Society for Pediatric Pain Medicine
Better Care for Children in Pain

Deepa Kattail, MD MHS FAAP
Assistant Professor
McMaster University

12 year old female with a diagnosis of functional dyspepsia has been referred to your pediatric chronic pain program for management of pain. She complaints of constant throat and stomach pain for the last 1 year. She has had extensive work-up by the gastroenterologists, including endoscopy, esophageal manometry and MRI of her abdomen that have all shown normal findings. She missed approximately 2 full days of school per a week, due to abdominal pain, thus prompting her parents to keep her at home. Her mother describes her as being quite anxious, in fact she was unable to sleep last night due to today’s appointment and was crying before entering the room to see you today. Last year, prior to onset of her pain, she was able to competitively dance, but this has now been put on hold. In addition to multidisciplinary approach to chronic pain management, including psychosocial support, pain education and assessment by physiotherapy, which medication would be appropriate and evidence based for first line treatment?

Elizabeth Pedigo, MD
Assistant Professor,
Doernbecher Children's Hospital at Oregon Health & Science University

There is a new otolaryngologist at your hospital and you are the anesthesiologist assigned to work with her. After your first case, which happens to be an adenotonsillectomy in a four year-old male with OSA, she asks you what dose of tramadol she should write for as an analgesic for the child to take at home. Which of the following is incorrect:

Petrus Paulus Steyn, MD
Fellow, Department of Anesthesiology and Critical Care Medicine
Children's Hospital of Philadelphia

A 14-year-old basketball player presents for a shoulder arthroscopy and a Bankart repair of his right shoulder. In the preoperative holding area, you inform the patient and his mother that you plan to have him under general anesthesia for this procedure and that you want to perform an ultrasound guided single-shot interscalene block after he is asleep for postoperative pain management. After describing the procedure, its potential minor and major complications and alternatives,  you ask the patient and his mother if they have any questions.

The mother notes that her son has an upcoming school dance (in a month) and wants to know:

> What the likelihood is that ‘this eyelid droop’ will happen?
> If it does happen how long it will take to go away?
> Is it ever permanent?
> Can it happen on both sides?

What will you tell her?

Patricia Richardson, PhD
Pediatric Pain Psychology Postdoctoral Fellow
Stanford University

A 16-year-old girl presented with widespread musculoskeletal pain and headaches. Symptoms were treated with medication management and outpatient physical therapy (PT). Several months into follow-up, the patient was not making progress, continued to report elevated pain, and had stopped attending school. It was revealed that she was not taking prescribed medication or engaging in PT because she did not think these services would be helpful. Her life was further complicated by ongoing stress related to poor familial relationships and her parents’ impending divorce.

Written by Ben Ekstrom MD, FAAP
Center for Pain Relief

A 15-year-old, otherwise healthy female gymnast presents to the pediatric chronic pain clinic with a six-month history of low back pain. The pain has been getting progressively worse over time and is not associated with any radicular symptoms. There was no significant injury prior to the onset of pain. She has been missing practices with increasing frequency. Her mood and academic performance are beginning to be impacted by the back pain. You suspect she may have developed lumbar spondylolysis. With regards to this disease, which of the following is NOT true?