Meeting Reviews

Review of the Fourth Annual Meeting of the Society for Pediatric Pain Medicine

By Franklin Chiao, MD and Anjana Kundu, MBBS, MD, DA, ABIHM

The fourth Annual Meeting of the Society for Pediatric Pain Medicine, held in Austin Texas, showcased an exceptional educational program. The day opened with a welcome note from Dr. Sabine Kost-Byerly, the president of SPPM and Dr. Stephen Hays, from Vanderbilt University Medical Center, who chaired the Annual Meeting program.

The focus of the first session was “science of pain” and opened with a great review of neuroimaging in pediatric pain disorders by Dr. Alyssa A. Lebel, Pediatric neurologist and a pain physician, from Boston Children’s Hospital. She analyzed functional MRI, diffusion tensor imaging, NIRS, MR spectroscopy, resting state networks, arterial spin labeling, and magnetoencehalography. 

This was followed by a presentation by researcher and RN, Terri Voepel-Lewis, focused on assessment of pain in cognitively impaired children where self-report of pain is unlikely, or subject to biases due to the varying degree of cognitive developments. She discussed the objective pain scales used in this population and pitfalls or biases that may pose challenges to appropriate assessment and management of pain amongst this population. Another fascinating and emerging pain assessment tool using facial expressions especially for the neonatal population has gained some attention in the recent years.

Dr. Carrie Menser, Vanderbilt University, discussed her research exploring the relationship between crying acoustics and pain amongst neonates.  This is a promising area, but does pose the challenges of identification of cry acoustics based on nociceptive pain from those occurring due to their distressing events such as hunger, or other physical non-painful stressors.  Further investigation in this area needs to be done on an algorithmic approach.  

The second session of the day focused on acute pain and regional analgesia, with emphasis on new directions for old techniques, featuring both new and well established speakers.  Dr. Benjamin Record of Memorial Sloan-Kettering Cancer Center opened the session by discussing the literature supporting the merits of intermittent mandatory bolus epidural analgesia and contrasting it with our current common practices of continuous and PCEA modes. Programmed intermittent epidural boluses compared with continuous infusion or PCEA resulted in less total local anesthetic dose requirement while providing comparable analgesia.

Next, Dr. Megan Brockel of Children’s Hospital of Colorado evaluated available evidence for enhanced recovery after surgery (ERAS) protocols in adults and children. The available literature on ERAS demonstrates that a systematic, multidisciplinary approach to perioperative management of patients reduces complications, length of stay and readmission rates. It also highlights the pivotal role of appropriate analgesia in the ERAS pathways.

The third presentation of this session featured Dr. Charles B. Berde of Boston Children’s Hospital sharing available research on options for longer acting local anesthetics, including his own extensive research on Neosaxotoxin.  While the current local anesthetics in use provide relatively limited (hours) duration of analgesia and relatively lower potency, Neosaxitoxin research may provide prolonged analgesia lasting up to two to three days.  These morning sessions provided a glimpse into the exciting innovations and research occurring in the field of pediatric pain management, enhancing our ability to provide better care for our children as a specialty.

Lunch featured an excellent collection of Problem Based Learning Discussions spanning across acute, chronic, cancer pain, regional analgesia and palliative care topics.

Post-lunch sessions featured presentations related to chronic pain, complementary and alternative medicine and palliative care topics. Dr. Tracy Jackson of Vanderbilt University Medical Center discussed the current factors contributing to the opioid epidemic, and how we can actively combat the crisis. She also highlighted the roles played by appropriate evaluation, patient education about chronic pain and use of multidisciplinary approaches beyond pharmaceutical agents in treatment of chronic pain.

The presentation by music therapist Shea Ingram from Cook Children’s hospital in Ft. Worth, Texas was a treat not only for our intellect with the evidence discussed, but also as a fantastic experiential exercise when she led the audience through a demonstration of how music can engage people in a more positive mindset, enhancing production of “feel good” neurotransmitters. Thus, music has a very positive impact on pain management and creating social connections, a major factor in those suffering from pain.

Dr. Meredith Brooks, also of Cook Children’s in Ft. Worth, discussed the range of interventional techniques for chronic pain in children. These techniques are less commonly employed in the pediatric population as compared to adult patients, but Dr. Brooks was able to demonstrate evidence from the available literature supporting the use of interventional techniques in appropriate conditions.

The fourth and final session of the day, led by Dr. Sapna Kudchadkar from Johns Hopkins, featured the award-winning research poster presentations from Regional Analgesia, Acute, Chronic and Palliative Pain.  The final podium presentations of the day were dedicated to the review of medical literature relevant to pediatric pain medicine. Dr. Vidya Chidambaran from Cincinnati Children’s Hospital presented the topic from basic science research, Dr. Lisqelia Santana-Rojas from Florida presented the top publications about acute pain and regional analgesia and Dr. Neil Raj Singhal from Phoenix presented the latest literature on chronic pain and palliative care.

Upon the conclusion of the podium presentations, the attendees had more in store for them and could quench their academic and intellectual thirst by attending an excellent collection of Moderated Poster Sessions and a variety of workshops, including creating the ideal pediatric pain management service, ultrasound-guided pediatric chronic pain management, and jointly offered workshops with SPA on acupuncture and advanced ultrasound-guided regional anesthesia.

Overall, this day was packed with great content for everyone engaged in the practice of pediatric pain and regional anesthesia!

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