Meeting Reviews

Changing Horizons

By Elisha Peterson, MD, FAAP
Director of Chronic Pain
Children's National Hospital
Washington, District of Columbia

At the SPPM conference in the Changing Horizons Session, Dr. G. Allen Finley delivered a lecture titled “It is Time to Change the World:  Advocacy, Institutional Culture, and Children’s Pain”.  He reminded us that despite the increased number of pediatric pain publications, there is still an overwhelming percentage of pain that is either not treated or undertreated in pediatric medical care.  He emphasized that knowing the right thing to do does not translate into doing the right thing.  He charged us with reviewing organizational practices and embed within the workflow guidelines that minimize pain to change this culture of “I do not have time/or an order to pretreat with EMLA”.  Dr. Finley shared parent narratives that illustrated that the most difficult time of a parent’s life was to watch their child in pain.  ChildKind was introduced, an organization that aims to reduce the suffering of children worldwide.  They have a certification process for hospitals to acknowledge the institutions that have demonstrated commitment to the prevention and treatment of pain in pediatrics.

Dr. Monique Ribeiro delivered the second lecture in this series titled “Shrinking Suffering:  A Psychiatrist’s Approach to Pediatric Chronic Pain”.  She provided us with an overview of the paucity of FDA approved drugs to address psychopathology in children.  Despite the few FDA approved drugs, Dr. Ribeiro instructed that most mood disturbances in children respond to cognitive behavioral therapy.  If the mood disturbance interferes with the child’s ability to participate in therapy, this is the time to introduce a pharmacologic agent.  The most common medications for addressing mood disturbance are SSRIs and families should be instructed that it takes three-six weeks to start working. 

Physicians should be candid about the side effects of such agents as well, so families are not alarmed.  Medications should be started in conjunction with weekly cognitive therapy so the patient is closely monitored during initiation- the child’s therapist can then alert the physician of any concerning symptoms.  A team approach is necessary when treating children with chronic pain.