Pediatric Pain Management Services
Inpatient Pain and Symptom Management ConsultationThe inpatient team of the Pain Management Service consists of pain management physicians, an advanced practice nurse, a child psychologist, and a massage therapist.
The inpatient pain management team provides pain and symptom management around the clock, seven days a week, with expert consultation for hospitalized patients who are experiencing pain associated with a variety of illnesses or treatments including:
- Pain due to injury
- Pain following surgery
- Pain associated with illness or treatment for an illness (cancer, sickle cell anemia, etc.)
- Nausea, itching, or other unpleasant symptoms or side effects of diseases and their treatments;
- Anxiety and stress due to hospitalization;
- Weaning management from long term use of pain killers and sedatives;
- Prescription of outpatient pain management programs.
Outpatient Pain and Symptom Management ClinicThe Pain Management Clinic provides evaluation and treatment to children who are not hospitalized, but who are experiencing chronic or recurrent pain..
The initial clinic evaluation is conducted by a team that includes physicians, an advanced practice nurse, a child psychologist, and usually a physical therapist, with additional evaluation by our pain management child psychiatry consultant as appropriate. The clinic provides conventional medical management of pain and related symptoms, interventional pain management, as well as a full spectrum of nonpharmacologic methods, such as acupuncture, acupressure, biofeedback, relaxation training, and medical hypnosis.
Examples of problems treated at the Outpatient Pain and Symptom Management Clinic include:
- Chronic or recurrent headaches;
- Chronic or recurrent abdominal pain;
- Complex regional pain syndromes (also known as reflex sympathetic dystrophy) and other forms of neuropathic pain;
- Back pain and other forms of myofacial pain;
- Pain secondary to acute or chronic illness (arthritis, cancer, etc.);
Packard Pediatric Pain Rehabilitation Center (PPPRC)Some patients struggle to recover from chronic or recurrent pain problems with typical outpatient treatments, and find themselves very limited in their ability to engage in their usual activities. When this happens, more intensive intervention provided by the PPPRC is often needed in order to restore children to their usual daily lives. This highly structured, intensive program is based on the biospychosocial model of illness, and is designed to address both the physical and psychological aspects of chronic pain conditions. The PPPRC has both an intpatient, and an intensive outpatient program. Patients are assigned to either program based on their level of disability, what is medically appropriate for their condition, and most effective for their recovery.
To determine eligibility for the PPPRC, patients should be referred to the Outpatient Pain and Symptom Management Clinic by their primary care physician or pain management physician.
Outpatient Rehabilitation Program:
Patients in the intensive outpatient program (PPRC-o) are treated in an all-day program that combines several hours a day of intensive physical and occupational therapy, an hour or more of psychotherapy, and two hours of school work at the LPCH School designed to restore and maintain the child's academic standing. Psychiatric evaluation, neuropsychological, and educational testing are provided when needed. Family therapy, parent meetings, and care conferences with the entire treatment team happen weekly. Medical management includes analgesic medication management, medical management of sleep, anxiety, and mood disorders, and therapeutic drug monitoring. Diagnostic and therapeutic nerve blocks are utilized when they are needed to support the child through the process of physical therapy, which may be painful.
The program treats children with chronic musculoskeletal pain disorders, such as complex regional pain syndromes (CRPS), amplified pain disorder, and severe myofascial pain interfering with daily function, as well as other chronic pain disorders on a case by case basis if the team evaluation determines that their condition may be improved with a highly structured rehabilitation approach.
The length of treatment is typically 4-8 weeks. Families from out of town are accommodated for a nominal fee in the Ronald McDonald House when space is available. Discounted rates can be arranged through Packard Children's family housing office for families preferring a nearby motel or hotel, or when the Ronald McDonald House is fully booked. Patients who are admitted to the program are assisted by the social work department to help work out the logistical issues of extended stays.
Inpatient Rehabilitation Program:
Patients appropriate for the inpatient rehabilitation program (PPRC-i) include the following:
- Patients whose functional disability excludes them from PPRC-o. Examples include patients
who are wheelchair bound and unable to safely transfer in and out of their chair, or who
cannot toilet themselves independently.
- Patients requiring a complex diagnostic evaluation that requires multiple consulting medical
- Patients requiring narcotic or sedative medication detoxification.
- Patients needing epidural catheters or other pain management procedures.
psychotherapy, and educational support, in addition to the appropriate medical intervention. The
length of stay is variable, and patients may be transitioned to the intensive outpatient program if their
condition warrants it.
Families from out of town are accommodated for a nominal fee in the Ronald McDonald House when
space is available. Discounted rates can be arranged through Packard Children's family housing
office for families preferring a nearby motel or hotel, or when the Ronald McDonald House is fully