Society for Pediatric Pain Medicine
Better Care for Children in Pain

{“questions”:{“sfhwf”:{“id”:”sfhwf”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”A 16-year-old nulliparous female presents to the pain clinic for discussion of pain management options around placement of an intrauterine device (IUD) for contraception. She has seen the videos on TikTok(1) and is anxious about the potential discomfort during the procedure. She has no significant medical history and is not currently taking any medications. Vital signs are stable. Which of the following is the most effective analgesic technique for pain relief during the procedure?”,”desc”:””,”hint”:””,”answers”:{“7twn4”:{“id”:”7twn4″,”image”:””,”imageId”:””,”title”:”A. No pain management required”},”jr2uw”:{“id”:”jr2uw”,”image”:””,”imageId”:””,”title”:”B. Ibuprofen and acetaminophen”},”uceym”:{“id”:”uceym”,”image”:””,”imageId”:””,”title”:”C. Paracervical block”,”isCorrect”:”1″},”ju5tx”:{“id”:”ju5tx”,”image”:””,”imageId”:””,”title”:”D. Pre-procedure anxiolytic”}}}},”results”:{“ufgbu”:{“id”:”ufgbu”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2024\/10\/SPPM-QOM-October-2024.pdf”}}}

{“questions”:{“11wj3”:{“id”:”11wj3″,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”A 17-year-old male with a history of degloving injury to his left lower extremity following a traumatic ATV accident who has undergone 3 separate reconstructive surgeries, complicated by ongoing burning pain to the left lateral leg\/foot. He presents to your clinic for preoperative evaluation preceding his last and most involved surgery. In addition to his home regimen (acetaminophen, celecoxib, amitriptyline, pregabalin, and sometimes oxycodone), his previous perioperative analgesic regimen included sciatic nerve blocks with indwelling catheters, scheduled ketorolac, and oxycodone and IV hydromorphone as needed for breakthrough pain. Despite this, his acute-on-chronic pain has been difficult to treat post-operatively, interfering with his sleep and recovery. \r\n\r\nYou discuss the option of adding a ketamine infusion to his regimen but the patient is hesitant about receiving ketamine, citing its association with a highly-publicized death of a celebrity. He tearfully describes knowing friends who became mentally altered temporarily after taking ketamine tablets obtained online. You would like to educate your patient about ketamine use in treating pain. \r\n\r\nWhich of the following statements is TRUE? “,”desc”:””,”hint”:””,”answers”:{“3h78o”:{“id”:”3h78o”,”image”:””,”imageId”:””,”title”:”A. Injectable ketamine is a treatment approved by the FDA for pain management.”},”6cuev”:{“id”:”6cuev”,”image”:””,”imageId”:””,”title”:”B. Research indicates that ketamine is highly efficacious in treating non-neuropathic pain conditions including fibromyalgia, cancer pain, ischemic pain, and migraine headaches.”},”o1qpu”:{“id”:”o1qpu”,”image”:””,”imageId”:””,”title”:”C. According to the 2018 ASRA guidelines, since ketamine is given at subanesthetic doses to treat chronic pain conditions, personnel in charge of its administration only require DEA licensure and ACLS training.”},”0faxz”:{“id”:”0faxz”,”image”:””,”imageId”:””,”title”:”D. Ketamine is a non-addictive \u201cstreet\u201d drug popular for its euphoric and sensory-heightening properties.”},”8uyy4″:{“id”:”8uyy4″,”image”:””,”imageId”:””,”title”:”E. Ketamine can be shipped to patients as oral and injectable forms when prescribed by a clinician with appropriate DEA prescribing privileges.”,”isCorrect”:”1″}}}},”results”:{“bv73h”:{“id”:”bv73h”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2024\/09\/SPPM-QOM-September-2024.pdf”}}}

{“questions”:{“zktug”:{“id”:”zktug”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Emma, a 10-year-old girl, has been experiencing chronic musculoskeletal pain for the past six months. Her parents report that she often has difficulty falling asleep and wakes up frequently throughout the night. Despite trying various bedtime routines, Emma’s sleep problems persist, and she frequently complains of feeling tired during the day. Her pediatrician has noted that Emma’s pain seems to be worse on days following poor sleep, and her response to pain medication has been inconsistent. Given Emma’s chronic pain condition and sleep disturbances, her pediatrician is considering different strategies to help improve her sleep quality and manage her pain more effectively. \r\nWhich of the following statements about the relationship between chronic pain and sleep disturbances in children is most accurate?\r\n”,”desc”:””,”hint”:””,”answers”:{“e8r7p”:{“id”:”e8r7p”,”image”:””,”imageId”:””,”title”:”A) Just as acute pain influences sleep quality, chronic pain is also responsible for chronic sleep disorders in children.”},”dj74q”:{“id”:”dj74q”,”image”:””,”imageId”:””,”title”:”B) Sleep mechanisms may adapt over time in children, hence chronic pain may not always be associated with sleep disturbances.”,”isCorrect”:”1″},”z0rm9″:{“id”:”z0rm9″,”image”:””,”imageId”:””,”title”:”C) Behavioral interventions to modify sleep patterns have no significant impact on pain perception in children with chronic pain.”},”pxuaj”:{“id”:”pxuaj”,”image”:””,”imageId”:””,”title”:”D) Deprivation of Rapid Eye Movement sleep does not influence pain perception in children.”},”9e3ia”:{“id”:”9e3ia”,”image”:””,”imageId”:””,”title”:”E) Over-the-counter melatonin has been shown to be ineffective in regulating circadian rhythm and improving sleep quality in children with chronic pain.”}}}},”results”:{“zbw28”:{“id”:”zbw28″,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2024\/08\/SPPM-QOM-August-2024.pdf”}}}

{“questions”:{“qz8bx”:{“id”:”qz8bx”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”An 18-month-old female presents for right hip open reduction, capsulorrhaphy, adductor tenotomy, iliopsoas lengthening, and pelvic osteotomy +\/- femoral osteotomy. As part of the procedure, she will undergo bilateral hip arthrograms. She will have a spica cast applied at the end of the procedure. She has a history of developmental hip dysplasia and recurrent hip dislocations but is otherwise healthy. She has not had anesthesia before.\r\n\r\nDue to contraindications for other regional techniques, the perioperative team decides to perform a fascia iliaca block as part of the patient\u2019s multimodal pain control. What is a major benefit of performing this technique from a suprainguinal approach rather than infra-inguinal (from below the inguinal ligament)?\r\n”,”desc”:””,”hint”:””,”answers”:{“zugow”:{“id”:”zugow”,”image”:””,”imageId”:””,”title”:”A.\tExpanded antithrombotic\/thrombolytic options for patients needing anticoagulation”},”n2qux”:{“id”:”n2qux”,”image”:””,”imageId”:””,”title”:”B.\tMore consistent sensory blockade of the anterior, medial, and lateral thigh”,”isCorrect”:”1″},”1gust”:{“id”:”1gust”,”image”:””,”imageId”:””,”title”:”C.\tBetter visualization of the deep femoral artery”},”4lvop”:{“id”:”4lvop”,”image”:””,”imageId”:””,”title”:”D.\tImproved motor sparing”}}}},”results”:{“kuvg2”:{“id”:”kuvg2″,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2024\/07\/SPPM-QOM-July-2024.pdf”}}}

{“questions”:{“aut5f”:{“id”:”aut5f”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”You are consulted for a 1-hr-old 34-week, 2 kg infant who was born to a GIP1 mother with a history of severe OI and chronic pain who has been taking methadone 15mg TID during the pregnancy. Mother is unavailable, but father is at bedside and reports mother has been slowly weaning her dose of methadone from a daily dose of 100 mg a day to limit fetal exposure. She has also received prn hydrocodone\/acetaminophen, for a recent fracture and has used 40mg hydrocodone in the last 48 hours. Father reports fetal ultrasounds showing limb length discrepancies and evidence of possible in-utero rib and limb fractures. \r\nNo x-rays have been done yet but are planned. Mother is planning to breast feed the infant and to continue taking methadone. The neonatology team is concerned about neonatal opioid withdrawal syndrome (NOWS) as well as pain management for possible fracture pain. \r\nIn addition to acetaminophen, documentation of withdrawal and pain scores, which of the following therapeutic approaches is the most appropriate in this patient? \r\n”,”desc”:””,”hint”:””,”answers”:{“55jo8”:{“id”:”55jo8″,”image”:””,”imageId”:””,”title”:”A. As needed PO or IV morphine every 2 hours”,”isCorrect”:”1″},”y1shk”:{“id”:”y1shk”,”image”:””,”imageId”:””,”title”:”B. Around the clock lorazepam for the first 48 hours and then a slow wean”},”rmy3z”:{“id”:”rmy3z”,”image”:””,”imageId”:””,”title”:”C. Eat, Sleep, Console with no additional opioids”},”5z6jq”:{“id”:”5z6jq”,”image”:””,”imageId”:””,”title”:”D. Start a dexmedetomidine infusion for 48 hours”}}}},”results”:{“5023u”:{“id”:”5023u”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2024\/06\/SPPM-QOM-June-2024.pdf”}}}