Pedia Pain Focus

Rare diseases are...well rare, but pain and suffering associated with them is not!  It requires early recognition or even preempting the pain inoder to prevent development of chronic an drefractory pain. In commemoration of the International Rare Diseases Day, I bring you an episode focused on promptly identifying and managing the pain associated with pediatric rare diseases and the challenges associated with that. Takeaways in This Episode Why we should talk about rare diseases. What makes a disease rare and what is an orphan disease Which rare diseases are commonly encountered amongst children  How big an issue is pain management for these children Common causes leading to pain experiences in a rare disease Common challenges to managing pain in a rare disease What should a healthcare professional know and do about managing pain for these children Links Pedia Pain Focus #51. Digital Interventions for Self Management of Pediatric Pain National Organization for Rare Disorders American Syringomyelia and Chi

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 outco

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 hea

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 metaph

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.

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 pr

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 pr

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

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 Sol

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

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 Phys

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 H

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 th

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

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. Bottomlin

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 Mana

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 passion

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. Am

“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 pla

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 P