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Novel Approach to Pediatric Pain Management

Word cloud graphic of pain symptoms

Chronic pain is one of the most common conditions encountered by health care professionals. This is particularly true among older (≥65 years) patients, but nearly 30% of children suffer from chronic pain as well. Unfortunately, only in the past 20 years has attention started to focus on this underrecognized pediatric population.

Pain may stem from organic disease, such as cancer or from a process known as central sensitization in which the pain condition itself becomes the disease. Regardless of the etiology, pain interferes with daily functioning and impacts not only the individual, but the entire family and social network.

Advanced understanding for the need to treat pain has developed, but the increased awareness has not necessarily led to better outcomes. Most research has focused on the adult population, recognizing that chronic pain has serious financial implications reaching billions of dollars in health care expenses and lost wages. However, the cost of pediatric pain is estimated to reach approximately $30 billion annually. This is compounded by lost wages from parents that take time away from work, lose jobs, and drive children to endless doctor's appointments seeking treatment. Children suffer from poor school attendance and essentially can become disabled.

Adults benefit from earlier diagnosis, readily accessible intervention, and more evidenced-based treatment options, yet for pediatric patients there is still a paucity of literature and education on best practices.

"When the cry arose for the need to treat cancer pain and chronic pain better, we may have underappreciated the complexity of pain," said Charles E. Argoff, M.D., professor of Neurology at Albany Medical College and director of the Comprehensive Pain Center at Albany Medical Center in New York, referencing our previous decades. "We attempted to increase symptomatic treatment, and did not anticipate problems like the ones we are seeing now, like long-term side effects of chronic opioid therapy."

In an effort to improve pain outcomes and creatively combat the opioid epidemic, Cook Children's Health Care System is supporting the only comprehensive Center for Pain Management and Integrative Health in the Southwest United States. Our referral network extends throughout the state of Texas, New Mexico, Oklahoma, Arkansas and Louisiana. Artee Gandhi, M.D. as recently named an Endowed Chair Award recipient from the Cook Children's Health Foundation to develop and lead the program, which will bring together conventional medicine and complementary therapies under one roof. Our treatment approach incorporates strategies that focus on medications, mind-body therapies, lifestyle modifications, psychological support, and interventional pain procedures. Complementary therapies offered include acupuncture, biofeedback, cognitive behavioral therapy, massage therapy and yoga therapy. Our new yoga program and yoga therapist will provide individual inpatient consults, group classes for patients from Behavioral Health (inpatient and partial hospitalization program), Oncology, Neurorehabilitation, a parent/child class in the Child Life Zone and community classes two evenings each week.

"As healthcare providers, it is our responsibility to ease the pain and suffering of all our children in a safe and effective manner. How a child responds to pain is influenced by genetics, environment, and previous experiences. From a child's first set of immunizations, to a child's first broken arm, to a child's 5th surgery for cancer, we must recognize that pain is a continuum and each exposure builds on itself lending to the development of chronic pain and worsening fear. Through innovation, research, and education we will make a difference in every child's experience." - Artee Gandhi MD, Medical Director, Cook Children's Pain Management

Providing wholistic care to pediatric patients by treating mind, body, and spirit is vital to the program's success.

Additional Cook Children's Pain Management plans include:

The comfort menu: A tool to reduce procedural pain

  • Encourage consistent collaboration with family and providers to reduce procedural pain by incorporating comfort holds, breastfeeding, topical pain relievers and distraction
  • Improve the patient experience

Pain management stewardship

  • Promote leadership commitment and culture
  • Implement clinical pathways and organizational policies
  • Advance clinical knowledge, expertise and practice
  • Enhance patient and caregiver education
  • Monitor performance data regarding prescription medications
  • Support community collaboration through Fort Worth Safe Communities 
  • Expand the use of complementary therapies to be readily available for all patients

Pain Management Appointments/Referrals
Pain Management Information


Contributing author:

Artee Gandhi, MD

Artee Gandhi, MD

Pain Management

Meet Dr. Gandhi


Cook Children's Pain Management team

Great outcomes begin with great input. Having a medical system where every department, doctor, and care team member works together means that your child can have quick access to testing, diagnosis and treatment, and that means better outcomes now and in the future.

If your patient is suffering from pain, we can help. To schedule an appointment, refer a patient or speak to our staff, please call Cook Children's Pain Management department at 682-885-7246.


References:

  • National Quality Forum NQP Playbook Opioid Stewardship
  • Sen D, Christie D. "Chronic idiopathic pain syndromes." Best Practice and Research Clinical Rheumatology. 2006 Vol 20, NO 2, pp369-386.