Pedia Pain Focus

Have you ever had any of your patients say that they don't think physical therapy helps their pain? Or that the physical therapy made their pain worse? It would certainly not surprise me, if you said yes. And in that case, this is definitely is the episode you want to listen to carefully.  And if your answer to my question was no, this is an episode for you too, my friend. Because sooner or later you too will join this elite club with rest of us. However, this episode will give you the framework and tools to change that in your practice.  Learn it from our guest who magically rehabilitates patients debilitated by pain .    Kathleen Lynch, DPT joins us to share how she motivates her patients to do physical therapy and be fully engaged with it. She also shares strategies and tools that can be used in assessing patients if they are in need of physical therapy. Kathleen’s goal is to discharge physiotherapist patients to self care by educating more healthcare professionals and patients.    Worry no more about pati

Pain and mental illnesses coexist, often more than any of other illnesses. Both of them have a profound effect on a child's child’s quality of life, individually.  Now imagine the magnitude of impact  when they co-exist.   In this episode, Dr. Anjana Kundu, with guest speaker Dr. Mirabelle Mattar, a child, and adolescent psychiatrist, discusses the intricate and dynamic relationship between pediatric pain and mental health, likely cause or affect and prognosis for a child with pain in the setting of mental health issues or vice-versa.  They also discussed the factors which may predispose a child to a higher risk of chronic pain and mental problems, role of trauma, PTSD and other adverse events on pediatric pain.   Takeaways In This Episode: How Dr. Mattar became interested and her journey to the intersection of pediatric mental health and pain Some unexpected discovery during this journey among children with chronic pain Importance of understanding the effects of chronic pain on mental health in children. Wh

Acute pain may be a protective and adaptive phenomenon, but chronic pain is nothing but damaging and a burden in every way possible and for all involved directly or indirectly. So how do we reduce or can we reduce burden?   Join me in this episode to learn the factors that contribute to chronicity of pain and whether we can prevent it.   Takeaways in This Episode Complexities of pain and its impact for the individuals and the society What differentiates acute from chronic pain and why that is important Various factors contributing to pain and its chronicity Modifiable vs. Non-modifiable factors How demographic factors contribute to chronic pain and what  if anything can be done to stop their contribution to chronic pain Which lifestyle factors might have the most impact on chronicity of pain Genetic and epigenetic factors involved with chronic pain Family, social and cultural factors influencing pain and progression to chronic pain Clinical and biological factors involved with chronic of pain Your role in re

Did you know that redheads can tolerate more spicy foods than those with dark hair? This is supported by biology and genetics.  Ask any anesthesiologist or a dentist and they'll tell you - often with a sigh, I might add - that taking care of redhead is can be challenging! The issue of pain perception, tolerance, response to pain and  response to different classes of medications is a complicated and murky one when it comes to people with natural red hair.   Join me in this episode to learn about the evidence we have for complexity of pain and its management in redheads, recent emerging evidence that explains why and more importantly how to effectively navigate this complexity, ensuring safe and effective care of these patients.   Takeaways in This Episode When an anesthesiologist or a dentist see a redhead Why redheads have more dental problems and toothaches Why redheads sometimes need more pain medications and at other times need less Variability in pain responses amongst redheads The redhead gene and its i

Pediatric pain management is fraught with reasons that make it feel like we are operating blindfolded. Many treatments are used without clear indications or evidence specifically in this population.  What if you had a way to study what you do in pediatric pain management, while you do it, would you embrace it?   In this episode, Dr. Drake Ross, a specialty pediatrician at Starship Children’s Health in Auckland, New Zealand with training in pediatric pain and palliative care, shares with us the features, goals and outcomes of their Rapid pharmacovigilance program, a multi institutional collaborative clinical research endeavor. This program provides real-time evaluation of net clinical benefit of what we do in our day to  day clinical practice, while  we do it!   Takeaways In This Episode   What got Dr. Drake’s to transition from general pediatrics into palliative care and pediatric pain medicine How he get interested in pharmacovigilance and how he initiated that for pediatric pain medicine as the RAPID multi

How is it that when 1 in 3 school age children reports  chronic or recurrent pain, yet we fail to ensure that there is adequate help available for these children? That our system ensure at least basic level of pain medicine training for healthcare professionals? These are a few of the questions we discuss in this episode, but more importantly we talk about how we CAN make a difference from wherever we are today, rather than waiting for someone else to invoke change and for something else to happen first.  This episode is about increasing awareness, believing  and investing in yourself. This is about taking charge and making the change rather than waiting for change to happen! Believing and investing in yourself is the best way to shift your thinking from a paradigm of excuses to one of solutions.   It's time to shift the paradigm in pediatric pain medicine and it all starts with awareness, knowledge and priority!   Join me in this episode as Dr. Asha Padmanabhan, MD FASA sits me down in the guest seat in this

Time pressure in today's healthcare visits is a reality. Increasingly there is more emphasis on value and efficiency in clinical care delivery. Meanwhile changing factors in healthcare delivery with shorter visit times, increasing amounts of required documentation for compliance, and the perceived quality and time spent with your patient and their family have added to the challenges that physicians and healthcare professionals face daily.    Though it may not be possible to have the luxury of more time to conduct thorough clinical care encounters necessary for complex conditions like pain, but some elements, if incorporated in our daily clinical work can most definitely lead to safe, smooth, and efficient healthcare encounters with improved outcomes and increased satisfaction for both patients and healthcare professionals.   Join me in this episode to discover these essential elements which will help you shine in the quality of your encounters with your patients.   Takeaways in This Episode Factors influenci

How does one reconcile the facts that DSM diagnostic criteria for Autism Spectrum Disorder includes pain insensitivity and a high pain threshold,  while these children report that their clothes feel like sand paper and their fingers while shampooing feel like sharp metal?  Join me in this episode to look at where the truth lies, with emerging evidence that helps us better understand the relationship between pain and ASD, what if anything is different about pain among children with ASD, and how we should approach pain issues amongst these children!   Takeaways in This Episode What constitutes Autism Spectrum Disorder Prevalence of ASD Historical beliefs around ASD and pain, and contributing factors for those beliefs  Current and emerging literature  around ASD and pain What Stimulus over-reactivity is and how that plays out in ASD Genetics evidence around ASD and pain Summarizing ASD and pain among children and considerations for accurate assessment and effective treatment   Links Listen to other helpful and

In this episode, Blake Windsor, MD a pediatrician with a subspecialty in training for pediatric pain medicine, and a board certified headache specialist discusses post concussive headaches and unique challenges it poses. Headache is the most common post traumatic or post concussive symptom. Even when a child is given the appropriate care, in many cases we find that they still experience post-concussive pain long after we expect them to recover.  He points that often there is much confusion and debate around what people refer to as Post-Concussive Syndrome, when in reality there seem to be somewhat arbitrary lines surrounding the term. Dr. Windsor also believes that pediatric pain medicine should be as common as other specialties, because it makes the work of other specialties much more streamline and accessible to patients.    Listen in on this episode as Dr. Windsor walks us through the uniqueness of post-concussive headaches, various stages, risk factors, identification and treatment!   Takeaways In This Ep

This conversation with Marjorie Gloff, MD and Renee Robinson, DNP, APRN makes me convinced that the expression "Preparation is half the battle won" must have been coined with the idea of perioperative medicine and perioperative surgical home (PSH) in mind!  They are the co-directors of the Center for Perioperative Medicine and Medicine in the Department of Anesthesiology and Perioperative Medicine at the University of Rochester School of Medicine and Dentistry. In this episode, they share how to desilo the care of pediatric patients especially around the perioperative period, how an informal conversation triggered a grassroots level effort which subsequently resulted in a well-organized multidisciplinary team that provides comprehensive, coordinated and team based care for children in need of surgical procedures, developed a comprehensive screening tool or the PSH. They also share the steps involved in the development of periop medicine and PSH programs that employs a biopsychosocial model to optimize systems

Chronic pain is often overlooked, and when it comes to children, it is even more so.  The continued neglect of children's pain affects the ability to truly evaluate the extent of the problem and challenges these kids and their families face.   The United States Pain Foundation, a pain advocacy organization, conducted a survey to assess how children with a pain diagnosis and their families experience chronic pain, what challenges and barriers they face and what they hope for in their pain care.    In this episode, I’m joined by Nicole Hemmenway, the current CEO of the US Pain Foundation and the Founder of the INvisible Project and Casey Cashman, Director of Fundraising and the Pediatric Pain Warrior Program part of the US Pain Foundation. They are strong advocates for pediatric pain, inspired by their own pain experiences. They discuss the findings of this survey, share their experiences with the pediatric pain patients and families that they support through their programs.  They also share their hopes and som

Treatment of pain is challenging to say the least. For one it is difficult to understand the complexity of the pain experience. This episode explains the components of nociception and the pain experience.  It also examines the targets for pain control and thus provides comprehensive framework for choosing the right analgesic treatments!   Takeaways in This Episode Components of Nociception How a noxious injury becomes a pain impulse The pain perception pathways Interpretation of pain Modulation of pain Peripheral and central targets for pain control How various pain treatments work and at what levels 3 Unique features of pain - Wind-Up Phenomenon, Hyperesthesia, Central Sensitization Links Other Helpful Episodes: Episode 80. Stop Treating Pain Like a Symptom Episode 79. Pain Amongst Neonates, Infants and Young Children with Dr. Kanwaljeet "Sunny" Anand Proactive Pain Solutions Physicians Academy Clinicians Pain Evaluation Toolkit      

Pain isn't simply a symptom of another disease or a result of another noxious or traumatic event. It's an independent entity in itself in majority of the situations. It's time we stopped approaching it with the Cartesian model framework.   Join me in this episode to learn about how and when a pain can be considered a symptom and when it needs to be treated like any other independent chronic diagnosis, and why that is important. Takeaways in This Episode The reason(s) I am even talking about this The biggest misconception about pain Why this misconception get propagated Classification of pain and why that is important What I mean by "not all pain is created equal" There's more to chronic pain than just "chronic pain" - classification of chronic pain as defined by IASP task force and the WHO Major differences between acute and chronic pain Mechanisms at play in acute and chronic pain The benefits of understanding these distinctions and classifications Links International Association for the Study of Pain (IA

There's no better way to kick off September as the Pain Awareness Month than bringing you a conversation with Dr. Kanwaljeet S. Anand, whose research took the medical world by storm, even risking his license, as he sought out to answer the question of; what if we give children anesthesia and analgesia?  I truly believe that he is the reason why my career as a pediatric pain and palliative care physician exists today and serves as an available path for many healthcare professionals. In this episode,  Dr.  Anand, a professor of Pediatrics, Anesthesiology, Perioperative, and Pain Medicine at Stanford University School of Medicine, describes his groundbreaking research back in the 80s, when a popular held belief was that babies don’t feel pain!  With the findings  and intervention offered in his RCT, they were able to cut down the infant mortality rates by half.  It is the work of doctors like him that paved the path for someone like me to practice pediatric pain management as a specialty-- hoping to save and imp

When the gold standard for pain assessment is verbal report, children's pain assessment and management requires specific knowledge and understanding.  Children at these important stages of growth create key memories-- and the last thing we need is a whole generation of children that associate getting medical attention with pain.   Globally, when children come in to the emergency room, pain is a component of their presentation 50 to 80% of the time. As medical practitioners, prioritizing the critical elements of a child’s illness should be the main concern-- but we also must ease their pain and suffering related to their health condition and prioritize minimizing their procedural pain.   In this episode, Samina Ali, MD, a pediatric emergency medicine physician and pain expert at the Stollery Children’s Hospital and University of Alberta, Canada shares her clinical and research experience in pediatric pain. Realizing that emergency room visits and procedures may have just as much capability to distress and trau

Chronic pain in children can be a really serious condition and many of them may have a long journey to get where they need to be! Says Julia Wager, PhD,  an accomplished pediatric pain psychologist and head of research department, at the German Paediatric Pain Center, Children's and Adolescents' Hospital Datteln, Germany.   Join me for part 2 of my conversation with Dr. Wager to learn about the short and long term outcomes of intensive interdisciplinary pain rehabilitation program for pediatric chronic pain.   She discussed their short term and longitudinal data (8 years) from intensive pain rehabilitation program for pediatric chronic pain management. As Dr. Wager says - We want them to be a child again and not a chronic pain patient for life!  Discover what these surprising findings are and what impact they have on short and long term management of these children!   Takeaways in This Episode The immediate, short and long term outcomes from the intensive interdisciplinary pain treatment of children's chroni

In society and healthcare, people understand that kids with cancer do suffer pain, but people did not understand that children without an obvious somatic condition could suffer pain that really need treatment; says Julia Wager, PhD,  an accomplished pediatric pain psychologist and head of research department, at the German Paediatric Pain Center, Children's and Adolescents' Hospital Datteln, Germany.   Join me in conversation with Dr. Wager to hear about the necessity and impact of intensive interdisciplinary pain rehabilitation program for pediatric chronic pain.   This is a 2 part episodeIn this episode we discuss the nuts and bolts of a pediatric pain rehabilitation program, who it is appropriate for, the approaches, team make up, fiscal considerations, unique offerings of the program and why they are important, while part two (episode 77) will cover the short and long term outcomes with longitudinal data from intensive pain rehabilitation program for pediatric pain management. As Dr. Wager says - It's oft

Research in the past decade has demonstrated a complex, bidirectional communication between the central nervous system and the enteric nervous system; the Gut-Brain Axis (GBA). This knowledge has provided much more clarity on many of the chronic pain conditions which previously had been mislabeled, misdiagnosed and mismanaged for sure, often being relegated to the category of "in their head", like the Irritable Bowel Syndrome, Functional Abdominal Pain and many more!   More importantly, it  allows us to identify the underlying etiopathophysiology for these condition as well as the targets for treatments.   The concept of the GBA surely gives a whole new meaning and explanation to the expressions "gut feeling" and "butterflies in the stomach"!    Join me in this episode to learn what exactly is the GBA, how it plays a role in the pediatric chronic pain syndrome including and beyond abdominal pain and how to manage  these conditions more effectively.   Takeaways in This Episode What Gut-Brain Axis is Component

Dr. Dhanu Sant, an integrative pediatrician and trained herbal and plant medicine specialist returns to discuss herbs for pain management to stress management, to their role as adaptogens and beyond.  She discusses safe use of herbs for a variety of health conditions but specifically for pain management, along with misconceptions, caution and .  She has dedicated her work to learning more about plant medicine and herbs to enhance the quality of care that she's providing for her pediatric patients.  She says - I was using a lot of diet and lifestyle remedies, and this felt like a natural adjunct to that.   Takeaways in This Episode The reason for Dr Sant to pursue further training herbal and plant medicine in addition to her traditional training as a pediatrician. Unique aspects of herbs, spices and plants used as medicine Safety issues around some of the commonly used herbs and how to navigate them Impact of gut health on pain and immune system and herbs that modulate them Herbs for various pain conditions f

Ask Ashley Koff, RD, what she recommends as a healthy diet. Her answer? It’s always personal.    When it comes to pediatric pain management, nutrition is both challenging and essential for our patients. And the idea of nutrition can be overwhelming, and contradictory, for healthcare professionals as well. My guest, an award winning expert dietician, is also a master at taking big, complex and overwhelming concepts and turning them into simple, bite sized pieces that are easy to understand and put into practice.  Nutritional advice has become a fact sheet based afterthought of our medical practice. Most of us didn’t receive the proper training that we need to provide useful guidance to patients, and we only realize this when we need to apply that advice to our own lives and family members.    What’s worse, in this era of social media, there is so much emphasis on selling yourself as a physician that the baseline of our oath gets lost. As Ms. Koff puts it beautifully - We don’t need to advertise what we can do.