Pedia Pain Focus

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 act

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

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 e

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 th

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 maj

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 misma

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 pai

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

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

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 effective

Melatonin use for sleep issues is widespread among all ages despite a lack of recommendation for insomnia by the expert guidelines. Increased stress levels and disrupted routines in the current environment, has many more people turning to melatonin for respite with sleep problems. This episode explores what melatonin is or is not, when and how it should be taken and what caution, if any, is needed wit its use, especially as it relates to children.  Also discussed are the controversies around its use for certain indications, its quality, regulatory issues and how one can ensure getting the right quality products.  Links   AASM Practice Guidelines Circadian Rhythm Clinical Guidelines Consumerlab.com  

Doctors and other professionals with prescriptive authority can prescribe any medications they deem appropriate for the treatment of their patient's condition, but the liability risk may be weighing on their minds, in the event of adverse outcomes related to use of off label medications. Meanwhile, a vast majority of medications used for pediatric pain have not specifically been labeled for use for that particular indication, age group or dosage.  This episode explores the implications of off-label medication use and how to appropriately counsel your patients when using off label medications.  Takeaways in This Episode: What constitutes off-label medication use & how prevalent is it? What leads to off label use of medications What does it mean for a prescriber to use a medication off-label? The considerations that a healthcare professional/prescriber should make when evaluating off-label use of a medication. Steps in counseling your patient & family when using a medication off-label, that will ensure

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 pa

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 &

Narrative Medicine or art of storytelling in healthcare is a unique but essential skill in improving healthcare outcomes. Continuing my conversation with Ms. Beth Turner about the transformative power of storytelling in pediatric pain care.  Takeaways in This Episode Particular words and phrases, directives relevant to storytelling/narrative medicine in pediatric pain. Guiding a patient to be a hero in their own story. Empowering and giving hope even when the exact diagnosis or treatment may be unclear. "Closing the gap" when patient and HCP narratives do not align. Role of trauma in pain management. Role of boundaries (Hint: they are meant to be inclusive) Storytelling as an opportunity to grow and transform. Checklist for Healthcare Professionals to master the skills in narrative medicine. Links Beth Turner Narrative Medicine Checklist Peter Levine PHD Pedia Pain Focus episode #15 Proactive Pain Solutions

This episode uncovers the unique factors which predispose healthcare professionals to an increased risk for trauma and stress during COVID-19 pandemic, early signs of stress & trauma and provides a framework and a toolkit for effectively managing this stress and cultivating resilience. Takeaways in This Episode Reasons why healthcare professionals are at increased risk of trauma and stress during COVID-19 pandemic. The subtle (or not so subtle) signs of trauma and stress. Ways to effectively and proactively manage trauma and stress and foster resilience.  Why it is important to manage stress and trauma. A resilience & self-care toolkit, and helpful resources. Links CDC Headspace Proactive Pain Solutions Resilience & Self care Toolkit

Storytelling is a powerful tool in healthcare especially for pain management and children with their such imaginations are perfect partners for this. This is a healthcare professionals' personal guide to incorporating the art of storytelling in caring of their patients, their teams, loved ones and themselves! Takeaways in This Episode: Impact of Storytelling in our lives and in our practice. Storytelling as a way of being, a relationship to ourselves and to those we influence or interact with.  Incorporating the narrative medicine/storytelling elements in your practice without additional burden. Influence of quantum physics in storytelling. Interface of Mindfulness and Storytelling. Living a bigger life through storytelling and enhancing job satisfaction, performance and stability, personal health & wellness Harnessing the creative power of children in storytelling regardless of their age. Links: Columbia University Narrative Medicine Code Lavender Beth Turner Proactive Pain Solutions       

Understanding and proper utilization of QI in healthcare is essential for improved efficiency, safety, patient outcomes and ultimately satisfaction in a clinician's practice, but it can seem like a monumental task. Dr. Thomas Taghon demystifies the concepts of QI and shares how each of us can make it a routine part of our clinical care, that actually works FOR you! Takeaways In This Episode: The 6 dimensions of QI and what elements have particularly higher relevance in pain care How you can standardize care where evidence base does not exist What considerations must one take into account when setting up QI programs Tricks to ensure a strong QI practice despite lack of a "fancy database" and high tech resources. Personnel characteristic important to the success of your QI programs Running a successful QI program, even if your team doesn’t have specific training in QI methodologies Right sizing a QI team Appropriate timing for introduction of QI training for healthcare professionals   Leveraging technology beyo

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 Exstr

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 c