All workshops will be offered on Friday, April 23, 2021; 4:00-6:00pm EST
NEW! Explaining the Unexplainable: The Art of Educating Families about Chronic Pain
Coordinator: Kenneth R. Goldschneider, MD, FAAP; Rachel Zoffness, PhD
Adriaan Louw, PT, PhD, CSMT; Sara Williams, PhD
More than almost anything else, patients and families desire an explanation for what is happening to them. Too often, practitioners are under-prepared to discuss pain, and patients take away messages such as “the doctor said the pain is all in my head.” An interdisciplinary panel (physician, pain psychology, physiotherapy) will lead participants through a series of presentations and exercises designed to augment the participants’ ability to present often difficult material to patients and their families. The core presentations will be followed by break-out sessions in which participants will practice “elevator speech” presentations on various common topics that arise in pediatric pain clinics, including how pain works in the brain, how pain becomes chronic, the role of thoughts and emotions in pain, and the importance of a biopsychosocial approach to treatment. The objective of such mini-presentations is to help the practitioner incorporate effective education into clinic visits, especially in the present setting of telehealth, where time constraints and logistics eat into the time usually allotted to education.
NEW! Improving Pain in Hospitalized Children with Multidisciplinary Care Plans: Identifying Barriers and Finding Solutions Across Specialties, Disciplines, Services and Institutional Organizations
Coordinator: Magdalena Anitescu, MD; Alina Lazar, MD
Tina Drossos, PhD; Sarah Hoehn, MD, MBe; Jennie Ott
There is compelling evidence that pain has persistently been undertreated in hospitalized children. Studies have found that children receive less analgesia than adults in comparable situations, significant numbers of hospitalized children experience unacceptable levels of pain, and knowledge of current pain management practices by health care staff is lacking.
Achieving improvement in pain management within pediatric hospitals demands broad inclusion of numerous stakeholders, diverse clinical expertise, and leadership, and is resource and time intensive. Although creating a dedicated pediatric acute pain service may be the ideal solution, in real life numerous factors (limited budgets, resources, time) make such an option sometimes impractical or even impossible to achieve. This should not deter smaller institutions from ardently seeking ways to improve the quality of pain management for their pediatric patients and provide an excuse for maintaining status quo.
In the current climate of financial accountability, rapid evolution of knowledge and state-of-the-art clinical practices, new creative solutions are needed to ensure that the needs of our pediatric patients are met. This workshop intends to explore problem solving strategies, creative ideas, and opportunities to reach across silos to create practical, feasible, effective, and financially responsible solutions for pediatric pain management needs in smaller-size or mixed pediatric-adult hospitals. As a starting point to the discussion, we will describe the process we undertook at the University of Chicago to address these challenges in an institution-wide effort that engaged multiple departments and stakeholders.
Pain and Symptom Management in Pediatric Palliative Care
Coordinator: Anjali Koka, MD; Bobbie Riley, MD, FAAP
Doralina L. Anghelescu, MD; Charles B. Berde, MD, PhD; Sabrina Carrie, MD; R. Scott Dingeman, MD, FAAP; Monique Ribeiro, MD
Pain is one of the main complaints of children with progressive life-limiting conditions. Systemic medications and psychological support are a mainstay of therapy in pediatric palliative care. Regional anesthesia and chronic pain interventions can be utilized for pediatric patients in situations where there is inadequate pain relief or intolerable side-effects. Decision-making around when and how to perform and manage interventions in pediatric patients is complex. Some considerations include identifying the sources of pain, therapy in different end-of-life (EOL) settings, identifying patient-specific goals, balancing medication side-effects, and identifying appropriates routes of drug delivery (oral, SL, SQ, IV, epidural, intrathecal). The goal of this workshop is to provide education and a structure for gathering and synthesizing information around pain and symptom management in pediatric palliative care.
Participants will review the use of procedures, medications and non-medical interventions in palliative care. Topics covered will include opioids, non-opioid adjuvants, stimulants, antidepressants, mood stabilizers, antipsychotics, anxiolytics and muscle relaxants. Participants will be exposed to consideration for long-term placement of peripheral regional catheters, neuraxial (epidural and intrathecal) catheters and ports, celiac plexus blocks, and other sympathetic blocks and ablative therapies. They will learn about imaging techniques, equipment, and long-term catheter management. Specifically, participants will review x-rays, MRI, ultrasound and CT images of the spine, discuss the use of fluoroscopy for epidural placement and confirmation of placement (epidurograms), and learn how to place tunneled catheters for long-term use. Discussions will include predicting and trouble-shooting complications. Additionally, they will gain experience having End-of-Life (EOL) discussions and managing difficult patient/family interactions.
Integrating Acupuncture in Pediatric Perioperative Care and Pain Medicine Workshop
Coordinator: Yuan-Chi Lin, MD, MPH
Brenda Golianu, MD; Rosalie Tassone, MD, MPH; Cynthia Tung, MD; Shu-Ming Wang, MD
Acupuncture is a technique of Traditional Chinese Medicine that has been practiced for over 3,000 years. It involves the insertion and manipulation of hair-thin needles into distinct points on the body to balance a patient’s Qi - the body’s energy force. The National Institutes of Health issued a Consensus Statement of Acupuncture, declaring there was promising evidence to support the efficacy of acupuncture in reducing postoperative surgery and dental pain, as well as chemotherapy-related nausea and vomiting.1
Acupuncture has also been shown to reduce postoperative opioid dose requirements. Sun and colleagues conducted a systematic review of fifteen RCTs designed to examine the benefits of acupuncture for acute postoperative pain.2 Acupuncture was associated with a lower incidence of opioid-related side effects, including nausea, sedation, dizziness, pruritus, and urinary retention, as well as a lower dose of opioids.2 A more recent systematic review and meta-analysis of the efficacy of acupuncture for post-operative pain management showed that patients who received acupuncture or related techniques, for example, electroacupuncture or Transcutaneous electric acupuncture point stimulation, had less pain and used less opioid analgesics on the first day after the surgery.3 Another study of opioid consumption compared acupuncture versus morphine usage among 300 patients with acute onset moderate to severe pain in an emergency department. The investigators found a 92% success rate with pain reduction more than 50% in the acupuncture group compared to 78% in the morphine group.4 In a study of pediatric patients undergoing bilateral myringotomy and tubes placement, acupuncture treatment provided significant benefit in pain and agitation reduction. The number of patients who required analgesia was considerably fewer in the acupuncture group compared to that in the control. No adverse effects related to the acupuncture treatment were observed.5 Perioperative acupuncture may be a useful adjunct for acute postoperative pain management.2
The National Institutes of Health also suggests that the use of acupuncture results in satisfactory treatment for addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma. Depending on the situation, acupuncture may be used as an adjunct treatment, acceptable alternative therapy, or a treatment that is integrated into a comprehensive management program.1 Nahin and others reviewed 150 RCTs conducted in the United States over the past 50 years. They concluded that the strongest evidence was in support of acupuncture for back pain and osteoarthritis of the knee.6
Acupuncture can be integrated in pediatric perioperative care and pain practice. Upon completion of this workshop, participants will have an enhanced knowledge of acupuncture and have opportunities to integrate acupuncture for the practice of pediatric anesthesia and pediatric pain medicine. Attendees will attend twenty minutes of didactic lecture. And participants will rotate through four different teaching stations. Ample time will allow attendees to participate in hands-on demonstration of acupuncture and related techniques.
All Program & Schedule Times are Eastern Time (EDT)