Pediatric Chronic Pain. Objectives. Kathy Reid, RN, MN, NP Pediatric Chronic Pain Program Stollery Children s Hospital Edmonton AB

Transcription

1 Pediatric Chronic Pain Kathy Reid, RN, MN, NP Pediatric Chronic Pain Program Stollery Children s Hospital Edmonton AB Objectives The importance of validating chronic pain in pediatrics Discuss pharmacological, physical and psychological management approaches When and how to refer to our Stollery Chronic Pain clinic I have nothing to disclose 2 Suzie Age 13 9 month history of crampy, peri-umbilical pain and nausea 4 th time she and her mom in your office in 6 months 3 visits to the ER for abdominal pain Her blood work is normal, her abdominal x-rays have shown fecal loading and she is on regular doses of laxatives GI consult IBS Suzie reports that she can t go to school due to pain, and she s not sleeping very well at night Mom frustrated she s not getting any better do something 3 1

2 What is Chronic Pain? Chronic pain in children is the result of a dynamic integration of biological processes, psychological factors, and sociocultural context, considered within a developmental trajectory (American Pain Society, 2001) 4 Invisible pain Will they believe me? Will they trust my pain? 5 What we know Children with chronic pain feel that their voices were muted or ignored in encounters with medical professionals (Carter, 2004) Children report that physicians often don t seem to get it and thought I was lying, I was making it up (Meldrum, 2009) Adolescents want their questions answered and want clear communication. They want their health care providers to be trustworthy and honest. (Van Staa et al, 2011) 6 2

3 The value of listening Tell me about your pain 7 The importance of validating pain We believe you 8 Validation and explanation The nervous system is sending pain signals to the brain when there is nothing harmful going on in the body It s a bit like a smoke alarm going off all the time when there is no fire. It s kind of like the volume on your i-pod. Sometimes it seems too loud 9 3

4 3 P s of managing chronic pain Pharmacological therapies Physical therapies Psychological therapies Choose active therapies over passive therapies for long term benefit Address Sleep! 10 Pharmacological Therapies Limited evidence in the use of pharmacological interventions for children with chronic pain in general. Anticonvulsants may be prescribed for neuropathic pain Opioids may be appropriate Monitor the over the counter medications! 11 Physical Therapies Paced exercise programs Daily activity critical to the success of therapy Start low, go slow Yoga (Kuttner et al, 2006) 12 4

5 Psychological Therapies Cognitive- behavioural therapy (CBT) addresses the connections between thoughts, feelings and behaviours Effective for several pain conditions (Palermo et al, 2010) Effective for managing headaches (Eccleston et al, 2003) 13 Explaining the treatment approaches The recovery from chronic pain is like trying to get a car with four flat tires moving again. You can fill one tire with medication, but you still won t go anywhere unless you fill the other three tires. You might fill one tire with cognitive behavioral skills, one with physical therapy, and one with gentle activity such as swimming (Dr. B Dick, 2013) 14 Our Stollery Clinic Our Team: Physician, Nurse Practitioner, Physiotherapist Psychologist Biopsychosocial approach 2 hour initial assessment maximize the time to listen to the child tell their story Validation of the pain your pain is real Set goals, develop a plan 15 5

6 What we offer Physiotherapy sessions Medications if indicated Teens Pain week CBT program for teens Parent Pain hour group session Children Individual session to work on behavioural strategies 16 Referral Criteria Inclusion criteria: 0-17years, 11 months; chronic pain of at least three months duration; chronic pain as primary complaint; chronic pain which impacts activities of daily living, school attendance, sleep, quality of life or family functioning Referral form on the website 17 Our results We see significant improvement in Function (FDI p.017): anxiety (RCADS p.036); sleep (p.033) Parents note significant improvement in FDI(p.002) and sleep (p=.006) Pain scores less 18 6

7 Helping Suzie Validate her pain Medications unlikely to be effective but could trial Amitriptyline (start low, go slow) Teach parents that distraction is more helpful than sympathetic responses (Walker, 2006) Reinforce well behaviours such as school attendance Develop strategies to avoid reinforcing illness behaviours Gentle daily activity yoga, swimming are both good. Address her sleep! Thank you 21 7