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BMC Engages Pediatrics, Psychiatry, Family And Integrative Medicine To Provide Care For Children With Chronic Pain

March 04, 2015

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(Boston) - March 4, 2015 - Boston Medical Center (BMC) has opened an interdisciplinary Pediatric Pain Clinic that will help patients and their parents better manage acute, complex and recurrent pain and its lasting effects. The new clinic treats patients with diseases that commonly cause chronic pain, including Sickle Cell Disease, as well as any distressing painful symptom in childhood or adolescence. The Pediatric Pain Clinic is a partnership between BMC’s Departments of Pediatrics and Psychiatry and is collaborating with the Department of Family Medicine and the Program for Integrative Medicine & Health Disparities.

According to the American Pain Society, chronic pain in children is the result of a complex interaction of biological processes, psychological factors, and sociocultural factors, and it is estimated to affect 20 to 35 percent of children and adolescents globally.

The Pediatric Pain Clinic’s approach to care considers the “cycle of pain.” Recurring pain, or any unpleasant sensory experience associated with harm or injury, often leads to decreased physical activity. A lack of physical activity over time causes a child’s muscles to become shorter, weaker, and deconditioned, a process in which pain sensitivity can be more severe. A child may come to fear their pain, and thus avoid activity altogether. In turn, these events result in more pain for the child and continue the cycle.

“One of our main goals is to enable kids who experience chronic pain to participate in typical, age-appropriate activities by providing better access to chronic pain care,” said Caitlin Neri, MD, medical director of the Pediatric Pain Clinic who is a trained pediatric hematologist and oncologist. “Pain affects all areas of a child’s or adolescent’s life and can have a significant impact on the child’s relationships, schooling, and family life. If it’s not treated properly, the pain can even cause issues that appear later in adulthood.”

Sickle Cell Disease (SCD) is known to cause some of the most extreme, whole-body pain “crises,” as well as chronic pain that can last for weeks or months at a time. Because hematologists treat patients with SCD, they are well-versed on the negative effects pain can have on these pediatric patients.

“Our experience treating SCD patients will not only help improve access to acute and chronic pain care for these patients, but all painful syndromes that we see in BMC patients,” said Neri.

Providers will utilize an interdisciplinary approach to pain management, and its successful regimens may include: developing pain management plans with a child’s school, physical therapy and home exercise programs, coping and relaxation strategies, cognitive-behavioral therapy, as well as other integrative therapies available at BMC such as acupuncture, aroma therapy, massage therapy, and even yoga.

“Anxiety, stress, and mood issues often play a significant role in worsening a child’s pain, and so the combination of cognitive behavioral therapy and relaxation strategies are essential to effectively treat chronic pain,” said Laura Goldstein, PsyD, co-director of the pain clinic, who specializes in therapeutic interventions to improve medical coping and pain management and is trained in in biofeedback and hypnosis. “As providers, we want to give families hope and empower children to gain control over their pain.”

“There is often a role for medications in management of pain in children, but we know that medications alone do not completely relieve severe, complex, and chronic pain,” said Neri. “Used in concert with one another, treatments including medications, behavioral interventions, physical therapy, and integrative therapies may all be necessary to address this type of pain.”

The Pediatric Pain Clinic is open for patients on Wednesday afternoons for treatment, which allocates time for families to meet with the full team of specialists: Dr. Neri, Goldstein, and Laura Dickman, a licensed social worker who provides support, counseling, and education to each family who visits the pain clinic.

"I meet with the parent or caregiver separate from the child to discuss psychosocial stressors and provide additional guidance for the family," said Dickman.

Pain clinic patients can schedule same day, on campus appointments with BMC’s integrative medicine team. While all patient evaluations are completed at BMC, some treatment and integrative therapies could be done at appropriate community locations and clinics, and clinic staff also work closely with each patient’s primary care physician.