Society for Pediatric Pain Medicine
Better Care for Children in Pain

{“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”}}}

{“questions”:{“c64yr”:{“id”:”c64yr”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”An 18-year-old female presents to your office with intermittent unilateral shooting pain localized to her left costal margin for the past 10 months. The pain is worse when laughing or twisting her torso. She occasionally feels a popping sensation associated with the pain. She is a gymnast who trains 20+ hours weekly, though does not endorse any inciting accident or activity causing the pain. On physical examination, you note that she is hypermobile in her shoulders with tenderness to palpation of her left costal margin. You send her for a dynamic ultrasound of her ribcage. \r\nWhich of the following is the most likely diagnosis: \r\n”,”desc”:””,”hint”:””,”answers”:{“epu3v”:{“id”:”epu3v”,”image”:””,”imageId”:””,”title”:”A)\tSlipping Rib Syndrome”,”isCorrect”:”1″},”v4sdo”:{“id”:”v4sdo”,”image”:””,”imageId”:””,”title”:”B)\tEhlers\u2019s Danlos Syndrome”},”6ogxl”:{“id”:”6ogxl”,”image”:””,”imageId”:””,”title”:”C)\tCostochondritis”},”znaev”:{“id”:”znaev”,”image”:””,”imageId”:””,”title”:”D)\tTietze Syndrome”}}}},”results”:{“j3hsy”:{“id”:”j3hsy”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2024\/05\/SPPM-QOM-May-2024.pdf”}}}

{“questions”:{“71ld7”:{“id”:”71ld7″,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”A 15-year-old previously healthy female was referred by dermatology for widespread itching refractory to multiple dermatologic treatments. Careful history suggested the itching sensations may have a neuropathic quality similar to paresthesias. As a pain physician comfortable with neuropathic medications, the referring physician would like you to consider a trial of gabapentin related to a possible small fiber neuropathy. On follow up, the patient reports >50% improvement in itching with low doses of gabapentin. As this is the first treatment to reduce symptoms, her mother would like to know why it helped when other treatments failed and whether she has a small fiber neuropathy. \r\n\r\nA lab evaluation was performed and was notable for a low vitamin B12 of 170 (normal 232-1245 pg\/mL). The patient denies other symptoms and there are no red flag symptoms for cancers, fatigue, or other chronic systemic diseases. The remainder of the small fiber neuropathy lab investigation is normal, including no signs of anemia, normal inflammatory levels, normal folic acid and other micronutrients, and normal thyroid studies. \r\n \r\nWhat is the next best step in management? \r\n”,”desc”:””,”hint”:””,”answers”:{“g51q0”:{“id”:”g51q0″,”image”:””,”imageId”:””,”title”:”A.\tGive intramuscular B12″},”o0lnp”:{“id”:”o0lnp”,”image”:””,”imageId”:””,”title”:”B.\tRefer to hematology\/oncology”},”ql9bt”:{“id”:”ql9bt”,”image”:””,”imageId”:””,”title”:”C.\tCheck homocysteine and methylmalonic acid levels”,”isCorrect”:”1″},”jfrfb”:{“id”:”jfrfb”,”image”:””,”imageId”:””,”title”:”D.\tCheck Intrinsic factor antibodies”}}}},”results”:{“8kqn6”:{“id”:”8kqn6″,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2024\/04\/SPPM-QOM-April-2024.pdf”}}}