Pedia Pain Focus

What does pain look like? In today’s episode, I discuss different ways in which our biases and experiences can often overshadow the experience of the patient, impact clinician-patient encounters and the importance of context in every situation.    Is there a specific look to pain? Have you ever wondered if a patient is exaggerating their pain? It is common for chronic pain sufferers to hear comments like, “But you look so normal, you can’t be in that much pain.” These comments can be especially detrimental coming from a physician.    I also discuss the "Catch 22 of pain" where we emphasize improvement in function over reduction in pain scores for the optimal outcomes, and also undermine patient's pain intensity watching them follow that advice!    Takeaways in This Episode The automatic assumptions about pain When should you believe the self report of pain. How accurate is the statement "When someone says they’re in pain, they’re in pain" ?  Considering the context of the situation, the patients’ previous ex

Dr. Clara Cohen experienced the magic of acupuncture from a young age when she was able to recover from scoliosis related pain as a child.  She initially worked as a personal trainer, but felt a strong desire to help her clients in an even more impactful way. That’s when she discovered acupuncture.    Now a doctorate of Traditional Chinese Medicine and in practice for 18 years, she offers the introduction to acupuncture as something that doesn't cure or treat anything! Her abundant passion for natural medicine and harnessing the body's healing ability drives her practice.  Dr. Cohen says, “I’m an acupuncturist by day, but I’m a naturopathic doctor-wannabe by night.”    In this episode, Dr. Cohen shares some incredible stories of success from her pediatric patients over the years. We explore the use of acupuncture for pain management, her best practices for treating children, how she promotes healing at all ages and what healthcare professionals need to know about acupuncture and counseling their patients arou

We all know of Botox use to reduce signs of aging. Approved in 2010 to treat migraines in adults, it’s now also being explored (as an off-label treatment) for management of pediatric migraines.    In this episode, Dr. Shalini Shah, MD, MBA, the Vice-Chair for the Department of Anesthesiology & Perioperative Care and Enterprise Director of Pain Services at UC Irvine Health, shares their clinical and reseach findings, as well as the indications, caution, nuances, and protocol for use of botox in pediatric migraine. Her work on the effectiveness of Botox in pediatric patients experiencing migraines has been published in peer reviewed journals and been featured in Time Magazine and on NBC Nightly News.    We discuss her landmark work, the results of her study, protocols, indications and how you can best advocate for your patients to receive the same treatment.    Takeaways in This Episode   How Dr. Shah became interested in use of botox for pediatric headaches. Findings of her pediatric study including longi

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 througho

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 vasoccl

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 cou

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

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 Ho

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. S

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 integ

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

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 Certifie

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 recommend

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

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 professi

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 differe

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

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  Gui

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 par

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