthesiologist or a dentist and they'll tell you - often with a sigh, I might add - that taking care of redhead is can be challenging!

The issue of pain perception, tolerance, response to pain and response to different classes of medications is a complicated and murky one when it comes to people with natural red hair.

Join me in this episode to learn about the evidence we have for complexity of pain and its management in redheads, recent emerging evidence that explains why and more importantly how to effectively navigate this complexity, ensuring safe and effective care of these patients.

Takeaways in This Episode

When an anesthesiologist or a dentist see a redhead
Why redheads have more dental problems and toothaches
Why redheads sometimes need more pain medications and at other times need less
Variability in pain responses amongst redheads
The redhead gene and its implications
Do redhead really tolerate more spicy foods than others?
Do they bleed more compared to others with darker hair?
Recent study providing insights about the genetics and reasons for differences in their pain perception, responses and treatments
What do Melanocortin, MC1R, MC4R have to do with pain
How you reconcile the different, complex and sometimes murky findings and provide safe and effective pain care for redheads

Links

Proactive Pain Solutions

Other Helpful Episodes on Opioid Safety

Episode#30 . Ensuring Opioid Safety for Children and Teens with Rita Agarwal, MD

Episode# 29. Opioid Stewardship: Responsible Pediatric Pain Care! with Benjamin Lee, MD

Proactive Pain Solutions Physicians Academy

Clinicians Pain Evaluation Toolkit

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Pediatric pain management is fraught with reasons that make it feel like we are operating blindfolded. Many treatments are used without clear indications or evidence specifically in this population. What if you had a way to study what you do in pediatric pain management, while you do it, would you embrace it?

In this episode, Dr. Drake Ross, a specialty pediatrician at Starship Children’s Health in Auckland, New Zealand with training in pediatric pain and palliative care, shares with us the features, goals and outcomes of their Rapid pharmacovigilance program, a multi institutional collaborative clinical research endeavor. This program provides real-time evaluation of net clinical benefit of what we do in our day to day clinical practice, while we do it!

Takeaways In This Episode

What got Dr. Drake’s to transition from general pediatrics into palliative care and pediatric pain medicine
How he get interested in pharmacovigilance and how he initiated that for pediatric pain medicine as the RAPID multi-institutional, international endeavor
What Rapid is?
Findings of their research thus far and what's on the horizon
How you can participate in this research endeavor while carrying out your daily clinical work and the benefits it offers as collaborators
How they determine their protocol numbers and demographics
What Dr. Drake hopes for Rapid to achieve
Unique benefits of this collaborative research compared with other databases based research (Hint: the ability of foresight and hindsight simultaneously!)
The biggest takeaways and his message to the audience

Links

Ross Drake, MB ChB, FRACP, FAChPM, FFPMANZCA

Rapid Program

Get involved with Rapid program

Alternate Contact

Attend the International Symposium on Pediatric Pain 2022

Clinicians’ Pain Evaluation Toolkit

Proactive Pain Solutions

About the Guest:

Ross Drake, MB ChB, FRACP, FAChPM, FFPMANZCA

Dr. Drake is a Pediatrician who specializes in Pain Medicine and Palliative Care for children having gained fellowships in Paediatrics, Palliative Medicine and Pain Medicine after he completed specialist training at Great Ormond Street Hospital in London and The Children’s Hospital at Westmead in Sydney.

Ross is Clinical Lead of the Paediatric Palliative Care and Complex Pain Services at Starship Children’s Hospital; both being the only specialist services of their type in New Zealand. Amongst his clinical duties he strives to improve the recognition and support of children/tamariki & young adults/rangitahi and their families/whānau requiring palliative care and the management of chronic pain. He remains very involved in developing a national approach to both disciplines and works to improve resourcing to enable equitable access and service delivery for all New Zealand children in need.

Dr Drake also regularly presents and teaches on various topics in children’s pain medicine and palliative care. More recently, he has been involved with establishing an international pharmacovigilance research collaborative (The RAPID Program) looking at the effectiveness and adverse effects of medications and other interventions commonly used in palliative care and pain management.

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How is it that when 1 in 3 school age children reports chronic or recurrent pain, yet we fail to ensure that there is adequate help available for these children? That our system ensure at least basic level of pain medicine training for healthcare professionals?

These are a few of the questions we discuss in this episode, but more importantly we talk about how we CAN make a difference from wherever we are today, rather than waiting for someone else to invoke change and for something else to happen first. This episode is about increasing awareness, believing and investing in yourself. This is about taking charge and making the change rather than waiting for change to happen!

Believing and investing in yourself is the best way to shift your thinking from a paradigm of excuses to one of solutions.

It's time to shift the paradigm in pediatric pain medicine and it all starts with awareness, knowledge and priority!

Join me in this episode as Dr. Asha Padmanabhan, MD FASA sits me down in the guest seat in this episode of my own podcast, and I share the state of pediatric pain medicine. We discuss the challenges, barriers and way forward to evoke change. It's not just a theoretical concept, but how I have lived and by example to evolve with and be the change.

Takeaways in This Episode

My path to medicine and pediatric pain medicine
Role of support system and visionaries in your life
Your grit and self belief
What leadership means and looks like to me
Finding support and steps forward in every situation
What proactive pain solutions mean and do
The current state of pain medicine for children
The challenges and barriers to adequate pain care for children
The path forward

Links

Proactive Pain Solutions

Proactive Pain Solutions Academy

Clinicians' Pain Evaluation Toolkit

Asha Padmanabhan, MD FASA

Listen to these other helpful episodes -

Episode #61. Getting out of your own way to success with Dr. Asha Padmanabhan

Episode #1. Pediatric Pain: A team sport in need of transformation

Episode #2. Three areas every healthcare provider can influence to improve children's pain care

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Time pressure in today's healthcare visits is a reality. Increasingly there is more emphasis on value and efficiency in clinical care delivery. Meanwhile changing factors in healthcare delivery with shorter visit times, increasing amounts of required documentation for compliance, and the perceived quality and time spent with your patient and their family have added to the challenges that physicians and healthcare professionals face daily.

Though it may not be possible to have the luxury of more time to conduct thorough clinical care encounters necessary for complex conditions like pain, but some elements, if incorporated in our daily clinical work can most definitely lead to safe, smooth, and efficient healthcare encounters with improved outcomes and increased satisfaction for both patients and healthcare professionals.

Join me in this episode to discover these essential elements which will help you shine in the quality of your encounters with your patients.

Takeaways in This Episode

Factors influencing the perceived quality of healthcare delivery
What's common between a flight and a clinical care visit
Elements of a successful and high quality, efficient clinical care encounter
How a healthcare professional can stay on time and influence the timely delivery of healthcare visit even in a complex system.
The role engagement plays in healthcare delivery and outcome and how to achieve that
How to achieve mindfulness and being present during every clinical encounter
What does intentional listening look like in a clinical acre visit
Draw the most useful information out of your patients without interrupting them
What are transitional phrases in healthcare encounters and what purpose do they serve
How to reconcile the differences between your patients goals and your goals for them.
Creating a beautiful wrap up for the clinical encounter and the Lollipop Effect

Links

Other recommended and helpful episodes -

Episode #62. Metaphors for Better Pediatric Pain Management

Episode #40. Owning your role as a physician leader in today’s healthcare

Episode #82. Chronic Pediatric Pain in 2021: US Pain Foundation Report.

Episode #26. Manage Memory, Manage Pain! with Melanie Noel, PhD

Episode #37. What authenticity in healthcare looks like.

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How does one reconcile the facts that DSM diagnostic criteria for Autism Spectrum Disorder includes pain insensitivity and a high pain threshold, while these children report that their clothes feel like sand paper and their fingers while shampooing feel like sharp metal?

Join me in this episode to look at where the truth lies, with emerging evidence that helps us better understand the relationship between pain and ASD, what if anything is different about pain among children with ASD, and how we should approach pain issues amongst these children!

Takeaways in This Episode

What constitutes Autism Spectrum Disorder
Prevalence of ASD
Historical beliefs around ASD and pain, and contributing factors for those beliefs
Current and emerging literature around ASD and pain
What Stimulus over-reactivity is and how that plays out in ASD
Genetics evidence around ASD and pain
Summarizing ASD and pain among children and considerations for accurate assessment and effective treatment

Links

Listen to other helpful and related podcast episodes -

Episode #84. Post-Concussive headache and Symptom Management in Children with Dr. Windsor

Episode #63. Integrative Pediatric Pain Management with Dr. Lonnie Zeltzer

Episode #81. How to Choose the Right Pain Treatments

Episode #72. Real vs. Fake: The Look of Pain

Episode #75. Role of Gut-Brain Axis in Pediatric Pain

Proactive Pain Solutions Physicians Academy

Clinicians Pain Evaluation Toolkit

Proactive Pain Solutions

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In this episode, Blake Windsor, MD a pediatrician with a subspecialty in training for pediatric pain medicine, and a board certified headache specialist discusses post concussive headaches and unique challenges it poses. Headache is the most common post traumatic or post concussive symptom. Even when a child is given the appropriate care, in many cases we find that they still experience post-concussive pain long after we expect them to recover.

He points that often there is much confusion and debate around what people refer to as Post-Concussive Syndrome, when in reality there seem to be somewhat arbitrary lines surrounding the term. Dr. Windsor also believes that pediatric pain medicine should be as common as other specialties, because it makes the work of other specialties much more streamline and accessible to patients.

Listen in on this episode as Dr. Windsor walks us through the uniqueness of post-concussive headaches, various stages, risk factors, identification and treatment!

Takeaways In This Episode

How Dr. Windsor’s experience with sickle cell patients in an inner city hospital led to his pursuit of a career in pediatric pain medicine
What makes post-concussive headaches so unique
Factors that result in a headache manifesting after traumatic brain injury
Other risk factors to keep in mind while testing and which groups are more vulnerable to them
Signs specific to post-concussive syndrome to look out for
When is the right time for a pain specialist to be involved in post-concussive care?
Treatments options to be considered after identifying their symptom cluster based on deficits exhibited
His advice to the audience

Links

R. Blake Windsor, MD

Connect with Dr. Windsor

Other Helpful Podcast Episodes

Episode #80. Stop treating Pain Like a Symptom!

Post-Concussion Symptom Scale

Clinicians’ Pain Evaluation Toolkit

Proactive Pain Solutions

About the Guest

Dr. R. Blake Windsor, M.D.

He is the Chief of Primas Health Pediatric Pain Medicine in the Upstate. He is a pediatrician with subspecialty training in pediatric pain medicine and is both a board-certified headache specialist and medical acupuncturist in South Carolina. He attended the University of Georgia followed by Mercer University School of Medicine where he subsequently worked in a combined post-graduate training program between Harvard Medical School and Boston University School of Medicine.

In 2018, he joined Prisma Health University of South Carolina School of Medicine in Greenville to launch the Carolinas' first comprehensive pediatric pain and headache program. It is the first comprehensive program of its kind in the Carolinas, and he leads a multidisciplinary group of pain specialists from medicine, nursing, psychology, and physical therapy. The team uses a multidisciplinary and holistic approach to complex medical diagnoses and symptoms, resulting in a comprehensive treatment plan that meets children and their families where they are and helps them break the cycle of pain.

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This conversation with Marjorie Gloff, MD and Renee Robinson, DNP, APRN makes me convinced that the expression "Preparation is half the battle won" must have been coined with the idea of perioperative medicine and perioperative surgical home (PSH) in mind!

They are the co-directors of the Center for Perioperative Medicine and Medicine in the Department of Anesthesiology and Perioperative Medicine at the University of Rochester School of Medicine and Dentistry. In this episode, they share how to desilo the care of pediatric patients especially around the perioperative period, how an informal conversation triggered a grassroots level effort which subsequently resulted in a well-organized multidisciplinary team that provides comprehensive, coordinated and team based care for children in need of surgical procedures, developed a comprehensive screening tool or the PSH.

They also share the steps involved in the development of periop medicine and PSH programs that employs a biopsychosocial model to optimize systems and individualized best practices in the care of a complex child with multiple and/or complex needs.

Takeaways In This Episode

What perioperative medicine entails and how it fits into their roles
Healthcare professionals that form their perioperative surgical home-based team
The minimum elements of perioperative surgical home that can be incorporated by anyone in any setting to provide optimal perioperative outcomes
Components of a perioperative surgical home
Objective criteria to determine if a child patient’s optimized health
Diagnoses and procedures that lend themselves to this kind of care model
How they determine what role each member of their team plays
Elements of their program and the steps they took to develop their program and educate their fellow peers
Why should a PSH model be considered and the expenses related to such a program
Standardization vs. individualized care in perioperative medicine
Distinction between PSH, perioperative medicine and Enhanced Recovery after Surgery (ERAS) models.

Links

Other Related Episode(s) -

Episode 58. ERAS - Enhanced Recovery (but not just)After Surgery

Clinicians’ Pain Evaluation Toolkit
Proactive Pain Solutions

Proactive Pain Solutions Physicians Academy

About the Guests

Marjorie S. Gloff, M.D.

Dr Gloff is an anesthesiologist currently practicing at the University of Rochester in Rochester, New York. Bearing a passion for pediatric perioperative medicine, she is the Director of the Center for Perioperative Medicine and the Associate Chair of Perioperative Medicine in the Department of Anesthesiology and Perioperative Medicine at the University of Rochester. She is also the Associate Chief Medical Officer for Patient Safety and Loss Prevention at the same university.
In 2004, She graduated with a Bachelor of Science in Cell and Developmental Biology at the University of Rochester and accomplished her Medical Degree in Medicine and Dentistry in 2008. She received her internship in anesthesiology at the University of Rochester Medical Center from 2008-2009 and went on to finish her residency at the same medical center from 2009-2012.

Renee Lynn Robinson, DNP, APRN

She has obtained a Doctorate of Nursing and is an advanced practice Registered Nurse with a specialty in family health currently practicing at the University of Rochester in, Rochester New York. She is the Associate Director of the Center for Perioperative Medicine. She is the recipient of awards such as the Medical Center Board Excellence Award APP in 2019 from URMC and the Quality Recognition: Perioperative Services COVID Management in 2021.

She graduated from the University of Rochester School of Nursing in 1996 and became a licensed nurse practitioner in 2001. In 2020, she received her Doctorate in Nursing Practice.

She and Dr. Gloff share the same passion for pediatric perioperative medicine and for the past six years, the duo has been spearheading a new program dedicated to improving and optimizing the process of pediatric care.

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Chronic pain is often overlooked, and when it comes to children, it is even more so. The continued neglect of children's pain affects the ability to truly evaluate the extent of the problem and challenges these kids and their families face.

The United States Pain Foundation, a pain advocacy organization, conducted a survey to assess how children with a pain diagnosis and their families experience chronic pain, what challenges and barriers they face and what they hope for in their pain care.

In this episode, I’m joined by Nicole Hemmenway, the current CEO of the US Pain Foundation and the Founder of the INvisible Project and Casey Cashman, Director of Fundraising and the Pediatric Pain Warrior Program part of the US Pain Foundation. They are strong advocates for pediatric pain, inspired by their own pain experiences. They discuss the findings of this survey, share their experiences with the pediatric pain patients and families that they support through their programs. They also share their hopes and some possible directions to address some of the challenges identified in this survey.

As healthcare professionals and clinicians, these findings are eye opening and a call for action to collectively invoke change in the care of pediatric chronic pain.

Takeaways In This Episode

Chronic pain is frequently overlooked due to its subjective nature
Why Ms. Hemmenway and Ms. Cashman got involved in the pediatric pain work, US Pain Foundation and the Pediatric Pain Warrior program
The reason(s) that prompted this survey
Survey findings
How much focus should be on the number rating of the pain and how meaningful, helpful that is.
Valuable way to assess and inquire about chronic pain and a patient's progress
Psychological impact, extent of mental health issues including self-harm, suicidal thoughts, ideation and attempts amongst pediatric chronic pain patients
Burden of disease on the family - financial and psychosocial
What therapies do patients and families wish were emphasized more - (Hint: Medications were at the bottom of the wishlist!)
Barriers to chronic pain care
Psychological toll of having to evaluate whether you can afford a therapy and how it may be/ to address it.
Best ways for parents to discuss these barriers with their child’s physician
Nicole and Casey's message to the listeners

Links

Nicole Hemmenway

Casey Cashman

Connect with Nicole Hemmenway and Casey Cashman

US Pain Foundation-Pediatric Pain Report 2021

Pediatric Pain Warrior Support Groups

U.S. Pain Foundation

Pediatric Pain Warrior

Clinicians’ Pain Evaluation Toolkit

Proactive Pain Solutions

About the Speakers

Nicole Hemmenway

Currently serves as CEO of the U.S. Pain Foundation, and directs the INvisible Project, an online and print magazine that highlights the experiences of people living with pain. Nicole is also an author and motivational speaker. Her book, No, It Is NOT in My Head: The Journey of a Chronic Pain Survivor from Wheelchair to Marathon, details her struggles and triumphs in dealing with complex regional pain syndrome, a debilitating neurological disorder. In September 2015, Nicole was featured in a campaign in USA Today in recognition of her role as an advocate for those living with chronic pain; and in 2017, she received the Unsung Hero Award for her work in the pain community. Nicole lives in the Bay Area with her husband and three young sons.

Casey Cashman

Serves as the Director of Fundraising and the Pediatric Pain Warrior Program. Casey Cashman uses her voice to fight passionately for the rights of people with pain, especially children. She has lived most of her life with multiple, serious health conditions, including reflex sympathetic dystrophy/CRPS and Ehlers-Danlos syndrome, among others.

Over the years, she began to connect more with patient organizations and realized she had a passion for helping others like her. In 2015, she was featured as a participant in the INvisible Project, which led to her joining the U.S. Pain Foundation as a staff member.

Before U.S. Pain Foundation, Casey spent many years working in Human Resources. She brings this knowledge and experience to the table in her role as director of the Pediatric Pain Warriors Program, where she provides compassionate support to kids with pain and their families as they travel along their pain journeys.

Casey also spearheads U.S. Pain’s fundraising efforts, and has helped create various programs and collaborations designed to support the organization’s free programs and services

Her son, Tyler, is also a budding advocate for the pain community. In honor of his mom, he founded Points for Pain, a fundraising program that has raised more than $100,000 for pediatric patients.

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Treatment of pain is challenging to say the least. For one it is difficult to understand the complexity of the pain experience. This episode explains the components of nociception and the pain experience. It also examines the targets for pain control and thus provides comprehensive framework for choosing the right analgesic treatments!

Takeaways in This Episode

Components of Nociception
How a noxious injury becomes a pain impulse
The pain perception pathways
Interpretation of pain
Modulation of pain
Peripheral and central targets for pain control
How various pain treatments work and at what levels
3 Unique features of pain - Wind-Up Phenomenon, Hyperesthesia, Central Sensitization

Links

Other Helpful Episodes:

Episode 80. Stop Treating Pain Like a Symptom

Episode 79. Pain Amongst Neonates, Infants and Young Children with Dr. Kanwaljeet "Sunny" Anand

Proactive Pain Solutions Physicians Academy

Clinicians Pain Evaluation Toolkit

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Pain isn't simply a symptom of another disease or a result of another noxious or traumatic event. It's an independent entity in itself in majority of the situations. It's time we stopped approaching it with the Cartesian model framework.

Join me in this episode to learn about how and when a pain can be considered a symptom and when it needs to be treated like any other independent chronic diagnosis, and why that is important.

Takeaways in This Episode

The reason(s) I am even talking about this
The biggest misconception about pain
Why this misconception get propagated
Classification of pain and why that is important
What I mean by "not all pain is created equal"
There's more to chronic pain than just "chronic pain" - classification of chronic pain as defined by IASP task force and the WHO
Major differences between acute and chronic pain
Mechanisms at play in acute and chronic pain
The benefits of understanding these distinctions and classifications

Links

International Association for the Study of Pain (IASP)

Other Relevant Episodes:

Episode #56. Making Pediatric Pain Matter.... with Dr Christopher Eccleston

Episode #78. Remodeling Pediatric Pain Management in Emergency Rooms with Dr. Samina Ali

Episode #62. Metaphors for Better Pediatric Pain Management

Episode #25 . Role of Epigenetics in Chronic Post-Surgical Pain with Dr. Vidya Chidambaran

Proactive Pain Solutions Physicians Academy

Clinicians Pain Evaluation Toolkit

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There's no better way to kick off September as the Pain Awareness Month than bringing you a conversation with Dr. Kanwaljeet S. Anand, whose research took the medical world by storm, even risking his license, as he sought out to answer the question of; what if we give children anesthesia and analgesia?

I truly believe that he is the reason why my career as a pediatric pain and palliative care physician exists today and serves as an available path for many healthcare professionals.

In this episode, Dr. Anand, a professor of Pediatrics, Anesthesiology, Perioperative, and Pain Medicine at Stanford University School of Medicine, describes his groundbreaking research back in the 80s, when a popular held belief was that babies don’t feel pain!

With the findings and intervention offered in his RCT, they were able to cut down the infant mortality rates by half. It is the work of doctors like him that paved the path for someone like me to practice pediatric pain management as a specialty-- hoping to save and improve the lives of many more children by debunking the fallacies that still surround children's pain and its management.

Takeaways In This Episode

What fueled Dr. Anand’s desire to research perioperative care for infants
His hypothesis around morbidity and mortality of neonates and infants undergoing surgeries, relationship to anesthetic management
Conducting the randomized controlled trial study and its results that changed the history and trajectory of childrens pain and perioperative management
Sometimes it’s worth picking the fights
How his study gained momentum and changed how the healthcare world approaches pain management for children and infants
When and how infants develop the ability to feel pain
The long-term consequences of poorly or inadequately managing children’s pain
Changing the minds of colleagues who perpetuate the belief that children are “hardy” and will “get over it”
Dr. Anand’s message to the audience

Links

Connect with Dr. Kanwaljeet S. Anand:

Stanford Profile

Love, Pain, and Intensive Care. K.J.S. Anand, Richard W. Hall

Clinicians’ Pain Evaluation Toolkit

Proactive Pain Solutions

About the Guest

Kanwaljeet S. Anand, MBBS, MD, D Phil, FRCCM

He is currently the professor of Pediatrics, Anesthesiology, Perioperative, and Pain Medicine at Stanford University School of Medicine. He directs the pain and stress neurobiology lab, the Jackson Vaughan Critical Care Research Fund, and he serves as the Editor of the journal Pediatric Research and is the Division Chief for Pediatric Critical Care at the Department of Pediatrics at Standford School of Medicine.

He graduated from M.G.M. Medical College, Indore (India). He received the D.Phil. degree as a Rhodes Scholar at the University of Oxford, followed by a post-doctoral fellowship at Harvard Medical School, a categorical Pediatrics residency training at Boston Children's Hospital, and a Critical Care Medicine fellowship at Massachusetts General Hospital in Boston.

He is the recipient of innumerable awards, including the Dr. Michael Blacow Award from the British Pediatric Association in 1986, the Pediatric Resident Research Award from the American Academy of Pediatrics, the inaugural Young Investigator Award in Pediatric Pain from the International Association for Study of Pain in 1994, the Jeffrey Lawson Award for advocacy of children's pain relief, the highest recognition in pediatric pain medicine in the United States. He's also been awarded many awards across Europe in many countries such as the Nils Rosén von Rosenstein Award from the Swedish Academy of Medicine and the 2015 Journées Nationales de Néonatologie Address at The Pasteur Institute to name a few.

For his dedication and work in the field of pediatric pain management, he is considered a world authority on pain and stress in newborns and pain management in infants.

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When the gold standard for pain assessment is verbal report, children's pain assessment and management requires specific knowledge and understanding. Children at these important stages of growth create key memories-- and the last thing we need is a whole generation of children that associate getting medical attention with pain.

Globally, when children come in to the emergency room, pain is a component of their presentation 50 to 80% of the time. As medical practitioners, prioritizing the critical elements of a child’s illness should be the main concern-- but we also must ease their pain and suffering related to their health condition and prioritize minimizing their procedural pain.

In this episode, Samina Ali, MD, a pediatric emergency medicine physician and pain expert at the Stollery Children’s Hospital and University of Alberta, Canada shares her clinical and research experience in pediatric pain. Realizing that emergency room visits and procedures may have just as much capability to distress and traumatize a child beyond their presenting condition, she has dedicated her work to researching how she and fellow medical practitioners can make children and their families feel safe and empowered through institutional culture change as well as effective knowledge translation and mobilization.

In creating an ER or any healthcare setting that caters to patient comfortability beyond just treating symptoms and illnesses, we can harbor a safer and more welcoming environment which can improve children’s experiences with receiving medical care, minimizing anxiety for future encounters, improving quality, safety, efficiency of and satisfaction with the work healthcare professionals perform.

Takeaways In This Episode

What motivated Dr. Samina to research pediatric pain and implement effective pain prevention and treatment strategies.
Common pain presentation in the emergency department and how it may impact the work.
Top reasons why pediatric pain may not get the needed priority and how practitioners handle competing priorities among patients in the emergency room
What the big leap of faith in pediatric healthcare is and how that affects pediatric pain.
Successful approaches she has spearheaded within her institution and beyond for better pediatric pain care
Helpful steps to help other practitioners engage in pain care efforts
Factors that result in or lead to disparities in pediatric pain care
The two main benefits of prioritizing pediatric pain care
Her view on advanced technology-based interventions and their roles
The common barriers in emergency rooms and how can they be addressed
Engaging administration to facilitate a top-down approach
Leveraging patients and their families voices to invoke change
Dr. Samina Ali’s message to the listeners

Connect with Dr. Samina Ali:

Website

Twitter

Links

Ep 64: Prevention and Management of Procedural and Needle Pain and Anxiety Among Children

Solutions for Kids in Pain (SKIP)

Translating Emergency Knowledge for Kids - Procedural Pain

Translating Emergency Knowledge for Kids - Pain Treatment

Commitment to Comfort

Clinicians’ Pain Evaluation Toolkit

Proactive Pain Solutions

About the Guest

Samina Ali, MD

She is a professor of Pediatrics and Emergency Medicine at the School of Medicine and Dentistry at the University of Alberta in Edmonton, Canada. She is also the research director at Pediatric Emergency Department Medicine. She holds provincial and national funding for the study of children's acute care and emergencies and pain in the country and supervises many learners with both clinical and research backgrounds.

She has served as the director for pediatric emergency medicine from 2003-2008 and again, from 2010-2013. She was also the Director of Professionalism for the University of Alberta from 2010-2013, and also serves as the Assistant Dean for Professionalism for the Faculty of Medicine and Dentistry.

As a practicing pediatric emergency physician, she is witness to the pain children experience from illnesses, injuries, and emergency room procedures. She has created a research program focused on improving children's pain and distress, mainly related to emergency department visits and procedures, and she shares many of those ways to improve pain experiences for the children, both in the hospital and in the community. In addition, she has been recently involved in the Canadian large effort for knowledge mobilization and knowledge translation in relation to her efforts in alleviating children’s distress and empower them and their families.

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Chronic pain in children can be a really serious condition and many of them may have a long journey to get where they need to be!

Says Julia Wager, PhD, an accomplished pediatric pain psychologist and head of research department, at the German Paediatric Pain Center, Children's and Adolescents' Hospital Datteln, Germany.

Join me for part 2 of my conversation with Dr. Wager to learn about the short and long term outcomes of intensive interdisciplinary pain rehabilitation program for pediatric chronic pain.

She discussed their short term and longitudinal data (8 years) from intensive pain rehabilitation program for pediatric chronic pain management.

As Dr. Wager says - We want them to be a child again and not a chronic pain patient for life!

Discover what these surprising findings are and what impact they have on short and long term management of these children!

Takeaways in This Episode

The immediate, short and long term outcomes from the intensive interdisciplinary pain treatment of children's chronic pain
Outcomes for the parents, caregivers and family
Mental health and emotional outcomes and implication of these outcomes
What findings surprised them amongst these children with chronic pain.
The implications of the these outcomes on management of these children's pain
Unique vulnerabilities of children with chronic pain
3 top instructions and type of awareness that is important for patients (children and their families) to know and be vigilant about.
What the after-care upon completion of the intensive pain rehabilitation program should include
Barriers to intensive pain rehabilitation program
Predictors of success for these patients
Financial outcomes and implications of intensive pain rehabilitation program
Dr. Wager's message to healthcare professionals

Links

Julia Wager, PhD

German Paediatric Pain Centre

Other Recommended Reading:

PREEMPT Trial 1

PREEMPT Trial 2

About the Guest Shalini Shah, MD, MBA, Associate Professor is Vice-Chair for the Department of Anesthesiology & Perioperative Care and Enterprise Director of Pain Services for University of California Irvine Health. Dr. Shah completed her residency in anesthesiology from Cornell University and a combined fellowship in adult and pediatric chronic pain at Harvard Medical School.

She is the founder of the Pediatric Pain Program at UC Irvine and has previously served as Associate Program Director for the Pain medicine fellowship. Dr. Shah is the recipient of the ASRA Chronic Pain Grant Award in 2017 for her landmark work in onabotulinumtoxinA (Botox) use in pediatric migraine pain. She has been featured in Time Magazine, The Doctors, NBC Nightly News, Business Insider and is a frequent guest on NPR on the topic of safe pain care options. Dr. Shah is an internationally invited lecturer and leads several industry and peer-reviewed NIH funded clinical trials in pediatric and adult pain medicine.

Dr. Shah currently serves as the Founding Chair, Committee of Pain Medicine at the California Society of Anesthesiologists (CSA) and President-Elect, CA Society of Interventional Pain Physicians (CALSIPP). Dr. Shah is strongly committed to pain advocacy and healthcare regulatory reform both in the state of California and nationally to improve healthcare experiences for patients.

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Pediatric pain has been left on the back burner for decades now-- where many clinicians 30 years ago thought that infants did not feel pain. With the progress made, both in pain management and technology, it’s about time that we call institutions to shift the culture, so we can work towards making pain visible-- so we can provide comfort to children patients that they desire and deserve.

In this episode, I’ve brought back Dr. Neil Schechter, to discuss his endeavor, ChildKind International. This passion project of his aims to have an open-access library to serve as a clearinghouse for information on pediatric pain research, and can serve as a reference to improve children's pain management.

ChildKind offers a certification for hospitals based on their commitment to and availability of certain measures to address pediatric pain and comfort adequately. Being certified, fosters trust from parents, promoting a positive experience for both patient and parent. In addition, with a pain management system throughout the institution contributes to higher staff retention and lower healthcare provider burnout.

With this huge step forward in creating accessible pain care, it’s up to us as clinicians to offer the same amount of care for our patients regardless of where they present for their care -- because it is not only the pain team or service's responsibility. It is all our responsibility.

Takeaways In This Episode

The current practices of handling pediatric pain
What Childkind International is and what led to its creation
How to enact change within the institution
ChildKind’s mission and 5 Principles
ChildKind’s role in promoting change and its benefits
The importance of change from the top-down and bottom-up
Pediatric pain is everyone’s responsibility
Dr. Schechter’s hopes for ChildKind and all healthcare institutions

Links

Neil Schechter MD

ChildKind International

Connect with ChildKind International: Facebook Instagram

Pedia Pain Focus Epi # 53. Are you making the most of your "Golden Half-Hour" with your pain patients?

Proactive Pain Solutions Physicians Academy

Clinicians’ Pain Evaluation Toolkit

Proactive Pain Solutions

About the Guest

Neil Schechter, MD

He is the President and CEO of ChildKind, an international organization dedicated to improving the quality of pediatric care. Currently, he directs the Chronic Pain Program at Boston Children’s Hospital and is an Associate Professor of Anesthesia at Harvard Medical School. Dr. Schechter graduated with a medical degree and completed pediatric training at the University of Connecticut. He also did his fellowships at Children’s Hospital and Harvard University in Boston.

His research initially focused on documenting the under-treatment of pain in children and issues of pain that are associated with chronic disease. His research, later on, shifted to the common pains connected to pediatric practice and to create procedures to improve pain-related practice patterns in health care providers and institutions.

Dr. Schechter is a passionate advocate for the betterment of pediatric pain care which allowed him to serve as a member of editorial boards and experts committees including the World Health Organization Committee and Palliative Care and the Task Force on Chronic Pain in Children of American Pain Society. He has also been the recipient of the Jeffrey Lawson Award for Advocacy in Children’s Pain Relief from the American Pain Society.

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pain is the most common and devastating symptom of Sickle Cell Disease. Despite the slow and elusive developement of therapeutic intervention in Sickle cell disease that would halt the vasocclusive crisis and the related pain, last few decades have brought about good progress with successful hemopoetic stem cell transplant as well as several therapeutic agents targeting various aspect of teh pathophysiliogy of SCD.

In this episode, I review the 4 major targets in the pathophysiology of SCD and approved therapeutic interventions and agents as well as those that are further along clinical trial with very promising results.

Takeaways in This Episode

What prompted me to do this update
How this episode is different from and how it complements the earlier published episode about sickle cell disease
The challenges presented by sickle cell disease
The major presentation and impact of sickle cell disease
4 main therapeutic targets with advances and ongoing trials
Newer FDA approved agents in management of vasocclusive crisis and pain
The success and challenges of stem cell transplant for SCD

Links

Pedia Pain Focus Episode #12. Master Your Sickle Cell Pain Care Skills

Pedia Pain Focus Episode #62. Metaphors for Better Pediatric Pain Management

Pedia Pain Focus Episode #21. How to Counsel your Patients on Off-Label Medication Use

Proactive Pain Solutions Physicians Academy

Proactive Pain Solutions

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Yoga is much more than just a physical exercise. It's an ancient mind and body based practice that involves self-paced physical movement, meditation, and breathing techniques. Practicing Yoga can change your and your patient's life in ways you never imagined!

An array of incredible benefits from yoga have become evident in healthcare, professional sports and our day-to-day lives promoting physical and mental well being. But how does it actually work? How does one heal through yoga? When is it appropriate to do yoga if you/your patient has pain?

Join me in this episode as I talk more about yoga with Ms. Amanda Machado, MPH. Not only is she a certified yoga teacher and entrepreneur, but she’s also a public health epidemiologist with over a decade of experience in disease prevention!

Amanda brings even her personal perspective to the practice of yoga, as she shares with us how it helped her heal from anxiety and trauma!

In addition, she shares the how yoga is beneficial for your pain patients, how to counsel your patients around yoga for pain and even how it’s beneficial to you and your patients above and beyond pain conditions!

Takeaways In This Episode

The role yoga played in Amanda’s personal healing journey
Tangible and intangible benefits from yoga including its role in our relationships with others
Applications and implications of yoga for pain management
Uniques aspects of yoga for pediatric patients including preventive and therapeutic benefits
What exactly does yoga entail and how to know which yoga is right for you/your patient (Hint: So much more than physical exercise!)
Finding the right yoga therapy, teacher and therapist (Yes there is such a thing!)
How to determine whether a patient should do physical therapy versus yoga
Ms. Machado's advice to healthcare professionals around yoga

Links

Amanda Machado

Connect with Amanda - Instagram Linkedin

Passage Studios | Yoga + HIIT + Spin

Pedia Pain Focus Epi# 63. Integrative Pediatric Pain Management with Dr. Lonnie Zeltzer

Clinicians Pain Evaluation Toolkit

Proactive Pain Solutions

About the Guest

Amanda Machado, MPH, is a Public Health Epidemiologist who has worked in healthcare for a decade, she is trained in both kinesiology as well as epidemiology, she researches root causes of disease, associations, and preventative intervention. Amanda is also a certified Yoga Teacher and entrepreneur and has her own business where she focuses on holistic wellness, helping people live a more conscious life, where they can heal, and grow. She also does business mentorship for practitioners looking to integrate evidence into their work, and those who want to bridge spiritual, emotional well-being with evidence based and scientific insights. She has published studies on happiness, high cost users of the health system and health behaviors that lead to illness, as well as on other clinical and prevention based topics. In her free time you can find her hiking a mountain in the Rockies, gardening, and spending time with her husband and dog Willow.

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Many factors contribute to children's pain being under estimated, under-recognized and inadequately treated. Kathryn Birnie, PhD shares her work identifying the top priorities essential for improvement in pediatric pain management.

Join me in this episode as she shares her patient-oriented research which includes them in priority setting and recognizing the areas where we need to focus on.

Her work is grounded in empowering the disempowered; the pediatric pain patients and their caregivers, working alongside and in concert with the clinicians, making the small and big shifts in doing so especially when there is a power differential.

Dr Birnie discusses the top 10 priorities identified in pediatric pain management, how they went about doing so, especially having to distill them down to 10 from >500 identified at the start. She shares which one or ones of them should be prioritized to the top of the line, how that is relevant to each one of us caring for children, and what surprising elements, perspectives or shifts they encountered in the course of this work.

We also explore her role as the Assistant Scientific Director of Solutions for Kids in Pain (SKIP), a knowledge mobilization initiative and how healthcare professionals and patients and families can participate in and benefit from SKIP.

Dr. Birnie is an Assistant Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at the University of Calgary and a clinical psychologist at Alberta Children’s Hospital.

Tune in to learn more about how she is contributing to shaping pain research, education and clinical care for kids with pain and how that influences us as healthcare professionals in our day to day work!

Takeaways In This Episode

How Dr. Birnie got involved in pediatric pain management and what fueled the work she’s doing right now
Dr. Birnie shares behind the scenes of her research, Partnering for Pain, and its design involving patients and families alongside the clinicians and other stakeholders in improving pain care of children.
The top 10 priorities in pediatric pain that Dr. Birnie and partners found
What priorities we should be focusing on
The gaps that various stakeholders need to be aware of in managing children's pain
Work that SKIP is doing to advance pediatric pain care
How institutions or healthcare professionals can be the beneficiaries of SKIP and how they may contribute to this important work
Dr. Birnie's words of advice to healthcare professionals taking care of children with pain

Links

Kathryn Birnie, PhD

Connect with Dr. Birnie - Linkedin Twitter @katebirnie

Partnering for Pain

Partnering for Pain Video

Keeping Up with Today - Dr Christine Chamber's Podcast

There's an App for that - Dr Jennifer Stinson's Podcast episode

Making Pediatric Pain Matter - Dr Christopher Eccleston's podcast Episode

Role of Epigenetics in Post-surgical Pain - Dr. Vidya Chidambaran's podcast episode

Manage Memory, Manage Pain - Dr Melanie Noel's podcast episode

Solutions for Kids in Pain (SKIP)

Clinicians Pain Evaluation Toolkit

Proactive Pain Solutions

About the Guest

Katie Birnie, Phd

Dr. Birnie completed her Ph.D. in Clinical Psychology at Dalhousie University in 2016, including a predoctoral residency in Pediatric Health Psychology at the IWK Health Centre. She completed a CIHR-funded postdoctoral fellowship at the University of Toronto and The Hospital for Sick Children. Dr. Birnie also spent time as a clinical research postdoctoral fellow and clinical psychologist at the University Health Network, including with the Transitional Pain Service at Toronto General Hospital and the Interventional Pain Program at Toronto Western Hospital. Dr. Birnie joined Alberta Children’s Hospital as a medical psychologist in 2018, where she continues to provide clinical care through the Vi Riddell Children’s Pain and Rehabilitation Program.

Dr. Birnie is a recognized leader in pain research and patient partnership, for which she has received a number of national and international accolades. She was the recipient of the 2020 Pain Awareness Award from the Canadian Pain Society and was selected as a 2020-2021 MAYDAY Fellow, a prestigious fellowship focused on communications and advocacy for improved pain care. Previously highlighted awards include the Dr. John T. Goodman Award for Trainee Research in Pediatric Pain, the Brain Star Award from the CIHR Institute of Neurosciences, Mental Health and Addiction, and a Vanier Canada Graduate Scholarship.

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Did you know that he pediatric pain patients rate feeling of isolation as the absolute worst thing, even above their pain?

Georgia Weston, MSW, endured years of isolation as a teen, suffering through her chronic pain alone, feeling not being believed. Now, she’s the Executive Director of Creative Healing for Youth in Pain (CHYP), a nonprofit that helps youths suffering from chronic pain by focusing on creative healing experiences. We discuss her firsthand experiences with her own pain, her work as the director of CHYP and the simple steps healthcare providers can take that will make a world of difference to their patients.

Takeaways in This Episode

Georgia's experiences with chronic pain as a child and how she became interested in pediatric pain management
Her journey to becoming the Executive Director of CHYP
Aspects of chronic pain that are worse than the physical pain itself
Barriers to accessibility of pain care for youth with chronic pain
What is CHYP, what they offer the youth and their families
How has CHYP helps bridge the gap of accessibility to pain care
Who/how the programs and services offered in CHYP are curated
Unique aspects of CHYP compared with other pediatric pain management support services, programs and organizations
How healthcare professionals, patients and families can access these resources
Georgia's advice to healthcare professionals dealing with pediatric pain issues.

Links

Georgia Weston, MSW

www.mychyp.org
Linkedin
Twitter
Facebook
Instagram
YouTube: Creative Healing for Youth in Pain

Pedia Pain Focus Epi#62. Metaphors for Better Pediatric Pain Management

Clinicians Pain Evaluation Toolkit

Proactive Pain Solutions

Books by Georgia Huston Weston

PAIN: An Owner's Manual: Intimate conversations about pain

Vienna's Waiting: A teenage girl’s battle with pain

About the Guest

Georgia Weston, MSW

Georgia Weston is the author of two books, Vienna’s Waiting and PAIN: An Owner’s Manual, where she provides insight into the mysterious world of chronic pain through her own story and the stories of others. In 2011, she founded the Teen Pain Help Foundation, a 501(c)3 charitable corporation created to help children and adolescents with chronic pain. Since founding the Teen Pain Help Foundation, Georgia has served as the Executive Director, raising funds for treatment, research, education, and increased public awareness of pediatric chronic pain. She also co-founded and was the Director of Programming for Art Rx, strengthening the partnership between the USC Suzanne Dworak-Peck School of Social Work and the USC Keck School of Medicine, specifically to better understand how art impacts pain. Georgia has experience creating and leading programs for organizations that provide therapeutic services for struggling individuals and families. She also has clinical social work experience, both as an outpatient therapist and residential therapist, for youth dealing with complex cognitive, behavioral, and social needs. In addition to her work with chyp, Georgia is a Research Associate on a Rally grant for an adolescent/young adult cancer pain telemedicine intervention study with the UCLA Pediatric Pain Research Program. Georgia has a Bachelor of Arts in psychology, with a minor in art, from St. Edward’s University. She has a Master of Social Work degree from the University of Southern California, with a concentration in Children, Youth, and Families, as well as a focus in Child and Adolescent Mental Health. In recognition of her humanitarian services, Georgia received the David Chow Humanitarian Foundation Award for 2019. Georgia is dedicated to empowering youth with chronic pain and their families through creative healing techniques and social support.

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Every child inevitably would experience pain in the course of their life, but if not addresses appropriately, these experiences can have long-lasting and detrimental effects which carry into adulthood. What's even more remarkable is that healthcare experiences including what we do as part of healthcare as professionals is often a significant part of what causes pain and anxiety for children.

Efforts to minimize distress, discomfort, pain and related anxiety should be a priority in healthcare. What can healthcare professionals do to prevent, minimize, and ease a child’s fear, anxiety and pain over the medical procedures that they need to undergo as part of their treatment and care?

Join me in this episode as I talk about the prevention and treatment of pain caused by procedures within the hospital and healthcare settings with Stefan Friedrichsdorf, MD, medical director of the Center of Pain, Palliative and Integrative Medicine at the UCSF Benioff Children’s Hospitals in Oakland and San Francisco!

Dr. Stefan Friedrichsdorf, MD, FAAP is a Professor of Pediatrics at the University of California at San Francisco (UCSF).

Find out about his "Comfort Promise" and 4 simple steps that every healthcare professional should ensure to relieve or decrease pain and anxiety among kids who are undergoing treatment and minor or major procedures. Dr Friedrichsdorf shares his experiences, findings, outcomes, implementation plan and even some of the common barriers as well as ways to address them often overlooked

Takeaways In This Episode:

How Dr. Stefan got involved in pediatric pain
Dr. Stefan talks about the prevention and treatment of pain caused by procedures in our hospital, and the staffs
Situations where children in hospitalized settings are experiencing pain and anxiety from their treatment procedures
The prevention and treatment of pain and anxiety caused by needles
What is the “comfort promise”?
The four steps to decrease pain and anxiety caused by vaccinations?
How to get past the barrier of having our colleagues recognize that this issue of fear and anxiety brought about by treatment procedures is an important issue?

Links

Stefan Friedrichsdorf, MD FAAP

Twitter

Hospital-wide initiative to eliminate or reduce needle pain

Clinicians Pain Evaluation Toolkit

Proactive Pain Solutions

About the guest:

Stefan Friedrichsdorf, MD FAAP

Stefan Friedrichsdorf is the medical director of the Center of Pain Medicine, Palliative Care and Integrative Medicine at the UCSF Benioff Children’s Hospitals in Oakland and San Francisco. He's a Professor of Pediatric at the UCSF.

Dr. Friedrichsdorf received the 2016 “Elizabeth Narcessian Award for Outstanding Educational Achievements in the Field of Pain” by the American Pain Society and the 2011 “Hastings Center Cunniff-Dixon Physician Award”. He was the medical director of the department of pain medicine, palliative care & integrative medicine at Children’s Minnesota from 2005-2020 and under his leadership the department grew into one of the largest and most comprehensive in the country. It received the “Circle of Life Award” by the American Hospital Association in 2008 and was the 2013 recipient of the “Clinical Centers of Excellence in Pain Management Award” by the American Pain Society and in 2018 the Albert Bandura Influencer Award from VitalSmarts.

He was the associate editor of the Journal of Pain and Symptom Management until 2020, the principal investigator of a National Institutes of Health (NIH) / National Cancer Institute (NCI) multisite study on the creation, implementation and evaluation of the Pediatric Palliative Care Curriculum “Education in Palliative and End-of-Life Care (EPEC)-Pediatrics”. In 2008 he founded and since then directs the annual Pediatric Pain Master Class, a unique week-long intensive course for interdisciplinary health professionals.

Dr. Friedrichsdorf has presented more than 750 lectures about pediatric pain medicine, palliative care and integrative medicine and has a track record of research and publications in the field, including more than 60 peer-reviewed articles and contributions to more than 25 books on the subject. He is president-elect of the Special Interest Group on Pain in Childhood of the International Association for the Study of Pain (IASP).

Dr. Friedrichsdorf received his MD degree from the Medical University of Lübeck, Germany, completed his pediatric residency at the University of Witten/Herdecke, Germany (Children’s Hospital Datteln), and undertook his fellowship in Pediatric Pain Medicine and Palliative Care at the University of Sydney, Australia (Children's Hospital at Westmead). He is double boarded in Pediatrics in Germany and the United States, a Diplomate of the American Board of Pediatrics, and trained in pediatric clinical hypnosis.

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Chronic pain is the result of dynamic interactions between psychological, biological, and social factors. In this episode, Dr. Lonnie Zeltzer, a veteran and pioneer of the best practices in pediatric pain medicine talks about the approaches you can take in assessing and treating complex chronic pediatric pain issues to ensure best outcomes!

Dr. Zeltzer has shared her decades of experience, research and wisdom in this episode. It's like getting a masterclass in all you want to know about taking acre of a pediatric pain patient.

There are many barriers when it comes to treating children’s pain. However, Dr Zeltzer shows you how to overcome them and how to choose the appropriate approaches that will be embraced by your patients and families when treating complex chronic pain in children.

Tune in to this episode as Dr. Lonnie talks about the integrated approach to pediatric pain management with a cohesive team of clinicians regardless of their geographic proximity.

Takeaways In This Episode:

What integrative medicine is and how it differs from the alternative medicine
What an integrated medical model looks like
What therapies are appropriate for your patient
How to decide which ones to pick when there are competing priorities and issues of cost, effectiveness, and beliefs
Harnessing the power of mind for pediatric pain care
The importance and practice of rebalancing your autonomic nervous system
The differences between complementary alternative therapies and integrative therapies
Dr. Zeltzer explains how to create an integrative pain care team
The framework Dr. Zeltzer use to decide which patients may need therapies with seemingly similar impact ( e.g. yoga vs. PT or CBT versus hypnotherapy)

Links

Lonnie Zeltzer, MD

Linkedin

Complementary, Alternative or Integrative Medicine: NCCIH Definitions

Conquering Your Child's Chronic Pain: A Pediatrician's Guide for Reclaiming a Normal Childhood

Clinicians Pain Evaluation Toolkit

Proactive Pain Solutions

About the Guest:

Dr. Lonnie Zeltzer

Dr. Zeltzer is a Professor of Pediatrics, Anesthesiology, Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA, Director of the Pediatric Pain Program at UCLA Mattel Children's Hospital, and Past-Medical Director of Trinity KidsCare pediatric hospice.

She is also Associate Director of the Patients and Survivors Program in the UCLA Jonsson Comprehensive Cancer Center, on the steering committee of the UCLA Centers for Integrative Medicine, the UCLA Psychoneuroimmunology Program, and the Center for Neurovisceral Sciences.

Dr. Zeltzer’s pain program integrates complementary and traditional therapies for the treatment of chronic and cancer pain in children, and she studies the development of chronic pain, mind-body-pain connections, and the impact of complementary therapies on chronic pain.

She has over 200 publications, including her book, "Conquering your Child's Chronic Pain: a Pediatrician's Guide for Reclaiming a Normal Childhood,"(HarperCollins, 2016).

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Metaphors have long been used to explain complicated and unfamiliar subjects. Use of metaphors, especially in pain management lends itself naturally to improved understanding, patient empowerment, treatment engagement and ultimately better outcomes.

In this episode, I review the concept of metaphors in pediatric pain management, along with giving you several metaphors to get you started right away, on the road to efficient and effective pediatric pain management.

Takeaways in This Episode

What are metaphors and why they matter
Who are the metaphors relevant to and who all should use them
Why are they uniquely suited to pediatric pain management
Whether all metaphors good in pain management and how language plays an essential role
3 essential areas to use metaphor sin when dealing with pediatric pain
Specific examples of metaphors in these 3 areas
Additional resources

Links

Clubhouse

Episode #49. Putting Pain Care Skills in Your Patients and Families' Hands.

Episode #53. Are You Making the Most of Your "Golden Half-Hour" with Your Pediatric Pain Patients?

Episode #27. InterDisciplinary Pain Education is Necessary to Change the Face of Pediatric Pain Care

Clinical use of metaphors in the treatment of chronic pain in children.

Clinicians Pain Evaluation Toolkit

Proactive Pain Solutions

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Have you ever judged yourself even before letting anyone else even have a glimpse at your capabilities? Or talked yourself out of something that later you've felt you could've or should have done. You're not alone! As you'll hear Asha Padmanabhan, MD, FASA discuss how even the most accomplished professionals create labels and barriers for their own progress, often unwillingly and subconsciously. More importantly, though, she walks you through how to recognize when we do that and how to turn those upside down and shake them out to reveal whether they are a reality or an assumed identity. She talks about how NOT to let us get in our own way!

She especially mentions some of the unique challenges faced by the women physicians and healthcare professionals. Despite the increasing numbers of women entering the medical profession, this hasn’t actually translated into more females in leadership roles.

Be the successful and resilient professional (or person) you are meant to be as Dr. Padmanabhan, a Board Certified Anesthesiologist and a physician coach, who has been in leadership roles for many years, joins us to talk about the challenges real or perceived and how to tap into your success potential and thrive!

Takeaways In This Episode:

Her experience and perspective on the challenges of being in a leadership role as a woman
How she landed in the leadership role and the experiences in navigating these leadership positions
The internal versus external challenges
The uniques challenges that women physicians and healthcare professionals face
Dr. Padmanabhan talks about the limiting beliefs, where they come from, and what to do with them
Getting past the limiting beliefs and getting out of your own way
Differentiating limiting beliefs and false bravado
Dr. Padmanabhan's experience with coaching and how it had been critical to her own progress through limiting beliefs

Links

Asha Padmanabhan, MD, FASA

Connect with Dr. Padmanabhan

LinkedIn, Facebook, Website

The Leadership Rx for Women Physicians Podcast

Work Life with Adam Grant

Clinicians’ Pain Evaluation Toolkit

Proactive Pain Solutions

About the Guest:

Asha Padmanabhan, MD, FASA

Asha Padmanabhan, MD, FASA is a Board Certified Anesthesiologist juggling a full-time clinical career with Administrative responsibilities, while being active in leadership at the State and National levels in anesthesia.

Having been in leadership for over 10 years, she realized that women physicians in leadership or aspiring to be leaders have a unique set of challenges. After years of running workshops and mentoring young women physicians, being coached helped her realize coaching was the very foundation to building skills to achieve career fulfillment and be a resilient leader.

She is passionate about empowering women physicians to be the leaders they can be, whether it’s with a title or not.She coaches women physicians in leadership development, career transformation and career resilience. She is also an entrepreneur with a thriving side gig in online retail.

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Dr. Jennifer Rabbitts, MD a Board certified pediatric anesthesiologist and prolific pain researcher studies pain and health outcomes including the influence of sleep and other factors on pain outcomes in the short and long term.

Sleep and pain have a bidirectional relationship, but it appears that sleep has the upper hand determining the sensitivity, intensity and duration of pain. Sleep as an important pillar of health, exerts its influence in many domains and many ways.

In this episode she discusses her findings on the salient ways in which sleep influences pain and other health outcomes of children undergoing surgery, both in the immediate peri-operative and post-operative period.

Takeaways in This Episode

How Dr. Rabbitts became interested in children's pain management
Why it is important to be studying the relationship between sleep and pain
Host of factors in the hospital which influence the quantity and quality of sleep during the peri-operative period
The American Academy of Sleep Medicine recommendations on the optimal amount of sleep for children and adolescents and whether it should be altered around surgery
Duration and stages of the impact of sleep disruptions after surgery
Whether and how sleep may play a role in development of persistent and chronic pain
How much reduction in sleep is needed for impacting the pain outcomes after surgery
A surprising finding that completely surprised me about sleep disruption and opioids in adolescents
Recommendations for change in clinical practice around sleep and surgery
Differences in the peri-operative outcomes of children with sleep disordered breathing/sleep apnea and children with acute sleep disruptions
Dr Rabbitts' recommendations for clinicians around sleep in the peri-operative period

Links

Jennifer Rabbitts, MD

Contact Dr. Rabbitts : Email, twitter

American Academy of Sleep Medicine

Clinicians Pain Evaluation Toolkit

Proactive Pain Solutions

About the Guest

Jennifer Rabbitts, MD

Jennifer Rabbitts, MD is a board certified pediatric anesthesiologist and pediatric pain researcher at Seattle Children’s Hospital. She’s an Associate Professor of Anesthesiology at the University of Washington.

Dr. Rabbits completed her medical school in South Africa and her residency and fellowship training at the Mayo clinic. Her work is focused on prevention and management of acute postoperative pain in children. Studying risk factors that predict which children will develop severe and longer lasting postoperative pain and investigating ways to modify them.

Her research has earned her several awards even from her residency days and she’s also been the recipient of the young investigator award, the future leaders in Pain research award from the American Pain Society.

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Today most of us conduct major chunks of our lives digitally and social media has now become a major tool for people to consume news, health information and even create community and connections. For us as physicians and Healthcare Professionals, this tool can connect us with peers from around the world to share information, collaborate, and make an impact, but it can also make or break our professional credibility, with or without our participation.

Join me in conversation with Dr. Jay-Sheree Allen, MD, a practicing Family Medicine Physician and learn the ins and outs of social media engagement, it's impact on healthcare professionals professional and person lives and how to own your digital footprint.

Social media is not all good and it's not all bad either, but one needs to be aware of the power and pitfalls of this powerful tool in today's world. Listen to Dr. Allen as she drops many beautiful gems throughout the interview and that you NEED to know to successfully navigate social media as a healthcare professional.

Takeaways In This Episode

The different Social Media platforms, and how to use the them effectively.
The unique offerings of Facebook that make it the tool of communication, connection and influence for one-third of the world's population.
Whether physicians and healthcare professionals have a preference of any particular social media platform(s) and why
Influence of social media on medical education and professional collaborations
The uniques aspects of LinkedIn, why physicians NEED it and how to maximize it for best outcomes
What social media uniquely offers for healthcare professionals
What is your digital footprint and narrative, how and why it is important to take ownership and control of your digital footprint for your professional and personal well being
The common pitfalls to be aware of in successfully navigating social media
Dissemination of credible information on social media, while maintaining the primary focus on excellent clinical care and avoiding unproductive landmines and the gaslighting culture.
Using social media to make a larger impact, efficiently
Best practices and what not to do when you’re on social media
Resources and ways to get started and effectively navigating the social media quagmire.
Dr Allen's advice to social media novices as well as experts.

Links

Jay-Sheree Allen, MD

Connect with Dr. Allen on ; Twitter, Instagram, LinkedIn

Pedia Pain Focus Episode # 56. Making Pediatric Pain Matter: Delivering a Transformation Action

#Medtwitter

Canva - Free Graphic Creation Tool

About the Guest

Jay-Sheree Allen, MD

Dr. Jay-Sheree Allen is a Board-Certified Family Medicine Physician and National Health Service Corps Scholar currently practicing in Central Minnesota. Dr Allen is committed to improving the health of millennials, both locally and globally, through the promotion and practice of Primary Care and Preventive Medicine. Recognizing the power of media to deliver relevant and timely health messages, she has published with ABC News Health, she is a contributor on Hippo Education’s Primary Care Reviews and Perspectives podcast and co-host of the new series Race and Medicine. She is also the creator and host of the Millennial Health Podcast.

She completed her residency training at the Mayo Clinic. While there, she was a member of the Mayo Clinic Alumni Association Board of Directors, President of the Mayo Fellows Association and recipient of one of the Mayo Clinic’s highest student honors: The Barbara Bush Award. She graduated from Meharry Medical College in Nashville Tennessee where she was the recipient of the Family Medicine Leadership Award and served as Miss Meharry, the institution’s community ambassador. She received her Bachelor’s degree in Psychology, Magna Cum Laude, from The City College of the City University of New York where she was a Colin Powell Fellow.

She founded Women of Excellence, Strength & Tenacity (WEST) an organization dedicated to empowering young women to live up to their highest potential. She continues to support philanthropic efforts in medicine, through volunteering locally and abroad. She serves on the American Academy of Family Physicians Foundation Board of Trustees, the Center Clinic Board of Directors and is the West/Midwest Regional Leader for the Global Jamaica Diaspora Youth Council.

She was named a 40 under 40 Leader in Health by the National Minority Quality Forum, she was featured in the book Against All Odds: Celebrating Black Women in Medicine and most recently was awarded the 2020 Townsend Harris Medal by the Board of Directors of the Alumni Association of the City College of New York.

Dr. Jay-Sheree Allen is Jamaican born and New York raised. She lives with her husband Dr. Joseph Akambase in Minnesota.

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The highest goal in healthcare is to provide high-quality care, safe and effective care for our patients that facilitates the best possible outcomes be it after their surgery or any other part of their healthcare journey. Pain and its management is one of the top determinants of quality of care, speed of recovery and the patient/families satisfaction.

Join me in this episode with Dr. Elizabeth Ross. MD as we talk about how ERAS (enhanced recovery after surgery) pathways have not just revolutionized the peri-oprative care of patients, but their pain and entire healthcare experience throughout the system!

Dr. Elizabeth is a pediatric regional and acute pain service anesthesiologist at the University of North Carolina Children’s Hospital.

She explains what ERAS is all about, how to get started, identify partners, increase team engagement, collaboration and the widespread quality, efficiency and financial gains as result. Ultimately, it improves satisfaction for patients/families and healthcare professionals, alike.

Takeaways In This Episode:

What ERAS is.
How Dr. Ross became involved in the ERAS work.
The difference between a protocol and a pathway
What the standardization of pathways/ERAS mean for clinical judgement and hoe it affects clinicians' autonomy in caring for their unique patients
A step by step breakdown of the ERAS pathway process
Engaging the multidisciplinary team members in coordination and delivery of consistent, high quality, safe and cost-effective care
Other areas of healthcare which benefit from the ERAS approach
Measuring the right outcomes when utilizing and assessing the impact of ERAS
How to get started with implementation of ERAS in your area of care
How ERAS is great for building team collaboration between interdisciplinary teams of healthcare professionals

Links

Elizabeth Ross, MD

ERAS

FREE Clinicians Pain Evaluation Toolkit

Proactive Pain Solutions

About the Guest

Elizabeth Ross MD

Dr. Elizabeth Ross is a pediatric anesthesiologist at UNC-Chapel Hill where she has been on the faculty for the past 7 years. She's a member of the Pediatric Acute Pain Service, and specializes in regional anesthesia. She leads the ERAS efforts at UNC and also serve as the Trauma Liaison for pediatric anesthesia.

She's also active in her department's Diversity, Equity and Inclusion committee, and serves as a University Ally. She plays a key role in the medical student, resident and fellow interviews, selection and education.

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Sink or swim or trial and error may be acceptable strategies in some situations, but they are hardly applicable when considering a much needed radical transformation in culture of health and wellness. Instead what we need to adopt is what many other fields have clearly relied upon for going from good to great; Coaching!

Somehow coaching has been conspicuously missing from a field that is high stakes, high stress and also high yield. Physicians, and clinicians for that matter, are left to figure out everything all on their own once they finish their clinical training.

In this episode, Dr. Elizabeth Brill, MD MBA, a highly successful clinician, a Physician Executive and a certified coach shares her own experience with coaching, the integral role it plays in a physician or clinician's professional and personal life.

Takeaways in This Episode

Dr. Brill's journey as a physician, an Physician Executive and as a coach
The benefits coaching offers in healthcare and for the healthcare professionals
The different types of coaching in healthcare
Qualities that make one ideally suited for coaching and the kinds of situations which particularly benefit from coaching.
The difference between mentorship and coaching
Can or should mentorship and coaching combined and what the effects would be.
Why coaching seems to be restricted at the executive and the "C suite" level in healthcare
Elements of the physician/executive coaching, what it entails, and what the sessions look like
Qualities to look for in a coach look for in a coach

Links

Elizabeth Brill, MD, MBA, FACOG

Hudson Institute of Coaching

FREE Clinicians' Pain Evaluation Toolkit

Proactive Pain Solutions

Women's Empowerment and Leadership Initiative

About the Guest

Elizabeth Brill, MD, MBA

Elizabeth Brill MD, MBA, FACOG serves as the Chief Medical Officer, at the Office of Community Care and Senior Advisor to the Acting Assistant Undersecretary for Health for Community Care at the United States Dept. of Veterans Affairs.

An Obstetrician and Gynecologist by training, Dr. Brill has not only been a highly successful clinician, she has successfully held many executive and administrative roles serving as the Vice President of Surgical Services, the Chief of Staff at the Cincinnati VA Medical Center and the COO at Ohio Health.

She is also a Certified Coach through the Hudson Institute of Coaching, has been coaching physicians both through a national initiative, Women's Empowerment and Leadership Initiative, and also coaches physicians and executives independently.

With decades of experience as a clinician and having served in many administrative and executive roles, she understands the landscape and the unique needs of physicians at all levels.

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Frequent does not mean trivial and simple does not mean easy! Says Dr. Chris Eccleston, PhD, director Center for Pain and Research at the University of Bath.

A primary goal of medicine is to relieve pain and suffering. Sadly though, this is poorly achieved, especially when it comes to pediatric patients, despite ample evidence for the detrimental longitudinal effects of poorly managed pain in kids. Children’s pain should also be prioritized, yet why is is so hard to do that? How then do we make pediatric pain matter, visible, understood and better?

In this episode, Dr Eccleston joins us to talk about how we can deliver transformative action in pediatric pain and make it matter.

Dr. Chris is a Professor of Pain Science at the University of Bath in the UK, and he runs the Center for Pain and Research at the university. His contributions to clinical and research aspects of pediatric pain medicine are immense. He has extensively written and published scientific and educational articles and stories that help the reader think from a new perspective.

And today, we’re discussing the paper/commission he wrote for the Lancet Child and Adolescent Health, including the behind the scenes story of that commission, and what inspired them to write it!

Takeaways In This Episode:

How Dr. Eccleston got interested in pediatric pain management
Reasons why for pediatric pain or chronic pain in general does not get acknowledged and therefore not addressed
Factors that contribute to sustained conversations and attention to an issue.
Why we may have a propensity to diminish others' pain
The starting point for making improvements to pediatric pain.
Discussion about the Lancet Commission paper on pediatric pain and what inspired Dr. Eccleston to write this about pediatric pain
How we deliver transformative action in pediatric pain
The 4 transformative goals
What does equity mean when it comes to pain and how must we work on making it an important issue
What to expect from this Lancet Commission article and what Dr Eccleston's hopes are.
Dr Eccleston' advice for healthcare professionals, the importance of serendipity, community and connection

Links

Christopher Eccleston PhD

The Lancet Commission - Delivering Transformative Action in Pediatric Pain

Center for Pain Research

IASP PICH (Pain in Child Health) research training Cochrane Pain, Palliative and Supportive Care Leadership Rx for Women Physicians FREE Clinicians' Pain Evaluation Toolkit

Proactive Pain Solutions

About the Author

Christopher Eccleston PhD

Christopher Eccleston PhD is a Professor of Pain Science at the University of Bath in the UK and the Director of the multidisciplinary centre for pain research.

His work has been focused on evidence based pain management, therapy development, technology innovation, and behavioral science. He has authored over 280 peer reviewed scientific publications and 3 books in the general field of pain, interoception, evidence based medicine, pain management, and digital therapeutics.

He was awarded the British Pain Society Medal in 2012, the Pain Champion Award for Contributions to European Pain Policy from the European Pain Federation in 2018, and the ‘Ronald Melzack’ award for pain science from the International Association for the Study of Pain in 2018.

He has chaired the University of Bath ethics and integrity committee (2018-) , and have held key editorial positions as a senior editor in Cochrane (2010-2020), and as the field editor for psychology in the journal PAIN (2010-2020).

His work is rooted in his beliefs;

"I aim to put the body back into psychology and psychology back into medicine. I’m interested in ensuring that the science we do is rigorous, and that integrity is assured in research and publication practice."

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Neuropathic pain, especially in children can be extremely challenging to recognize and treat. Dr. Alyssa Lebel MD, a dually trained pediatric neurologist and pain physician, provides a step by step explanation of neuropathic pain across the pediatric age groups and provides practical tools for how healthcare professionals can recognize and treat it effectively.

Takeaways in This Episode

Dr. Lebel's personal connection to and her journey into becoming a pediatric neurologist and pain physician
The unique features of pediatric nervous system and neurocognitive development
Features distinguishing pediatric neuropathic pain from that among the adults
What are functional neurological disorders or pain presentation of these disorders, and the findings on imaging (Hint: it’s not just made up or feigned symptoms)
Why and when neonates and infants develop neuropathic or chronic pain
Correlation between colic, headache, and/or abdominal pain
Ways to prevent the triggering of the central nervous system
Guide to an early recognition of neuropathic pain
Strategies to treat children's neuropathic pain
What the family/patient needs in addition to the treatment options.

Links

Alyssa Lebel MD

FREE Clinicians'Pain Evaluation Toolkit

Proactive Pain Solutions

About the Guest Speaker

Alyssa Lebel MD

Dr. Alyssa Lebel is the Co-Director of Headache Program, and a Senior Associate in Pain Medicine in the Department of Anesthesiology, Critical Care and Pain Medicine at Boston Children's Hospital. She's an Associate Professor of Anesthesia at the Harvard Medical School.

Dr. Lebel is fellowship trained in pediatric neurology and pain medicine. After her training Dr. Lebel chose to devote her clinical practice primarily to the treatment of patients with significant pain, initially in both adults and children with cancer, and then in patients of all ages with intractable neuropathic pain. Early in her career, she sought additional training in regional anesthesia and rehabilitative medicine to provide a comprehensive service for challenging referrals. Concurrently, she maintained a general pediatric neurology outpatient clinic and served as a teaching attending for the Department of Neurology. In Philadelphia, she continued to work for the Departments of Anesthesiology, Pain Division, and Neurology, on the inpatient and outpatient services as well as within a partial hospital program for pain rehabilitation, ultimately focusing on pediatric care while at Children's Hospital of Philadelphia. Currently, at Boston Children's Hospital, she has increasingly focused on patients with chronic headache. She has written extensively and lectured nationally and internationally on both the mechanisms and treatment of pediatric headache. She established and directs a multidisciplinary pain-management program for patients with chronic head pain. She is recognized by her colleagues as an expert in the comprehensive assessment and management of pediatric and young adult patients with headache and cranial neuralgia.

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COVID-19 led to closure of nearly all schools in the United States, affecting more than 55 million students. Efforts to continue children's education have been highly variable, ranging from remote learning, hybrid and modified in-person instructions. Return to school safely for children and staff is being implemented, again variably. Along with the safety concerns, there are significant concerns about the disruption to the learning process, mental health, nutrition and even safety.

I'm in conversation with Dr Anita Gupta, DO, PharmD examining the challenges, risks and considerations in ensuring safe return to school of children nationwide.

Takeaways in This Episode

Why it is important to weigh the risks, benefits and challenges to safe return to school.
Factors integral to ensuring safety of children, school staff and the community
Who needs to be involved in the planning to ensure a safe and expeditious
The CDC's policy to guide opening schools safely.
What mitigation measures should be required
What parents can do to support their children's physical and mental health.
How parents can ensure a good learning experience for their children.
Collective responsibilities to educate and ensure safety
Who are the children at even higher risk even beyond the learning challenges.

Links

Dr. Anita Gupta DO, PharmD

JAMA article on Data & Policy to Guide Safe Opening of Schools

FREE Clinicians' Pain Evaluation Toolkit

About the Guest Speaker

Dr. Anita Gupta DO, PharmD

Dr. Anita Gupta is a globally recognized leader, Hopkins anesthesiologist, pharmacist & policy expert.

She's the first appointed woman physician anesthesiologist to pioneer the expansion of the only opioid overdose antidote, naloxone, at the U.S. FDA. Also, the first woman physician anesthesiologist to Co-Chair the American Society of Anesthesiologist Committee on Prescription Opioid Abuse. First woman anesthesiologist-pharmacist alumnae of both Princeton University School of Public and International Affairs and Harvard University School of Business.

She is committed to addressing global public health, drug safety and policy. She's been appointed as an advisor to the U.S Food and Drug Administration and the U.S. Department of Defense.

Dr. Gupta has been featured on the cover of Philly Biz magazine as Top in Healthcare, international editor of three books by Oxford University Press.

Featured as a recognized healthcare thought leader for the Washington Post, Forbes, CNN, on emerging threats including the Coronavirus crisis, the Opioid crisis, Zika crisis, catastrophic train crashes, and high profile expert medical cases involving: Tiger Woods, Bill Cosby, Jolie, Prince, Lady Gaga, Beyonce and others.

She completed her pain fellowship from Johns Hopkins University, medical residency in anesthesiology at Georgetown University School of Medicine, and clinical physician scientist training during her medical residency at National Institutes of Health, NHLBI, doctorate in pharmacy at Rutgers University, medical school from Rowan University (formerly University of Medicine and Dentistry of New Jersey) and professional education from MIT in drug technology, masters in public policy and certificate in health policy from Princeton University and general management from Harvard Business School.

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Dr. Neil Schechter, MD, shares what the patients and families report as the most important and helpful elements during their pain care visit and what they desire from clinicians.

Additionally, he shares the practical tips to engage patients and families and how to effectively provide feedback during a pain evaluation even for the most complex patients.

Takeaways in This Episode

Dr. Neil Schechter's journey from developmental pediatrics to pediatric pain management.
What parents of children with chronic pain report as the most important and helpful elements in their pain care visits
Why these elements are felt to be equally if not more important than any medications, procedure or treatments modalities
Providing context of pain and its nuances for parents and healthcare professionals.
The impact of what healthcare professionals say to patients and families.
Importance of feedback during a pediatric pain care visits
3 Key components of feedback for patients and families during a pediatric pain care evaluation
Ways to create a lasting impact from your feedback
Keys to professional longevity with particular tips for pediatric pain professionals.
Dr Schechter's advice for healthcare professionals caring for children's pain

Links

Neil Schechter, MD

Pedia Pain Focus Episode #8. What Patients Want More Than Any Scripts or Tests

The Golden Half Hour in Chronic Pediatric Pain-Feedback as the First Intervention

ChildKind International

Chronic Pain & Illness Workbook for Teens

When Your Child Hurts

Clinicians' Pain Evaluation Toolkit

Proactive Pain Solutions

About the Guest Speaker

Neil Schechter, MD

Neil Schechter, MD is the Director of Chronic Pain Clinic; Senior Associate in Pain Medicine, in the Department of Anesthesiology, Critical Care and Pain Medicine at Boston Children's Hospital. He's an Associate Professor of Anesthesia at Harvard Medical School.

Dr. Schechter received his medical degree from the University of Connecticut. He completed pediatric training at the University of Connecticut and fellowships in psychosomatic pediatrics and developmental pediatrics at Children’s Hospital and Harvard University in Boston. He has authored over 120 articles and is the senior editor of Pain in Infants, Children, and Adolescents, the major multi-disciplinary textbook in the area of pediatric pain. He has served on a number of editorial boards and expert committees in the area of pediatric pain including the World Health Organization Expert Committee on Pediatric Pain and Palliative Care, the Task Force on Chronic Pain in Children of the American Pain Society, and the Rome IV Committee on Pediatric Functional Gastrointestinal Disorders. He has given numerous named lectureships and received the Jeffrey Lawson Award for Advocacy in Children’s Pain Relief from the American Pain Society.

Dr. Schechter’s initial research focus was on documenting the under-treatment of pain in children and attempting to understand its origin. He then became involved in issues of pain associated with chronic disease where his research focused on sickle cell disease and on painful procedures in children with chronic disease. Most recently, he has become interested in the more common pains associated with pediatric practice such as injection pain and functional pain syndromes as well as developing strategies to alter pain-related practice patterns in health care providers and institutions.

He is the President & CEO of ChildKind, a global initiative to reduce pain in children’s healthcare institutions.

The Chronic Pain and Illness Workbook for Teens: CBT and Mindfulness-Based Practices to Turn the Volume Down on Pain

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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

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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.

Cognitive-Behavioral Therapy for Chronic Pain in Children and Adolescents

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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

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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.

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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.

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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.

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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

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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

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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

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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

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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

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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

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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

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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.

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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)

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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

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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: allen.finley@dal.ca
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.

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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.

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“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”.

Handbook of Pediatric Chronic Pain: Current Science and Integrative Practice (Perspectives on Pain in Psychology)

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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 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!

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In these trying times, it is not uncommon to observe more emotional distresses, anxiety, depression, and grief from the inability to go out and engage with people. Given that, how can working with children around their pain be further improved? Not only in helping them in dealing with their physiological pain but also their psychological needs and distress?

Sam Huestis PhD is a Pediatric Pain Psychologist specializing in chronic pediatric pain management, Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Biofeedback, Family Therapy, Group Therapy, and clinical research, in pediatrics. She is a Clinical Assistant Professor of Anesthesiology & Pain Medicine Stanford University School of Medicine / Stanford Children's Health.

Having worked with and observed children, backed up with salient research, we will address the impact of Covid-19 pandemic on pediatric pain management and the different ways to improve it. Her great passion working with children and their psychology acts as a huge mirror that will get parents, physicians, health care providers, and hopefully even insurance companies to rethink the importance and impact of managing children's pain.

We are all struggling from this pandemic and hoping to get by. Listen to this episode to be further equipped in handling the children and teen pain management challenges.

Takeaways in This Episode

How Dr. Samantha Huestis began to love pediatrics and psychology
Children’s resilience as observed in the hospitals
How COVID impacted children’s recovery
The importance of following a routine with the new normal virtual learning
Some positive traits observed in people’s behavior during this pandemic
Cognitive Behavioral Therapy or CBT
Acceptance and Commitment Therapy or ACT
Group therapy for children
Acquiring therapeutic shared narratives and pain narratives
The use of metaphors in encouraging children to speak up
Working with children and parent’s goals
Working with insurance companies

Links

Samantha Huestis - https://profiles.stanford.edu/samantha-huestis
LinkedIn @samanthaehuestisphd
Proactive Pain Solutions
Managing Chronic Pediatric Pain PDF
WebMAP Mobile App by Tonya Palermo - https://apps.apple.com/us/app/webmap-mobile/id1296377145
The Comfortability: The Teen and Parent Pain Coping Workshop - https://www.thecomfortability.com/
Stanford Free Coping Websites - http://med.stanford.edu/content/dam/sm/elspap/documents/WEBSITES.pdf
Chip - http://publichealth.lacounty.gov/plan/chip.htm
The Creative Healing - http://creativehealingproject.com/

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Dr Whitaker is a pediatric anesthesiologist at the University of Vermont Children’s Hospital and an Assistant Professor of Anesthesiology, Neurological Sciences, & Pediatrics at The University of Vermont College of Medicine. His clinical interests lie in the anesthetic care of neonates and in spinal anesthesia for neonates, infants, and children. His research is focused on developing optimal anesthesia care for neonates and infants and his current research interests include developing novel ways to monitor pediatric regional anesthesia.

Today he shares how he got started with this practice, the groundwork established by his mentors, and the recent findings and developments in this field. We also talk about the general reception of spinal analgesia from parents, doctors, and other stakeholders.

This episode is very practical and eye opening. If you're being asked about it or are thinking of how to start incorporating spinal analgesia in your clinical practice or you’re still on the fence, this episode is definitely for you!

Takeaways In This Episode:

How Dr. Emmett Whitaker got interested and started the practice of spinal anesthetics
The importance of having a surgeon champion and the stakeholders being really engaged partners for a successful implementation of a new initiative/program
When is it appropriate to do spinal anesthesia analgesia for children
The benefits of pediatric spinal anesthesia
Parents' reception of pediatric spinal anesthesia
Anesthesiologists’ and surgeons reception of pediatric spinal anesthesia
How can an institution get started with pediatric spinal anesthesia program
Skill set required to perform this procedure
The typical workflow for pediatric spinal anesthesia
Dr. Emmett Whitaker’s final thoughts on pediatric spinal anesthesia

Links

Emmett Whitaker, MD

Contact Dr. Whitaker

Ensuring Opioid Safety for Children and Teens

Opioid Stewardship: Responsible Pediatric Pain Care!

Proactive Pain Solutions Physicians Academy

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We may think we really know the pain we or our patients have, but the pain experience is complex and its treatment can be just as complex, not to mention risky.

Understand and relieve children’s pain effectively and safely in today’s episode as we speak with Dr. Rita Agarwal, a Pediatric Anesthesiologist with an expertise with pediatric acute pain management, regional anesthesia, ambulatory anesthesia and opioid safety.

She shares her in-depth knowledge about pain, the right treatment options and specifically how to navigate treatment when opioids medications are used. She stresses on how and when it is safe and appropriate to use opioids for pediatric pain; including the right prescriptions, usage, storage and disposal of this (and other)substance.

Lastly, she notes that we must develop sensitivity when we speak with people using opioid treatment as it may carry stigma and negative connotations especially with the opioid epidemic in our society and especially because we’re dealing with pediatrics. We must evaluate and include multidisciplinary treatment options, AND educate our patients and families about safe and appropriate use, storage and disposal of their medication EACH TIME!

So the next time you treat a child’s pain, as Dr Agarwal said, don’t ever downplay the role of multimodal treatments, but provide them the necessary education in the use of medications, especially something with a higher risk profile like the opioids.

Takeaways In This Episode

When is it appropriate to prescribe opioids for pediatric pain.
Knowing Opioids; proper prescription, usage, storage, and disposal.
Understanding pain; and knowing the appropriate treatment options for specific pain diagnoses.
Reducing risk of opioid addiction and misuse.
Why it’s imperative to counsel families to keep these medications locked up,away from other members of the family, or potential visitors, even for short courses of opioid analgesics.
What should be included in the discussion adn how a clinician can achieve that efficiently in their practice.
How well intentioned friends or family members become the main source of opioid diversion and misuse.
Various avenues for Safe disposal methods available in the community
Relying on experts for the right treatment plans, when in doubt or feel pushed beyond your comfort.

Links

About Dr. Rita Agarwal
Society for Pediatric Pain Medicine
AAP Safe Medication Storage/Disposal Poster
AAP Safe Disposal of Unused Medications
DEA National Take Back Days
CDC Guidelines for Prescribing Opioids
FDA Guidelines on Safe Disposal of Medications
DEA Drug Disposal Information
Proactive Pain Solutions

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With 5 million middle & high school teens in US reporting misuse/abuse of opioids, it is imperative to understand and address the contributing factors. In conversation with Dr. Benjamin Lee MD, MPH, we examine appropriate, effective, pain management, balanced with appropriate risk mitigation when it comes to pediatric pain.

Dr. Lee is a board-certified pediatric anesthesiologist, pediatric pain and palliative care physician. He’s the Division Chief of Pain Medicine at Texas Children’s Hospital and Associate Professor of Anesthesiology at Baylor College of Medicine. A strong advocate for children's responsible pediatric pain management, he has done extensive work in the area of opioid stewardship.

Takeaways in This Episode

The informal conversations with colleagues and nurses that marked his research path involving opioid safety.
Finding from examining prescribing behaviors of clinicians, and what parents did with the leftover medications.
Common types of prescription errors and what can be done to fix them.
Scope of opioid prescriptions and the opioid epidemic.
When it is or isn't appropriate to prescribe opioids for children's pain.
What opioid stewardship in your clinical practice means.
Unique challenges related to COVID-19 pandemic around opioid prescriptions and monitoring, role of Prescription Drug Monitoring Programs (PDMPs), and telemedicine in opioid safety.
7 Fundamental actions of an opioid stewardship program.
Dr. Lee's "take home message" for safe and effective pediatric pain management practices.

Links

Dr. Benjamin Lee MD, MPH

Connect with Dr. Benjamin Lee, MD MPH

National Quality Forum Opioid Stewardship Program Playbook

Opioid Stewardship Fundamentals PDF

Society for Pediatric Pain Medicine

Proactive Pain Solutions

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Training in 3 different countries' medical systems and practicing across international borders, Dr. Deepa Kattail has a unique perspective on pediatric pain care and healthcare practices overall. She's a pediatric anesthesiologist, pain physician, fellowship director, assistant professor at McMaster University in Ontario, Canada and chairs the Communications Committee in the Society for Pediatric Pain Medicine (SPPM). Her unique experiences in various healthcare settings and her experiences and insights are a great resources for any clinician, but especially a pediatric pain professional.

Takeaways in This Episode

Unique aspects of training programs and healthcare practices in India, United States and Canada.
Influence of strong mentors on her choice of career and how she would practice.
What characteristics of her mentors and seniors influenced her own clinical and teaching practices.
Essential ingredients of an expert and the role of confidence.
What areas in medicine need to have more recognition as major contributions to the evolution of healthcare and in alignment with societal norms.
Transitional challenges in early career as a pediatric anesthesiologist and pain physician.
The type of training and essential elements in education of a pediatric pain physician (or anyone engaged in care of pediatric pain patients!).
Aspects of pediatric pain medicine that are enjoyable vs. challenging.
Key differences in the healthcare practices for pain management in USA and Canada
Role of a society and professional community in pediatric pain medicine.
Her advice to a new pediatric pain medicine professional.

Links

Deepa Kattail MD, MHS, FAAP

Twitter

Email Dr. Deepa Kattail

Society for Pediatric Pain Medicine

Proactive Pain Solutions Physicians Academy

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In this episode, Dr Rachel Zoffness, PhD discusses the role of scientifically supported, non-stigmatizing and interdisciplinary education in advancing the quality of pediatric pain medicine, for HCPs and patients.

Dr. Zoffness is a health and pain psychologist on faculty at UCSF School of Medicine, runs educational program for the trainees at UCSF and a pain workshop for HCPs. She’s is the author of the Chronic Pain & Illness Workbook for Teens and has a successful clinical practice in pediatric pain medicine. She's a self proclaimed "nerd" with a passion for science and education, who wanted to live at the intersection of medicine and psychology, patient care and education. She also brings a unique perspective due to her personal experience with chronic pain.

Takeaways in This Episode

Her controversial approach to treating her patient’s pain helping him get from being bedridden to the captaincy of his ultimate frisbee team.
Current gaps in pediatric pain management and how these contribute to the mismanagement of children's pain.
Why “training the trainer” is a imperative and how our current training system stacks up in that regard.
The bio-psychosocial framework of pediatric pain.
Where she (and other pediatric pain clinicians) experience resistance (Hint: It's more widespread than you think!)
Barriers to adequate education in pain medicine.
Pain as a ubiquitous experience and what YOU can do to eliminate the barriers to appropriate education.
How you can give back the power and hope that pain takes away from your patients and families.
How to create multidisciplinary teams, and what to do if you don’t have a multidisciplinary pain management team.
What you can do to remove the stigma from referral to pain psychology.
How to navigate the lack of time and still give your patients and families the needed education in addition to the treatment plans.
A kid-friendly 3 minute, "pain dial" metaphor explanation of pain for any child or family that you can adopt and implement right away.
Addressing the question "why do I need to see a psychologist if I’m feeling the pain in my body?".
What you can do to pivot and innovate during the COVID19 pandemic.

Links

Rachel Zoffness, PhD

Chronic Pain and Illness Workbook for Teens

CBT for Chronic Pain in Children and Adolescents

Pain Survival Guide

Pain: The Science of Suffering

The Comfort Ability

Lorimer Moseley TEDx Talk

WebMAP App

Pain: The Science of Suffering (Maps of the Mind)

The Pain Survival Guide: How to Become Resilient and Reclaim Your Life

Cognitive-Behavioral Therapy for Chronic Pain in Children and Adolescents 1st edition by Palermo, Tonya M. (2012) Paperback

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Join me in this episode as we uncover the influence of memory and language in children's pain management with Dr. Melanie Noel, PhD!

Dr. Melanie Noel is an Assistant Professor of Clinical Psychology at the University of Calgary, a Full Member of the Alberta Children's Hospital Research Institute (Behaviour and the Developing Brain Theme), and an Associate Member of the Mathison Centre for Mental Health Research and Education.

Her expertise is in the area of children’s memories of pain and co-occurring mental health issues and pediatric chronic pain. She has published conceptual psychological models of children’s pain memory development, co-occurring PTSD & chronic pain, and fear-avoidance.

Find out how words and memory impact children’s pain experiences, and its prognosis. Moreover, learn what we can do as parents, adults and clinicians to help them manage, cope, and alleviate it, in order to optimize future health outcomes and prevent chronic pain!

Takeaways in This Episode

Determinants of a child’s pain experience
The role of language, choice of words and narratives in pain management
Parent’s narrative and role in influencing their children’s pain experience and its prognosis
Dr. Melanie Noel’s significant findings and how it influences children’s pain and its outcomes
A 3-step approach to Re-framing a child’s memory of painful experience
Boosting a child's confidence and their ability to manage their pain
Dr. Melanie Noel's current research and projects, and her plans for the future

Links

Connect with Dr. Melanie Noel

Twitter

Email Dr. Melanie Noel

Additional resources for Dr. Melanie Noel

Role of Epigenetics in Chronic Post-Surgical Pain

Storytelling in Pediatric Pain Medicine

Storytelling in Pediatric Pain Medicine Part 2

Proactive Pain Solutions Physicians Academy

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Some children recover quickly from surgery while others may develop long lasting pain and disability. Research shows there are many factors that may play a role in how a child recovers from surgery, genetic or heritable factors being among those. Besides the gene structure, the response of these genes to other environmental and psychosocial factors may play a big role in the generation and propagation of pain. My guest's research examines what those factors are and how they may be affecting the behavior of the genes responsible for her patients' pain experiences. Find out what she discovered.

Takeaways in This Episode

How she became interested in this research and created her Pediatric Pain PAL lab.
What constitutes Chronic Post-surgical Pain (CPSP), how common is it among children (and adults) and why that might be relevant to us.
Psychosocial and perioperative factors that predict CPSP
Why the findings from Systematic reviews may be limited in their findings about ability to predict or impact CPSP.
Can you modify the genetic factors involved in pain experience after surgery and how.
Things that healthcare professionals do to change the response of the genes associated with pain, before during and after surgery.
CPSP related expenses, cost-effectiveness of genetic testing and when it should be considered.
Applicability of the epigenetics in chronic pain conditions

Links

Vidya Chidambaran, MD

Peds pain PAL

Publications

Epigenetics in Migraine

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The clinical presentation of EDS is quite varied, widespread and complex. Patients often have a widespread pain presentation or these are your "pain everywhere" patients. This is even more challenging when it comes to pediatric patients. In this part 2 of Caring for EDS, I speak with Dr Pradeep Chopra, a renowned expert in this condition, and explore the assessment and management techniques, the cautions, and how to improve the outcomes.

Takeaways in This Episode

Clinical picture of EDS patients and what a typical patient may look like.
The unique aspect of growing pains in children with EDS and how to address it.
Unique aspect of sleep disturbance for EDS patients and how it's different from other pain patients.
The appropriate age when patients can be diagnosed with EDS and what should be done in the interim.
Different diagnostics used for EDS
Role of genetic testing and what you should know before ordering genetic testing.
Therapeutic options for EDS - what medicines offer best options and how.
Low Dose Naltrexone for pain management
Why opioids can be much more harmful for these patients and what one must be aware of when using them.
What you should know about the type of activity, exercise and physical or occupational therapy for EDS patients.
What role do interventional pain management techniques play in their pain management.

Links

Pedia Pain Focus episode 23

Ehlers Danlos Syndrome Society

Chronic Pain Partners

Beighton Score

Low Dose Naltrexone Research Trust

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The clinical presentation of EDS is as varied, widespread and as complex. They may often present as pain "everywhere". This is even more challenging when it comes to pediatric patients. In this 2 part series on EDS, I speak with a renowned pain physician expert in this condition and explore the clinical features, assessment, diagnostic and therapeutic dilemmas and how to address them.

Takeaways in This Episode

What makes this condition and these patient so complex.
Reasons these patients may respond differently than other pain patients even with similar pain symptoms and similar medications and what you can watch for or do differently as a clinician.
Major differentiating feature(s) of EDS amongst children.
The double whammy of EDS patients.
The particular disadvantage of EDS patients as it relates to their GI symptoms.
Why it choosing brand name medications may be better for your EDS patients.
How to work through the complexities of multiple medications often needed for these patients and how to effectively determine whether they are effective.
Role of pharmacogenomics for EDS patients.
"One principle" in the treatment of EDS patients.
How to effectively assess and manage a patient presenting with "pain everywhere".

Links

Pradeep Chopra MD

Ehlers Danlos Syndrome

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Nothing sums up the challenges of sickle cell pain better than what our guest, Dr. Zempsky, quotes in the interview, "like having a thousand heart attacks". Anyone who's been involved in taking care of a sickle cell patient in pain, knows that this expression can easily describe the experience of patients and healthcare providers alike! Todays episode is focused on understanding the nature of pain in sickle cell disease, simplifying and improving the care of these patients, resulting in better outcomes.

Takeaways in This Episode:

The most common types of pain presentations in Sickle cell patients and how to differentiate them.
What challenges do clinicians face in taking care of sickle cell patients
There's more to sickle cell pain than what we've long believed (Hint:It's not just sickling)
Do the the inflammatory markers play any role in sickle cell?
Why are sickle cell disease patients having “heart attacks”?
Should we treat sickle cell crisis pain like post-operative pain?
The added challenges with improved sickle cell disease care and increased life expectancy of sickle cell patients.
What specific benefits does aggressive early management of vaso-occlusive episodes offer?
Are there early changes or signs that indicate transition from acute to chronic sickle cell pain?
What our ethical mandate as clinicians is, for our pain patients.
Where does the evidence for non-opioid analgesics in management of sickle cell pain fall?
Should sickle cell patients be following any particular dietary and nutritional supplements guidelines?
What he says about the role of vitamin D or glutamine and other supplements in sickle cell pain
What advice have we, as medical community, given our sickle cell patients and their parents that we are having to reverse the course on that now?
What his recommendations on activity for hospitalized sickle cell patients are.
What should our goal(s) be for sickle cell patients?
What crucial steps in care of sickle cell patients when presenting to the urgent care or emergency room lead to improved healthcare outcomes.
Quality care indicators for care of sickle cell patients in ER.
Utility of Individualized Care Plans in the care of sickle cell patients

Links Mentioned:

A Parent’s Pain Relief Toolkit

William Zempsky, MD

AAPT Diagnostic Criteria for Chronic Sickle Cell Disease Pain.

Evaluation and Treatment of Sickle Cell Pain in the Emergency Department

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In this episode, our guest Peter Shankman, an entrepreneur and major influencer, shares his expertise, tips and hacks on skyrocketing your productivity “getting hours back in your day”, customer satisfaction, and using the power of being neuroatypical to your advantage.

Takeaways In This Episode:

How growth within our company highlighted the relevance of this topic even more

The elements of Strategic Listening, why it is relevant in medicine,

how we tend to listen wrong, and how we can change that

What “Hippie-Dippie” sounding concept makes all the difference in the quality of care you provide

(Hint: It' not only sounds sounds simple, it IS very simple!)

How to grow an effective conversation with patients and make your clinical encounter productive even when your patients go off on tangents

A simple, effortless thing you could do to change the health outcomes for your patients.

How his own experience with the medical world as a teenager shaped his career and perspective on communication

How you can use your patient interactions to enhance your own growth as a successful healthcare provider.

How he harnesses the power of his ADHD to use it to his advantage

How you can get enough hours in your day despite your numerous tasks and hectic schedule

How to find your “zone of focus" and direct your own hyperfocus to allow most productivity,

Importance of finding your triggers for optimal performance

How to best help our patients, or colleagues or ourselves when they/we are neuroatypical, (ADD or ADHD)

Ways you can communicate with your supervisor/boss and create a supportive work environment to maximize productivity.

Links Included in This Episode:

Peter Shankman

https://www.shankminds.com/

Faster Than Normal Podcast

Faster Than Normal Book

Peter Shankman Books

Help a Reporter Out (HARO)

Faster Than Normal: Turbocharge Your Focus, Productivity, and Success with the Secrets of the ADHD Brain

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This episode delves into various factors that contribute to disparities in pediatric pain medicine. Discover:

Differences in pain care practices between developed and developing countries

Differences in pain experiences of racial minority patients

Factors contributing to disparities in pediatric pain

System level drivers of differences in pain experiences

Why asking parents to advocate for their children's pain may not be an effective approach to better pain care (Hint: It has much to do with assumptions, instead we need to ask better questions)

What their research findings reveal about disparities around pain assessment and treatment practices among racially diverse patients

What pediatric populations are particularly at risk for under-treatment of pain

Patients and family, clinician and institutional level measures to address disparities

Why the concept of "Equal Care" is flawed when it comes to pain care disparities (Hint: Think equitable care!)

Dynamics of personalized medicine and disparities in pain care

What is her advice for clinicians as well as patients and families that will help move the needle forward for better pediatric pain care.

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The obvious benefits of a strong, healthy partnership with patients and families in pediatric pain care are undeniable. But, in a time when a clinician may be held responsible for everything, criminal negligence, or child abuse related to undertreatment of pain or contributing to prescription drug abuse because they treated their patients' pain with medication, a better understanding of the fine and murky line of a clinician's ethical obligations becomes essential. Dr Douglas Diekema sheds light on the ethical concepts and guidelines for clinicians to effectively navigate these issues providing best possible care for their pediatric patients.

Takeaways in This Episode

What is the ‘‘best interest’’ principle in care of pediatric patients
Where does the ‘‘best interest’’ principle fall short?
What’s the role of the “harm principle? Who does it affect?
The parameters around “autonomy” in care of pediatric patients
Is there such a thing as “the Mature Minor” and where does it come into play in pediatric care?
Controversies around opioids prescriptions
Role and obligations of clinicians in prescriptions of opioids
Considerations when a clinician is faced with request for medical marijuana for a pediatric patient
The bottomline on marijuana use in pediatric patients

Links Mentioned

Douglas Diekema MD, MPH

Treuman Katz Center for Pediatric Bioethics

Podcast Episode 5

AAP Poster on Safe Storage and Disposal of Medications

AAP Policy Statement on Marijuana

Pediatric Bioethics Conference 2018

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If you have ever found yourself wondering about the gap between what you said and what your patient or families heard, you would not want to miss this episode, with great insights from Ms. Pamela Block, a mother to a child chronic pain and CEO of a community for patients and families with a rare complex condition. She shares her own contrasting experiences with complex medical care for her daughter, including pain and leaving us with terrific little tweaks that will augment our quality of clinical care and outcomes.

Takeaways From This Episode

What made her jump both feet into creating a patient and family community supported by healthcare providers
What patients and families see and hear during their medical encounters
Factors leading to success or failure in outcomes of chronic or complex pain care
Things that parents value, need and want in the care of their children's pain
Priorities of patients and families with chronic pain
The shifts that happen when parents feel heard and understand the goals
What providers can do to become more effective in helping the patients and families with complex pain, even during their routine care
What does a "quarterback" have to do with pain care
Challenges with complex and chronic pain care

Links Mentioned in this Episode

Free training for parents of children with pain

Association for the Bladder Exstrophy Community

Pamela Block

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This episode is all about creating winning strategies in healthcare and pain management when faced with rare, refractory and poorly understood diagnoses, that may not have any great treatment options. Story shared by the parents of my then 4 y/o patient with a rare and extremely painful condition, Erythromelalgia, highlights some of the elements that returned normalcy into their child's life despite this life long condition.

Takeaways in This Episode

How parents' early insights help with prompt and accurate diagnosis

How to proceed when little is known about a disease

What parents value even more than accurate diagnosis or treatment

What a parent sees, hears or feels when many specialists care for their child

What allowing parents to become active participants in healthcare can accomplish

Links Mentioned

Erythromelalgia

Fairytale's Daughter

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We continue our series on technological innovations designed to enhance the way we provide clinical care, deliver and receive information and education to and from our patients and families, leading to increased engagement, compliance and ownership by them. Today we talk to Rachel Trobman, Founder and CEO of OUCHIE an online platform for tracking and effectively managing chronic pain using multimodal treatments.

Takeaways From This Episode

How a FREE online platform is used for tracking pain, mood, function etc., how it’s used for education, pain management and creation of community for chronic pain patients.
How this platform can be used by any HCP for better care of their pain patients and how it can be customized to their particular needs and therapies.
What they do to ensure that patients, despite their pain, focus on what they CAN DO, rather than what they can’t.

Links Mentioned in this Episode

Ouchie

Rachel Trobman

Pedia Pain Focus Episode 3

Pedia Pain Focus Episode 4

US Pain Foundation

American Pain Society

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This brief bonus episode is packed with tips for safe prescribing, storage and disposal of opioids, and other controlled substances with misuse potential.

DEA National Prescription Take Back Day

CDC Guidelines for prescribing Opioids

FDA Information on Opioids

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In this episode Dr. Christine Chambers a prolific researcher, clinician, and academician, delves into the issues healthcare providers face with Social Media and online information, how they can effectively use SM for knowledge translation, and effective clinical partnerships.

Takeaways in This Episode:

How a 2.5 minute video revolutionized the way Knowledge sharing and translation occurs in medicine
What 3 factors led to development of this revolutionary work and how this paves the way for future knowledge sharing with patients and families
Unanticipated challenges in putting her ideas into practice and how she found an effective solution to create a video that went viral in multiple languages and continents
Obligation of HCP regarding SM, online content and communication
Effective strategies for HCP to help parent in navigating this ocean of online information

Links Mentioned in This Episode:

It Doesn’t Have to Hurt

It Doesn’t Have to Hurt Video

The Center for Pediatric Pain Research

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Limited access to pain care, especially in remote and rural areas, is no surprise and when it comes to pediatric pain care, it’s even more sporadic. My today’s guest, Ardith Doorenbos, MSN, PhD, shares her extensive work using Telemedicine for education, research and clinical care. Also included is your FREE Guide to Setting up Telemedicine Services.

Takeaways from this episode

What made her invested in Telemedicine
What are some of the expected and unexpected outcomes (cherry on top) and efficiencies of Telemedicine delivered pain care (Hint: it’s way more than just solving the access problem!)
How Telemedicine changed the outcomes, and QOL for both the patients AND healthcare providers
What 3 specific benefits resulted for healthcare providers
Economics of telemedicine for pain care
Considerations to determine what model of telemedicine is best for your setting

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With millions of children facing surgery related pain and another 40% of children dealing with chronic pain, learn what 3 pillars determine the quality of their pain care, what factors have major influence on these areas, and what considerations by healthcare providers, administrators and agencies can improve the future of pediatric pain care.

Takeaways from this episode

Major barriers to effective pain care of children’s pain
Common myths and misconceptions about children’s pain
IASP recommendations on wait times and how well we score on that benchmark for pediatric pain
Contributing factors to the barriers to pediatric pain care
How a mis-step in the 1940s hijacked the pediatric pain treatment efforts
An often misunderstood special power of children that clinicians need to harness for optimizing treatment outcomes.
Important elements to consider for designing effective solutions for pain care in children.

Links Included in this episode

Pedia Pain Focus podcast episode 1

https://www.iasp-pain.org/Guidelines

www.proactivepainsolutions.com/contact

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This inaugural episode of Pedia Pain Focus, discusses what fueled its creation, the core beliefs and philosophy driving enhanced pediatric pain care, the current status of pediatric pain medicine, need for transformative action, and as a healthcare provider who cares for any child faced with pain issues, why and how this podcast is going to aide provision of superior care of your patients.

Pedia Pain Focus: Recent Episodes

Dr. Anjana Kundu