Meeting Reviews
Interdisciplinary Care of Pediatric Patients
By Harshad Gurnaney, MD, MPH
Anesthesiology and Critical Care
Children’s Hospital of Philadelphia
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania
The SPPM meeting continued into Friday, February 28, for a special session titled “Interdisciplinary Care of Pediatric Patients.”
Dr. Stefan J. Friedrichsdorf from Children’s Minnesota presented the “Advances in Our Understanding of Pediatric Pain Pathophysiology and Assessment.” In this presentation, Dr. Friedrichsdorf highlighted the role of multiple pathways in the modulation and perception of pain. He described our current understanding of pediatric pain pathophysiology and it’s implication upon pediatric pain assessment. He discussed the role that “Multimodal Analgesia” plays in the management of acute and chronic pain. He explained how multiple pharmacologic agents, behavioral interventions, rehabilitation, and integrative therapies all act synergistically to provide pediatric patient’s pain control with fewer side effects.
It was followed by a presentation by Dr. Suresh Thomas from Detroit Children’s Hospital, Wayne State University, on the use of multiple classes of pharmacologic agents as a part of the multidisciplinary approach in managing chronic pain in pediatric patients. He gave an overview of the pathophysiology of the different types of pediatric pain. He then provided practical strategies in his approach to pediatric chronic pain. He further recognized the importance of non-opioid medications and non-pharmacological methods in a pediatric chronic pain management plan.
Another wonderful presentation on the role of sensory processing disorder in chronic pain was delivered by Christopher Joseph, the Director of Physical Therapy at Kennedy Krieger Institute, Johns Hopkins University School of Medicine. He clearly defined the multiple subtypes of sensory processing disorder. He then provided the audience with an understanding of the Sensory Modulation Disorder, which is a deficiency in regulating the intensity and nature of responses to different sensory input. He discussed how patients who are experiencing chronic pain also have disorders in their ability to process all their senses. He then discussed the concepts of the optimal window of functioning, changing states and the role of fight or flight response.
Dr. Terri Voepel-Lewis from the University of Michigan gave a terrific talk on mitigating the risks of prescription opioids for children and adolescents. She discussed strategies that enhance adolescents'/parents' ability to make safe and effective pain management decisions. She shared her research on assessment tools to identify youth/families at risk for opioid analgesic adverse outcomes. Incorporating similar strategies that enhance parents/adolescents' ability to make safe and effective pain management decisions is essential in easing pediatric pain.
The final presentation was on "Pain Education: Explaining Pain to Youth and Families" by Dr. Rachel Zoffness, a clinical psychologist at UCSF. Dr. Zoffness discussed the biopsychosocial model for pain and the role of biobehavioral interventions in pain management. She has a distinctive way to "explain pain" to youth and families using neuroscience and metaphor during a clinical encounter. Dr. Zoffness skillfully illustrates the biopsychosocial model of pain and thus requires a biopsychosocial solution. She introduced the audience to a non-stigmatizing method of introducing biobehavioral interventions like CBT to pediatric pain patients. Her lecture was a very nice summary of the behavioral approach in pediatric pain management.
This half day symposium was very well received. The presentations covered numerous aspects of the management of chronic pain conditions in the pediatric population. They were presented by a diverse group of specialists who play vital roles in managing pediatric patients who have chronic pain conditions.
