Pediatric Pain Management Program – Nemours Children’s Hospital

Dr. Santana-Rojas: Good morning.
So there are two types of pain. There is acute pain, which is immediate pain after an injury. But if it lasts more than 3 to 6 months, that will be a chronic pain problem. And here in the program, that’s one of the criteria that we have – it’s chronic pain for more than 3 to 6 months. Leslie Edwards, Mom: About two years ago, she laid down to take a nap one day. And woke up that afternoon and she said ‘Mama, I just don’t feel good.’ And we put her in the shower and she just started screaming bloody murder. And she’s got juvenile rheumatoid arthritis, but she’s also got an amplified pain disorder. Dr. Santana-Rojas: She was not able to go
to school full time, not dancing, no playing basketball. Savannah: When I first met Dr. Santana she asked me, ‘Are you sure you want to do our program?’ And I told her ‘Yes, because I want something to keep down the pain low and not me feeling it.’ Dr. Boris: Pain programs really have to be
quite intensive in their approach. Most patients we’ve seen here have seen many providers in many different institutions. But what they haven’t done is come into a place where they’re seen day in and day out for a series of days up to a month long, focused directly on strengths and building back their capability. Dr. Santana-Rojas: It’s a three hour program. We have an hour of physical therapy, an hour of occupational therapy and one hour of behavioral therapy. There are together the emotional and the sensory component of pain, and you have to have a balance between those two. That’s why the behavioral component in our pain program is so important. Dr. Boris: So we teach kids how to understand how the pain signals in their body work and how they can overcome those signals. With Savannah we addressed everything from physical rehabilitation to the psychology of learning how to breathe in order to manage the pain and dampen the signals. Kaylin Luu, LCSW: Savannah had created goals for herself to improve her mood at home, improve her interactions with her family, and definitely wanted to return to her sports and dance in school. Mom took her back to the Ronald McDonald House where they were staying and practiced their exercises all night and was ready for the next day. Savannah: Well they gave me this exercise. Just think of a place where you really want to be. And just forget about everything. Kaylin: We have weekly meetings with the team and then with the family so that they’re able to hear feedback from us, give feedback of their own and ask any questions so that we’re all on the same page and all treating the child effectively. Tim Finlan, MSM, MHS, OTR/L: Savannah was at a point where she could exercise some, but then felt that that pain would come on
after the exercise and be overbearing. So she stopped doing her exercise and stopped being involved in activities that she liked. Dr. Boris: Very often kids will come in with
anxiety. They’ve been fearing discomfort day in and day out, and so they’re heightened in terms of feeling anxious. Tim: The first thing we need to do to break
that cycle is get them moving again. Seeing that patient over and over and over, you create a bond with that patient and a real strong trust with that patient – which is really what we need to help push them to that next step. Leslie: They took a lot of time with her,
with both of us, but especially her. Because this was our last hope. If this didn’t work, then we were just going to have to keep on the medicine and keep on with the pain and just kind of live life as best we could. Dr. Boris: Kids like Savannah, who is a brave girl, are classic for us. They’re kids who have been suffering, often in silence, for month after month after month. And what they need is a place where, again, they can get a variety of professionals putting their heads together and creating an intervention plan tailored to their needs. Dr. Santana-Rojas: You know my job is to have no – zero – pain in all my patients. So I’m going to do anything that is in my hands to figure out what’s going on to treat it. Kaylin: Some of our patients come in in a
wheelchair because of the pain and are able to leave walking fully. Savannah: I am back to basketball. I really want to do softball. I’m going to dance a lot. Leslie: We always called her our little bouncing ball because she was always up doing something. And now she’s back to doing that again. Now, mind you, it’s like sometimes, it’s like, maybe I’ve created a monster, but then again, you know we’re happy to see it back.

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