#88. Pharmacovigilance to Evaluate Efficacy and Net Clinical Benefit in Pediatric Pain Medicine

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 patients who do not go to their physical therapy session, as you will learn so much from Kathleen that will make your patients fully engaged. Listen now!

Takeaways In This Episode:

• How Kathleen become interested in physiotherapy.
• Her guide to approaching, assuring, and educating patients who are afraid to do physiotherapy.
• How any healthcare professionals can convey the value of including physical therapy in their treatment plan. 
• When to incorporate physiotherapy for pain management.
• Physical activity and therapy strategies pertinent to different diagnoses.
• Engaging a child and their family in self management of their pain using physical activity and  therapy.
• what type(s) of physiotherapy or occupational therapy is optimal for different conditions 
• Role(s) a physiotherapist plays in pain management and how it may be different than an occupational therapist.
• The optimal duration for physiotherapy
• How to overcome the barriers to access as it relates to physiotherapy.

Links

Clinicians Pain Evaluation Toolkit

Proactive Pain Solutions Physicians Academy

About the Guest Speaker:

Kathleen Lynch, DPT

Kathleen Lynch completed her Master's of Science in Physiotherapy in 2009 at the Dalhousie University and her Bachelors of Arts with Honors at McGill University in 2005. She's fluently bilingual both in French and English and has worked in a variety of pediatric environments including acute care, rehabilitation settings, school and home based settings. She's a physiotherapist at the Thames Valley Children's Center and Children's Hospital (TVCC) at London Health Science Centre

Kathleen is a doctor specialized in physical treatment of children to help reduce pain, restore mobility, rehabilitate an injury, or increase movement and overall function. As a physical therapist, Dr. Lynch can treat multiple conditions with exercises, ultrasound, electrical stimulation, joint mobilization, heat, ice, massage, laser or light therapy and more. Dr. Lynch will create a treatment plan based on the child's specific injury, disease or condition, and might target a specific body part or body system based on the individual.

She is also the pediatric lead in the Ontario chronic pain network as Operations Manager for the executive committee representing all the publicly funded chronic pain programs in Ontario, Canada. 

Pedia Pain Focus Podcast is hosted by Dr. Anjana Kundu, it's the 1st podcast dedicated to pediatric pain, providing education and tools for all healthcare professionals dealing with children's pain issues. If you're a pediatric healthcare provider, this one's for YOU! The podcast brings you renowned experts from the field of pediatric pain, healthcare technology and business, policy makers, healthcare advocates and more to share their innovations, expertise, and experience in the field.

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.
• What is the sequence of occurrence when pain and mental health issues co-exist and how does it matter.
• What should the focus of treatment entail
• Impact of regaining function and improving mental health
• Common chronic pain conditions associated with mental illnesses and vice versa
• Influence of trauma, ACES and PTSD on children's pain
• When to consult a  mental health professional for a child with pain issues
• Diagnosing conversion disorder
• Ways to work with the entire family unit especially when mental health and physical health issues are tangled. 
• A Message to YOU from Dr. Mattar

Links

Mirabelle Mattar, MD

Clinicians’ Pain Evaluation Toolkit

Proactive Pain Solutions

About the Guest Speaker

Mirabelle Mattar, MD

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 reducing the burden of pain

Links

Other Related and Helpful Episode to Listen to:

Episode #80. Stop treating pain like a symptom.

Episode #10. Disparities in pediatric pain

Episode #50. Stepping up pain care efforts for African American patients

Episode# 85. Pain amongst children with Autism Spectrum Disorder

Episodes #76 and #77. Impact of pediatric pain rehabilitation program Part 1 and 2.

Episode # 27. Interdisciplinary pain education is necessary to change the face of pediatric pain management.

Episode #60. Influence of sleep on peri-operative pain among children.

Episode #25. Role of epigenetics in chronic post surgical pain

Episode #89. The pain of being a Redhead

Proactive Pain Solutions

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 implications
• Do redhead really tolerate more spicy foods than others?
• Do they bleed more compared to others with darker hair?
• Recent study providing insights about the genetics and reasons for differences in their pain perception, responses and treatments
• What do Melanocortin, MC1R, MC4R have to do with pain
• How you reconcile the different, complex and sometimes murky findings and provide safe and effective pain care  for redheads

Links

Proactive Pain Solutions

Other Helpful Episodes on Opioid Safety

Episode#30 . Ensuring Opioid Safety for Children and Teens with Rita Agarwal, MD

Episode# 29. Opioid Stewardship: Responsible Pediatric Pain Care! with Benjamin Lee, MD

Proactive Pain Solutions Physicians Academy

Clinicians Pain Evaluation Toolkit

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-institutional, international endeavor
• What Rapid is?
• Findings of their research thus far and what's on the horizon
• How you can participate in this research endeavor while carrying out your daily clinical work and the benefits it offers as collaborators
• How they determine their protocol numbers and demographics
• What Dr. Drake hopes for Rapid to achieve 
• Unique benefits of this collaborative research compared with other databases  based research (Hint: the ability of foresight and hindsight simultaneously!)
• The biggest takeaways and his message to  the audience

Links

Ross Drake, MB ChB, FRACP, FAChPM, FFPMANZCA

Rapid Program

Get involved with Rapid program

Alternate Contact

Attend the International Symposium on Pediatric Pain 2022

Clinicians’ Pain Evaluation Toolkit

Proactive Pain Solutions

About the Guest: 

Ross Drake, MB ChB, FRACP, FAChPM, FFPMANZCA

Dr.  Drake is a Pediatrician who specializes in Pain Medicine and Palliative Care for children having gained fellowships in Paediatrics, Palliative Medicine and Pain Medicine after he completed specialist training at Great Ormond Street Hospital in London and The Children’s Hospital at Westmead in Sydney. 

Ross is Clinical Lead of the Paediatric Palliative Care and Complex Pain Services at Starship Children’s Hospital; both being the only specialist services of their type in New Zealand. Amongst his clinical duties he strives to improve the recognition and support of children/tamariki & young adults/rangitahi and their families/whānau requiring palliative care and the management of chronic pain. He remains very involved in developing a national approach to both disciplines and works to improve resourcing to enable equitable access and service delivery for all New Zealand children in need.

Dr Drake also regularly presents and teaches on various topics in children’s pain medicine and palliative care. More recently, he has been involved with establishing an international pharmacovigilance research collaborative (The RAPID Program) looking at the effectiveness and adverse effects of medications and other interventions commonly used in palliative care and pain management. 

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 episode of my own podcast, and I share the state of pediatric pain medicine. We discuss the challenges, barriers and way forward to evoke change. It's not just a theoretical concept, but how I have lived and by example to evolve with and be the change.

Takeaways in This Episode

• My path to medicine and pediatric pain medicine
• Role of support system and visionaries in your life
• Your grit and self belief
• What leadership means and looks like to me
• Finding support and steps forward in every situation
• What proactive pain solutions mean and do
• The current state of pain medicine for children
• The challenges and barriers to adequate pain care for children
• The path forward

Links

Proactive Pain Solutions

Proactive Pain Solutions Academy

Clinicians' Pain Evaluation Toolkit

Asha Padmanabhan, MD FASA

Listen to these other helpful episodes - 

Episode #61. Getting out of your own way to success with Dr. Asha Padmanabhan

Episode #1. Pediatric Pain: A team sport in need of transformation

Episode #2. Three areas every healthcare provider can influence to improve children's pain care

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 influencing the perceived quality of healthcare delivery
• What's common between a flight and a clinical care visit
• Elements of a successful and high quality, efficient clinical care encounter
• How a healthcare professional can stay on time and influence the  timely delivery of healthcare visit even in a complex system.
• The role engagement  plays in healthcare delivery and outcome and how to achieve that
• How to achieve mindfulness and being present during every clinical encounter
• What does intentional listening look like in a clinical acre visit
• Draw the most useful information out of your patients without interrupting them
• What are transitional phrases in healthcare encounters and what purpose do they serve
• How to reconcile the differences between your patients goals and your goals for them.
• Creating a beautiful wrap up for the clinical encounter and the Lollipop Effect

Links

Other recommended and helpful episodes - 

Episode #62. Metaphors for Better Pediatric Pain Management

Episode #40. Owning your role as a physician leader in today’s healthcare

Episode #82. Chronic Pediatric Pain in 2021: US Pain Foundation Report.

Episode #26. Manage Memory, Manage Pain! with Melanie Noel, PhD

Episode #37. What authenticity in healthcare looks like.

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 related podcast episodes -

Episode #84. Post-Concussive headache and Symptom Management in Children with Dr. Windsor

Episode #63. Integrative Pediatric Pain Management with Dr. Lonnie Zeltzer

Episode #81. How to Choose the Right Pain Treatments

Episode #72. Real vs. Fake: The Look of Pain

Episode #75. Role of Gut-Brain Axis in Pediatric Pain

Proactive Pain Solutions Physicians Academy

Clinicians Pain Evaluation Toolkit

Proactive Pain Solutions

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 Episode

• How Dr. Windsor’s experience with sickle cell patients in an inner city hospital led to his pursuit of a career in pediatric pain medicine
• What makes post-concussive headaches so unique
• Factors that result in a headache manifesting after traumatic brain injury
• Other risk factors to keep in mind while testing and which groups are more vulnerable to them
• Signs specific to post-concussive syndrome to look out for
• When is the right time for a pain specialist to be involved in post-concussive care?
• Treatments options to be considered after identifying their symptom cluster based on deficits exhibited
• His advice to the audience

Links

R. Blake Windsor, MD

Connect with Dr. Windsor

Other Helpful Podcast Episodes

Episode #80. Stop treating Pain Like a Symptom!

Post-Concussion Symptom Scale

Clinicians’ Pain Evaluation Toolkit

Proactive Pain Solutions

About the Guest 

Dr. R. Blake Windsor, M.D.

He is the Chief of Primas Health Pediatric Pain Medicine in the Upstate. He is a pediatrician with subspecialty training in pediatric pain medicine and is both a board-certified headache specialist and medical acupuncturist in South Carolina. He attended the University of Georgia followed by Mercer University School of Medicine where he subsequently worked in a combined post-graduate training program between Harvard Medical School and Boston University School of Medicine. 

In 2018, he joined Prisma Health University of South Carolina School of Medicine in Greenville to launch the Carolinas' first comprehensive pediatric pain and headache program. It is the first comprehensive program of its kind in the Carolinas, and he leads a multidisciplinary group of pain specialists from medicine, nursing, psychology, and physical therapy. The team uses a multidisciplinary and holistic approach to complex medical diagnoses and symptoms, resulting in a comprehensive treatment plan that meets children and their families where they are and helps them break the cycle of pain.

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 and individualized best practices in the care of a complex child with multiple and/or complex needs.

Takeaways In This Episode

• What perioperative medicine entails and how it fits into their roles
• Healthcare professionals that form their perioperative surgical home-based team
• The minimum elements of perioperative surgical home that can be incorporated by anyone in any setting to provide optimal perioperative outcomes
• Components of a perioperative surgical home
• Objective criteria to determine if a child patient’s optimized health
• Diagnoses and procedures that lend themselves to this kind of care model
• How they determine what role each member of their team plays
• Elements  of their program and the steps they took to develop their program and educate their fellow peers
• Why should a PSH model be considered and the expenses related to such a program
• Standardization vs. individualized care in perioperative medicine
• Distinction between PSH, perioperative medicine and Enhanced Recovery after Surgery (ERAS) models. 

Links

Other Related Episode(s) -

Episode 58. ERAS - Enhanced Recovery (but not just)After Surgery

Clinicians’ Pain Evaluation Toolkit
Proactive Pain Solutions

Proactive Pain Solutions Physicians Academy

About the Guests

Marjorie S. Gloff, M.D.

Dr Gloff is an anesthesiologist currently practicing at the University of Rochester in Rochester, New York. Bearing a passion for pediatric perioperative medicine, she is the Director of the Center for Perioperative Medicine and the Associate Chair of Perioperative Medicine in the Department of Anesthesiology and Perioperative Medicine at the University of Rochester. She is also the Associate Chief Medical Officer for Patient Safety and Loss Prevention at the same university.
In 2004, She graduated with a Bachelor of Science in Cell and Developmental Biology at the University of Rochester and accomplished her Medical Degree in Medicine and Dentistry in 2008. She received her internship in anesthesiology at the University of Rochester Medical Center from 2008-2009 and went on to finish her residency at the same medical center from 2009-2012.

Renee Lynn Robinson, DNP, APRN

She has obtained a Doctorate of Nursing and is an advanced  practice Registered Nurse with a specialty in family health currently practicing at the University of Rochester in, Rochester New York. She is the Associate Director of the Center for Perioperative Medicine. She is the recipient of awards such as the Medical Center Board Excellence Award APP in 2019 from URMC and the Quality Recognition: Perioperative Services COVID Management in 2021.

She graduated from the University of Rochester School of Nursing in 1996 and became a licensed nurse practitioner in 2001. In 2020, she received her Doctorate in Nursing Practice.

She and Dr. Gloff share the same passion for pediatric perioperative medicine and for the past six years, the duo has been spearheading a new program dedicated to improving and optimizing the process of pediatric care.