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 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.  

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 some possible directions to address some of the challenges identified in this survey.   As healthcare professionals and clinicians, these findings are eye opening and a call for action to collectively invoke change  in the care of pediatric chronic pain.   Takeaways In This Episode   Chronic pain is frequently overlooked due to its subjective nature Why Ms. Hemmenway and Ms. Cashman got involved in the pediatric pain work, US Pain Foundation and the Pediatric Pain Warrior program The reason(s) that prompted this survey Survey findings How much focus should be on the number rating of the pain and how meaningful, helpful that is. Valuable way to assess and inquire about chronic pain and a patient's progress Psychological impact, extent of mental health issues including self-harm, suicidal thoughts, ideation and attempts amongst pediatric chronic pain patients Burden of disease on the family - financial and  psychosocial What therapies do patients and families wish were emphasized more - (Hint: Medications were at the bottom of the wishlist!)  Barriers to chronic pain care Psychological toll of having to evaluate whether you can afford a therapy and how it may be/ to address it. Best ways for parents to discuss these barriers with their child's physician Nicole and Casey's message to the listeners   Links Nicole Hemmenway Casey Cashman Connect with Nicole Hemmenway and Casey Cashman US Pain Foundation-Pediatric Pain Report 2021  Pediatric Pain Warrior Support Groups U.S. Pain Foundation Pediatric Pain Warrior  Register for upcoming Pediatric Pain Warrior Support Group Clinicians' Pain Evaluation Toolkit Proactive Pain Solutions   About the Speakers   Nicole Hemmenway Currently serves as CEO of the U.S. Pain Foundation, and directs the INvisible Project, an online and print magazine that highlights the experiences of people living with pain. Nicole is also an author and motivational speaker. Her book, No, It Is NOT in My Head: The Journey of a Chronic Pain Survivor from Wheelchair to Marathon, details her struggles and triumphs in dealing with complex regional pain syndrome, a debilitating neurological disorder. In September 2015, Nicole was featured in a campaign in USA Today in recognition of her role as an advocate for those living with chronic pain; and in 2017, she received the Unsung Hero Award for her work in the pain community. Nicole lives in the Bay Area with her husband and three young sons.   Casey Cashman Serves as the Director of Fundraising and the Pediatric Pain Warrior Program. Casey Cashman uses her voice to fight passionately for the rights of people with pain, especially children. She has lived most of her life with multiple, serious health conditions, including reflex sympathetic dystrophy/CRPS and Ehlers-Danlos syndrome, among others.    Over the years, she began to connect more with patient organizations and realized she had a passion for helping others like her. In 2015, she was featured as a participant in the INvisible Project, which led to her joining the U.S. Pain Foundation as a staff member.   Before U.S. Pain Foundation, Casey spent many years working in Human Resources. She brings this knowledge and experience to the table in her role as director of the Pediatric Pain Warriors Program, where she provides compassionate support to kids with pain and their families as they travel along their pain journeys.    Casey also spearheads U.S. Pain's fundraising efforts, and has helped create various programs and collaborations designed to support the organization's free programs and services   Her son, Tyler, is also a budding advocate for the pain community. In honor of his mom, he founded Points for Pain, a fundraising program that has raised more than $100,000 for pediatric patients.     

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 (IASP) Other Relevant Episodes:   Episode #56. Making Pediatric Pain Matter.... with Dr Christopher Eccleston Episode #78. Remodeling Pediatric Pain Management in Emergency Rooms with Dr. Samina Ali Episode #62. Metaphors for Better Pediatric Pain Management Episode #25 . Role of Epigenetics in Chronic Post-Surgical Pain with Dr. Vidya Chidambaran Proactive Pain Solutions Physicians Academy Clinicians Pain Evaluation Toolkit

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 improve the lives of many more children by debunking the fallacies that still surround children's pain and its management.   Takeaways In This Episode   What fueled Dr. Anand's desire to research perioperative care for infants His hypothesis around morbidity and mortality of neonates and infants undergoing surgeries, relationship to anesthetic management  Conducting the randomized controlled trial study and its results that changed the history and trajectory of childrens pain and perioperative management Sometimes it's worth picking the fights How his study gained momentum and changed how the healthcare world approaches pain management for children and infants When and how infants develop the ability to feel pain The long-term consequences of poorly or inadequately  managing children's pain Changing the minds of colleagues who perpetuate the belief that children are “hardy” and will “get over it” Dr. Anand's message to the audience   Links Connect with Dr. Kanwaljeet S. Anand: Stanford Profile LinkedIn Love, Pain, and Intensive Care. K.J.S. Anand, Richard W. Hall Clinicians' Pain Evaluation Toolkit Proactive Pain Solutions   About the Guest    Kanwaljeet S. Anand, MBBS, MD, D Phil, FRCCM   He is currently the professor of Pediatrics, Anesthesiology, Perioperative, and Pain Medicine at Stanford University School of Medicine. He directs the pain and stress neurobiology lab, the Jackson Vaughan Critical Care Research Fund, and he serves as the Editor of the journal Pediatric Research and is the Division Chief for Pediatric Critical Care at the Department of Pediatrics at Standford School of Medicine. He graduated from M.G.M. Medical College, Indore (India). He received the D.Phil. degree as a Rhodes Scholar at the University of Oxford, followed by a post-doctoral fellowship at Harvard Medical School, a categorical Pediatrics residency training at Boston Children's Hospital, and a Critical Care Medicine fellowship at Massachusetts General Hospital in Boston. He is the recipient of innumerable awards, including the Dr. Michael Blacow Award from the British Pediatric Association in 1986, the Pediatric Resident Research Award from the American Academy of Pediatrics, the inaugural Young Investigator Award in Pediatric Pain from the International Association for Study of Pain in 1994, the Jeffrey Lawson Award for advocacy of children's pain relief, the highest recognition in pediatric pain medicine in the United States. He's also been awarded many awards across Europe in many countries such as the Nils Rosén von Rosenstein Award from the Swedish Academy of Medicine and the 2015 Journées Nationales de Néonatologie Address at The Pasteur Institute to name a few. For his dedication and work in the field of pediatric pain management, he is considered a world authority on pain and stress in newborns and pain management in infants. 

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 traumatize a child beyond their presenting condition, she has dedicated her work to researching how she and fellow medical practitioners can make children and their families feel safe and empowered through institutional culture change as well as effective knowledge translation and mobilization.     In creating an ER or any healthcare setting that caters to patient comfortability beyond just treating symptoms and illnesses, we can harbor a safer and more welcoming environment which can improve children's experiences with receiving medical care, minimizing anxiety for future encounters, improving quality, safety, efficiency of and satisfaction with the work healthcare professionals perform.   Takeaways In This Episode   What motivated Dr. Samina to research pediatric pain and implement effective pain prevention and treatment strategies. Common pain presentation in the emergency department and how it may impact the work. Top reasons why pediatric pain may not get the needed priority and how practitioners handle competing priorities among patients in the emergency room What the big leap of faith in pediatric healthcare is and how that affects pediatric pain. Successful approaches she has spearheaded  within her institution and beyond for better pediatric pain care Helpful steps to help other practitioners engage in pain care efforts  Factors that result in or lead to disparities in pediatric pain care The two main benefits of prioritizing pediatric pain care Her view on advanced technology-based interventions and their roles The common barriers in emergency rooms and how can they be addressed Engaging administration to facilitate a top-down approach Leveraging patients and their families voices to invoke change Dr. Samina Ali's message to the listeners   Connect with Dr. Samina Ali:   Website Twitter   Links   Ep 64: Prevention and Management of Procedural and Needle Pain and Anxiety Among Children Solutions for Kids in Pain (SKIP) Translating Emergency Knowledge for Kids - Procedural Pain Translating Emergency Knowledge for Kids - Pain Treatment Commitment to Comfort Clinicians' Pain Evaluation Toolkit Proactive Pain Solutions   About the Guest   Samina Ali, MD   She is a professor of Pediatrics and Emergency Medicine at the School of Medicine and Dentistry at the University of Alberta in Edmonton, Canada. She is also the research director at Pediatric Emergency Department Medicine. She holds provincial and national funding for the study of children's acute care and emergencies and pain in the country and supervises many learners with both clinical and research backgrounds. She has served as the director for pediatric emergency medicine from 2003-2008 and again, from 2010-2013. She was also the Director of Professionalism for the University of Alberta from 2010-2013, and also serves as the Assistant Dean for Professionalism for the Faculty of Medicine and Dentistry. As a practicing pediatric emergency physician, she is witness to the pain children experience from illnesses, injuries, and emergency room procedures. She has created a research program focused on improving children's pain and distress, mainly related to emergency department visits and procedures, and she shares many of those ways to improve pain experiences for the children, both in the hospital and in the community. In addition, she has been recently involved in the Canadian large effort for knowledge mobilization and knowledge translation in relation to her efforts in alleviating children's distress and empower them and their families.

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 chronic pain Outcomes for the parents, caregivers and family Mental health and emotional outcomes and implication of these outcomes What findings surprised them amongst these children with chronic pain. The implications of the these outcomes on management of these children's pain Unique vulnerabilities of children with chronic pain 3 top instructions and type of awareness that is important for patients (children and their families) to know and be vigilant about. What the after-care upon completion of the intensive pain rehabilitation program should include Barriers to intensive pain rehabilitation program Predictors of success for these patients Financial outcomes and implications of intensive pain rehabilitation program Dr. Wager's message to healthcare professionals   Links Julia Wager, PhD German Paediatric Pain Centre Related articles by Dr Wager: Long term outcomes of children with severe chronic pain Impact of Pediatric Pain Rehabilitation Program Part 1. Epi #76 List of Pediatric Pain Clinics Proactive Pain Solutions Clinicians Pain Evaluation Toolkit

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 often the small things that make a big impact for a given child and the family. Discover what these small things are!   Takeaways in This Episode How Dr. Julia Wager became interested in pediatric pain and intensive interdisciplinary pain treatment of children's pain The indications for an intensive pain rehabilitation program for pediatric pain Types of patients who are appropriate or not a good fit for this model of care The team make up Structure of the program Patient and family evaluation and treatment approaches for each Approaches for patient and family engagement in the treatment program Reimbursement and approval for intensive pain rehabilitation treatment for pediatric pain and ways to support justification when needed. Links Julia Wager, PhD German Paediatric Pain Centre Related articles by Dr Wager: Long term outcomes of children with severe chronic pain List of Pediatric Pain Clinics Proactive Pain Solutions Clinicians Pain Evaluation Toolkit    

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 Components of GBA How does the gut influence the cognitive, emotional and nociceptive functions of the brain How the Gut Microbiota influences the GBA Role of GBA in pediatric pain conditions Modulating the GBA Targets for pain management Foods that regulate the GBA    Links Other Related and helpful Episodes to Listen to - Episode# 73. Nutrition Supplements and Pediatric Pain Episode# 74. Asset or Liability: What You Need to Know about Herbs for Pediatric Pain Management  Episode #71. Acupuncture Rocks for Managing Pediatric Pain management  and Beyond with Clara Cohen Proactive Pain Solutions Clinicians Pain Evaluation Toolkit

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 from neonatal period to young adults Adaptogens and the role they play in pain and overall health Most effective forms to use different herbs Caution, safety issues and considerations for when to use herbs Resources to learn more about herbs to advance your knowledge, broaden your toolkit or to guide your patients and their families when they use herbs. Dr Sant's message to healthcare professionals   Links Dhanu Sant, MD Connect with Dr. Sant Twitter   Linkedin   Facebook WholeKids Pediatrics ThriveWell Pediatrics Episode #33 Critical Role of Primary Care in Pediatric Pain Management Episode #73 Nutrition, Supplements and Pediatric Pain Dr. Aviva Romm Tieraona Low Dog Proactive Pain Solutions Resources for Herbal Safety: Consumer Lab https://www.nal.usda.gov/fnic/herbal-information https://medlineplus.gov/druginfo/herb_All.html https://www.nccih.nih.gov/health/herbsataglance   About the Guest Dhanu Sant, MD Dr. Sant attended medical school at The Ohio State University.  She completed her residency at Nationwide Children's Hospital.  Prior to starting WholeKids Pediatrics, Dr. Sant was in a private practice for 10 years with a large pediatric group.     Dr. Sant is a primary care pediatrician who has sought out additional training in integrative medicine. Her interest in establishing an integrative practice was spurred by her concern about the increased use and side effects of many medications and her deepening respect for the body's natural healing capabilities.      Continuing education in complementary therapies has allowed Dr. Sant to broaden her treatment options for both preventative and illness care.  Dr. Sant is a yoga teacher having finished yoga and prenatal yoga teacher training.  In addition, she loves teaching infant massage.          Dr. Sant now lives in Jacksonville, FL with her husband, John and her father.  With the loss of her mother in January 2021, Dr. Sant is honored to continue to be able to care for her father.  Dr. Sant and John are parents to 3 adult daughters who are finding their way through new ventures in Ohio and Michigan.  They visit sunny Florida often!   Dr. Sant is a Columbus native and is a huge fan of Buckeye football.  Dr. Sant loves to travel and her bucket list includes a safari in Africa and a trip to New Zealand.  In addition, she loves reading, especially about food, eating great food, cooking and yoga.    

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. We have the tools and knowledge to help people, we need to dig deeper and share how it applies to each individual patients' lifestyles, instead of defaulting to a one size fits all answer. How many times have you said sugar is inflammatory without considering the diet of that season that the patient might be eating? Does the patient even have access to healthy options at home?    A natural marketer, Ms. Ashley Koff had an interest in selling from a young age and studied marketing at Duke prior to her dietetics and nutrition degree. During her own health journey, she herself tried fad and even self-described crazy diets and exercises, but never felt healthy, until a integrative gastroenterologist changed her life  simply asking her the questions and showing her a better way  to make better and appropriate choices. That started her on her current journey as one of the most respected and sought after Dieticians in the country.    In this episode, we discuss the mistakes we are all guilty of making when it comes to nutritional advice. She shares her best practices and free nutritional resources for you and your patients to use. And she specifically relates that to pain management, especially for children and how we can best support our patients and empower them to make better choices.    Takeaways What nutrition truly means Popsicle for breakfast anyone? How a breakfast popsicle might be what a pain patient needs! What personalization in nutrition means and how it can and should be tailored to our own and our patients' bodies?  What our medical training lacks when it comes to nutrition and how the focus of practice today is skewed towards selling ourselves and gaining followers. How to turn that around!  Pain and nutrition especially when it comes to children How nutritional considerations for pediatric pain patients differ from consideration for a healthier life style What Gamifying nutrition for kids looks like and the results it yields. What is the rainbow evaluation and how you can you do it and how often Debunking the myths of nutrients vs. nutrition, good and bad foods. Role of supplements vs. natural intake. Food sourced nutrients vs. supplements and isollette nutrients Role sweeteners and sugars play in our body and in pain (Hint: It's not as bad as the rap it gets) Her message to healthcare professionals (Hint: Show not tell!) Links Ashley Koff RD Free Resources: https://thebetternutritionprogram.com/free-resources-from-the-better-nutrition-program/ Episode 50: Stepping Up Pain Care Efforts for African American Patients Episode 26: Manage Memory, Manage Pain! Episode 10: Disparities in Pediatric Pain Care Proactive Pain Solutions Physicians Academy Proactive Pain Solutions Clinicians Pain Evaluation Toolkit   About the Guest Ashley Koff RD An award-winning nutrition expert, Ashley helps lead the national conversation on better nutrition as a speaker, author, media and industry expert. Selected among CNN's Top 100 health makers, recognized in the Top 10 Social Health Makers in Nutrition (Sharecare.com) and among the top “50 Natural Influencers” in health and nutrition to follow on Twitter (NewHope360 and Shape.com), Koff was also selected for the first list of Top 10 Registered Dietitians in the US by Today's Dietitian Magazine.    Beyond running a thriving integrative nutrition practice working with top entertainment and national leaders, Koff's a highly sought after strategic nutrition consultant for companies like Procter & Gamble, Califia Farms, Nature's Path, Westin, SmartyPants and was appointed the California state representative for the Let's Move campaign. She's currently an advisor for Victress Capital, the Partnership for a Healthier America and Tufts University Friedman School of Nutrition's Entrepreneurship Program and a partner at BeyondBrands.  

What does pain look like? In today's episode, I discuss different ways in which our biases and experiences can often overshadow the experience of the patient, impact clinician-patient encounters and the importance of context in every situation.    Is there a specific look to pain? Have you ever wondered if a patient is exaggerating their pain? It is common for chronic pain sufferers to hear comments like, “But you look so normal, you can't be in that much pain.” These comments can be especially detrimental coming from a physician.    I also discuss the "Catch 22 of pain" where we emphasize improvement in function over reduction in pain scores for the optimal outcomes, and also undermine patient's pain intensity watching them follow that advice!    Takeaways in This Episode The automatic assumptions about pain When should you believe the self report of pain. How accurate is the statement "When someone says they're in pain, they're in pain" ?  Considering the context of the situation, the patients' previous experiences and other influences on pain experience and pain behaviors Impact of bias on pain {Hint: It's not just the patients/families!}  "Catch 22 of pain" - Patients can receive contradictory and diverse messages Stop considering pain solely as a symptom of some other illness and give it the due recognition as a disease process in itself, even in cases of acute pain Finding out what is driving your patient's behaviors, their illnesses; understanding what is underneath Links Managing Disagreement and Misalignment of Opinions in Pediatric Pain Care Episode 41 Manage Memory, Manage Pain! Episode 26 Disparities in Pediatric Pain Care Episode 10 Dr. Hans Killian's book, Facies Dolorosa Proactive Pain Solutions Academy Proactive Pain Solutions Clinicians Pain Evaluation Toolkit

Dr. Clara Cohen experienced the magic of acupuncture from a young age when she was able to recover from scoliosis related pain as a child.  She initially worked as a personal trainer, but felt a strong desire to help her clients in an even more impactful way. That's when she discovered acupuncture.    Now a doctorate of Traditional Chinese Medicine and in practice for 18 years, she offers the introduction to acupuncture as something that doesn't cure or treat anything! Her abundant passion for natural medicine and harnessing the body's healing ability drives her practice.  Dr. Cohen says, “I'm an acupuncturist by day, but I'm a naturopathic doctor-wannabe by night.”    In this episode, Dr. Cohen shares some incredible stories of success from her pediatric patients over the years. We explore the use of acupuncture for pain management, her best practices for treating children, how she promotes healing at all ages and what healthcare professionals need to know about acupuncture and counseling their patients around its use for pain management and in the broader health and wellness context.   Takeaways in This Episode What acupuncture is and what it does for our bodies. She discusses the 3 R's of acupuncture: Reset, Restart, and Regulate. What needs to be  and what she emphasizes  as the goal with her patients; optimal health, and what it takes to  achieve  (Hint: It's more than acupuncture, it takes efforts from the patients!) What conditions, ages and types of patients can and should Acupuncture be used for; acute vs. chronic, babies vs. older children vs. adults.  Specific acupuncture techniques for babies and children including non needle methods, and acupressure What things should your patients consider and how you can advice your patients to find the right acupuncturist What conditions should acupuncture be considered for and what factors influence the effectiveness of acupuncture therapy Setting the right expectations for acupuncture or any treatment modality for that matter. Using acupuncture for pediatric patients Different modalities of acupuncture and non-needle options Contraindications and caution around use of acupuncture therapy Dr. Cohen's advice for healthcare professionals    Links Clara Cohen B.Sc, L.Ac, DTCM Connect with Clara Cohen to find more helpful resources: Website    Facebook    Instagram   YouTube  Proactive Pain Solutions Academy Proactive Pain Solutions Clinicians Pain Evaluation Toolkit   About the Guest   Clara Cohen is a graduate of the International College of Traditional Chinese Medicine of Vancouver, where she completed a 5 year program as the Doctor of Traditional Chinese Medicine level. She has been a B.C. registered Acupuncturist with CTCMA since 2003, and focuses mainly in gynecology and mental health. She has been part of the Port Moody & Coquitlam Acupuncture community for many years. She has successfully treated uterus cancer, ovarian cysts & fibroids, dysmenorrhea, fertility issues, anxiety, depression, insomnia, as well as assisted many patients with IVF and IUI support. Clara Cohen has been a professor at the Boucher Institute of Naturopathic Medicine in New Westminster, since 2008 and enjoys every minute of it. She also keeps taking seminars and workshops on Chinese medicine & natural health to further improve her knowledge and to help her patients with their healing process. Over the years, she has taken extensive training under well-known specialists such as Sharon Weizenbaum, Jane Littleton and Robert Chu. Clara has been a presenter and speaker at many conferences. She spoke at the 2011 & 2013 BCNA conference in Vancouver, about Chinese medicine and fertility, and acupuncture during pregnancy. She was also a speaker at the first Cancer Symposium presented by the Boucher Institute in February 2011, about the benefits of Chinese medicine as part of cancer treatments. Clara originally comes from the French Alps, where her family used Chiropractic, Acupuncture, Homeopathy, Physiotherapy and Massage as their main healing sources. She graduated from Grenoble University with a Bachelor in Applied Nutrition. When she moved to Canada she became a Personal Trainer, and managed 2 fitness clubs in Vancouver and West Vancouver for 8 years. She has extensive training in exercise physiology, sports nutrition and weight issues. She has appeared on Breakfast Television twice, and has conducted countless workshops on natural health for many corporations, schools and community centers. 

We all know of Botox use to reduce signs of aging. Approved in 2010 to treat migraines in adults, it's now also being explored (as an off-label treatment) for management of pediatric migraines.    In this episode, Dr. Shalini Shah, MD, MBA, the Vice-Chair for the Department of Anesthesiology & Perioperative Care and Enterprise Director of Pain Services at UC Irvine Health, shares their clinical and reseach findings, as well as the indications, caution, nuances, and protocol for use of botox in pediatric migraine. Her work on the effectiveness of Botox in pediatric patients experiencing migraines has been published in peer reviewed journals and been featured in Time Magazine and on NBC Nightly News.    We discuss her landmark work, the results of her study, protocols, indications and how you can best advocate for your patients to receive the same treatment.    Takeaways in This Episode   How Dr. Shah became interested in use of botox for pediatric headaches. Findings of her pediatric study including longitudnal data for Botox treatments in pediatric migraine.  Dosage and protocol for Botox injection for peditaric migraine (Hint: You'll be surprisedby the dosage used in kids!) FDA's stance on Botox for children's migrainesand how to navigate the approval of this off label treatment with insurance companies. Indications, contraindications and precautions when using OnabotulinumtoxinA for headaches. (Hint: No allergy butuse of caution in certain conditions is crucial!) Outcomes and patients' response after the treatment with botox; improvement in all spheres.  Strategies for preauthorization or approval by the insurance company. Dr Shah's message to healthcare professionals treating pediatric headaches   Links   Shalini Shah, MD, MBA Connect with Dr. Shah - Twitter  Linkedin Dr. Shah's articles on Botox - Effectiveness of Botox in Pediatric Migraines  Botox for Prophylactic Treatment of Pediatric Migraines Proactive Pain Solutions Academy Proactive Pain Solutions Clinicians Pain Evaluation Toolkit Recommended Listening: Pedia Pain Focus Episode #21: How to Counsel Your Patients on Off-Label Medication Use Other Recommended Reading: PREEMPT Trial 1 PREEMPT Trial 2 About the Guest   Shalini Shah, MD, MBA, Associate Professor is Vice-Chair for the Department of Anesthesiology & Perioperative Care and Enterprise Director of Pain Services for University of California Irvine Health. Dr. Shah completed her residency in anesthesiology from Cornell University and a combined fellowship in adult and pediatric chronic pain at Harvard Medical School.    She is the founder of the Pediatric Pain Program at UC Irvine and has previously served as Associate Program Director for the Pain medicine fellowship. Dr. Shah is the recipient of the ASRA Chronic Pain Grant Award in 2017 for her landmark work in onabotulinumtoxinA (Botox) use in pediatric migraine pain. She has been featured in Time Magazine, The Doctors, NBC Nightly News, Business Insider and is a frequent guest on NPR on the topic of safe pain care options. Dr. Shah is an internationally invited lecturer and leads several industry and peer-reviewed NIH funded clinical trials in pediatric and adult pain medicine.   Dr. Shah currently serves as the Founding Chair, Committee of Pain Medicine at the California Society of Anesthesiologists (CSA) and President-Elect, CA Society of Interventional Pain Physicians (CALSIPP). Dr. Shah is strongly committed to pain advocacy and healthcare regulatory reform both in the state of California and nationally to improve healthcare experiences for patients.   

Pediatric pain has been left on the back burner for decades now-- where many clinicians 30 years ago thought that infants did not feel pain. With the progress made, both in pain management and technology, it's about time that we call institutions to shift the culture, so we can work towards making pain visible-- so we can provide comfort to children patients that they desire and deserve.   In this episode, I've brought back Dr. Neil Schechter, to discuss his endeavor, ChildKind International. This passion project of his aims to have an open-access library to serve as a clearinghouse for information on pediatric pain research, and can serve as a reference to improve children's pain management.   ChildKind offers a certification for hospitals based on their commitment to and availability of certain measures to address pediatric pain and comfort adequately. Being certified, fosters trust from parents, promoting a positive experience for both patient and parent. In addition, with a pain management system throughout the institution contributes to higher staff retention and lower healthcare provider burnout.   With this huge step forward in creating accessible pain care, it's up to us as clinicians to offer the same amount of care for our patients regardless of where they present for their care -- because it is not only the pain team or service's responsibility. It is all our responsibility.    Takeaways In This Episode The current practices of handling pediatric pain What Childkind International is and what led to its creation How to enact change within the institution ChildKind's mission and 5 Principles ChildKind's role in promoting change and its benefits The importance of change from the top-down and bottom-up Pediatric pain is everyone's responsibility  Dr. Schechter's hopes for ChildKind and all healthcare institutions   Links Neil Schechter MD ChildKind International Connect with ChildKind International: Facebook  Instagram LinkedIn Pedia Pain Focus Epi # 53. Are you making the most of your "Golden Half-Hour" with your pain patients? Proactive Pain Solutions Physicians Academy Clinicians' Pain Evaluation Toolkit Proactive Pain Solutions   About the Guest    Neil Schechter, MD He is the President and CEO of ChildKind, an international organization dedicated to improving the quality of pediatric care. Currently, he directs the Chronic Pain Program at Boston Children's Hospital and is an Associate Professor of Anesthesia at Harvard Medical School. Dr. Schechter graduated with a medical degree and completed pediatric training at the University of Connecticut. He also did his fellowships at Children's Hospital and Harvard University in Boston. His research initially focused on documenting the under-treatment of pain in children and issues of pain that are associated with chronic disease. His research, later on, shifted to the common pains connected to pediatric practice and to create procedures to improve pain-related practice patterns in health care providers and institutions. Dr. Schechter is a passionate advocate for the betterment of pediatric pain care which allowed him to serve as a member of editorial boards and experts committees including the World Health Organization Committee and Palliative Care and the Task Force on Chronic Pain in Children of American Pain Society. He has also been the recipient of the Jeffrey Lawson Award for Advocacy in Children's Pain Relief from the American Pain Society.

pain is the most common and devastating symptom of Sickle Cell Disease. Despite the slow and elusive developement of therapeutic intervention in Sickle cell disease that would halt the vasocclusive crisis and the related pain, last few decades have brought about good progress with successful hemopoetic stem cell transplant as well as several therapeutic agents targeting various aspect of teh pathophysiliogy of SCD.   In this episode, I review the 4 major targets in the pathophysiology of SCD and approved therapeutic interventions and agents as well as those that are further along clinical trial with very promising results.   Takeaways in This Episode What prompted me to do this update How this episode is different from and how it complements the earlier published episode about sickle cell disease The challenges presented by sickle cell disease The major presentation and impact of sickle cell disease 4 main therapeutic targets with advances and ongoing trials Newer FDA approved agents in management of vasocclusive crisis and pain The success and challenges of stem cell transplant for SCD   Links Pedia Pain Focus Episode #12. Master Your Sickle Cell Pain Care Skills Pedia Pain Focus Episode #62. Metaphors for Better Pediatric Pain Management  Pedia Pain Focus Episode #21. How to Counsel your Patients on Off-Label Medication Use Proactive Pain Solutions Physicians Academy Proactive Pain Solutions

Yoga is much more than just a physical exercise. It's an ancient mind and body based practice that involves self-paced physical movement, meditation, and breathing techniques.  Practicing Yoga can change your and your patient's life in ways you never imagined!   An array of incredible benefits from yoga have become evident in healthcare, professional sports and our day-to-day lives promoting physical and mental well being. But how does it actually work? How does one heal through yoga? When is it appropriate to do yoga if you/your patient has pain?   Join me in this episode as I talk more about yoga with Ms. Amanda Machado, MPH. Not only is she a certified yoga teacher and entrepreneur, but she's also a public health epidemiologist with over a decade of experience in disease prevention!   Amanda brings even her personal perspective to the practice of yoga, as she shares with us how it helped her heal from anxiety and trauma!  In addition, she shares the how yoga is beneficial for your pain patients, how to counsel your patients around yoga for pain and even how it's beneficial to you and your patients above and beyond pain conditions!   Takeaways In This Episode   The role yoga played in Amanda's personal healing journey Tangible and intangible benefits from yoga including its role in our relationships with others Applications and implications of yoga for pain management Uniques aspects of yoga for pediatric patients including preventive and therapeutic benefits  What exactly does yoga entail and how to know which yoga is right for you/your patient (Hint: So much more than physical exercise!) Finding the right yoga therapy, teacher and therapist (Yes there is such a thing!) How to determine whether a patient should do physical therapy versus yoga Ms. Machado's advice to healthcare professionals around yoga   Links    Amanda Machado Connect with Amanda - Instagram   Linkedin Passage Studios | Yoga + HIIT + Spin Pedia Pain Focus Epi# 63. Integrative Pediatric Pain Management with Dr. Lonnie Zeltzer Clinicians Pain Evaluation Toolkit Proactive Pain Solutions   About the Guest   Amanda Machado, MPH, is a Public Health Epidemiologist who has worked in healthcare for a decade, she is trained in both kinesiology as well as epidemiology, she researches root causes of disease, associations, and preventative intervention. Amanda is also a certified Yoga Teacher and entrepreneur and has her own business where she focuses on holistic wellness, helping people live a more conscious life, where they can heal, and grow. She also does business mentorship for practitioners looking to integrate evidence into their work, and those who want to bridge spiritual, emotional well-being with evidence based and scientific insights. She has published studies on happiness, high cost users of the health system and health behaviors that lead to illness, as well as on other clinical and prevention based topics. In her free time you can find her hiking a mountain in the Rockies, gardening, and spending time with her husband and dog Willow.   

Many factors contribute to children's pain being under estimated, under-recognized and inadequately treated. Kathryn Birnie, PhD shares her work identifying the top priorities essential for improvement in pediatric pain management. Join me in this episode as she shares her patient-oriented research which includes them in priority setting and recognizing the areas where we need to focus on.  Her work is grounded in empowering the disempowered; the pediatric pain patients and their caregivers, working alongside and in concert with the clinicians, making the small and big shifts in doing so especially when there is a power differential.  Dr Birnie discusses the top 10 priorities identified in pediatric pain management, how they went about doing so, especially having to distill them down to 10 from >500 identified at the start. She shares which one or ones of them should be prioritized to the top of the line, how that is relevant to each one of us caring for children, and what surprising elements, perspectives or shifts they encountered in the course of this work. We also explore her role as the Assistant Scientific Director of Solutions for Kids in Pain (SKIP), a knowledge mobilization initiative and how healthcare professionals and patients and families can participate in and benefit from SKIP.   Dr. Birnie is an Assistant Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at the University of Calgary and a clinical psychologist at Alberta Children's Hospital.   Tune in to learn more about how she is contributing to shaping pain research, education and clinical  care for kids with pain and how that influences us as healthcare professionals in our day to day work!   Takeaways In This Episode How Dr. Birnie got involved in pediatric pain management and what fueled the work she's doing right now Dr. Birnie shares behind the scenes of her research, Partnering for Pain, and its design involving patients and families alongside the clinicians and other stakeholders in improving pain care of children.    The top 10 priorities in pediatric pain that Dr. Birnie and partners found  What priorities we should be focusing on The gaps that various stakeholders need to be aware of in managing children's pain Work that SKIP is doing to advance pediatric pain care How institutions or healthcare professionals can be the beneficiaries of SKIP and how they may contribute to this important work Dr. Birnie's words of advice to healthcare professionals taking care of children with pain    Links  Kathryn Birnie, PhD Connect with Dr. Birnie -  Linkedin   Twitter @katebirnie Partnering for Pain Partnering for Pain Video Keeping Up with Today - Dr Christine Chamber's Podcast There's an App for that - Dr Jennifer Stinson's Podcast episode Making Pediatric Pain Matter - Dr Christopher Eccleston's podcast Episode Role of Epigenetics in Post-surgical Pain - Dr. Vidya Chidambaran's podcast episode Manage Memory, Manage Pain - Dr Melanie Noel's podcast episode Solutions for Kids in Pain (SKIP) Clinicians Pain Evaluation Toolkit Proactive Pain Solutions About the Guest Katie Birnie, Phd   Dr. Birnie completed her Ph.D. in Clinical Psychology at Dalhousie University in 2016, including a predoctoral residency in Pediatric Health Psychology at the IWK Health Centre. She completed a CIHR-funded postdoctoral fellowship at the University of Toronto and The Hospital for Sick Children. Dr. Birnie also spent time as a clinical research postdoctoral fellow and clinical psychologist at the University Health Network, including with the Transitional Pain Service at Toronto General Hospital and the Interventional Pain Program at Toronto Western Hospital. Dr. Birnie joined Alberta Children's Hospital as a medical psychologist in 2018, where she continues to provide clinical care through the Vi Riddell Children's Pain and Rehabilitation Program.   Dr. Birnie is a recognized leader in pain research and patient partnership, for which she has received a number of national and international accolades. She was the recipient of the 2020 Pain Awareness Award from the Canadian Pain Society and was selected as a 2020-2021 MAYDAY Fellow, a prestigious fellowship focused on communications and advocacy for improved pain care. Previously highlighted awards include the Dr. John T. Goodman Award for Trainee Research in Pediatric Pain, the Brain Star Award from the CIHR Institute of Neurosciences, Mental Health and Addiction, and a Vanier Canada Graduate Scholarship.

Did you know that he pediatric pain patients rate feeling of isolation as the absolute worst thing, even above their pain? Georgia Weston, MSW, endured years of isolation as a teen, suffering through her chronic pain alone, feeling not being believed. Now, she’s the Executive Director of Creative Healing for Youth in Pain (CHYP), a nonprofit that helps youths suffering from chronic pain by focusing on creative healing experiences. We discuss her firsthand experiences with her own pain, her work as the director of CHYP and the simple steps healthcare providers can take that will make a world of difference to their patients.    Takeaways in This Episode Georgia's experiences with chronic pain as a child and how she became interested in pediatric pain management Her journey to becoming the Executive Director of CHYP Aspects of chronic pain that are worse than the physical pain itself Barriers to accessibility of pain care for youth with chronic pain What is CHYP, what  they offer the youth and their families How has CHYP helps bridge the gap of accessibility to pain care Who/how the programs and services offered in CHYP are curated Unique aspects of CHYP compared with other pediatric pain management support services, programs and organizations How healthcare professionals, patients and families can access these resources Georgia's advice to healthcare professionals dealing with pediatric pain issues.   Links Georgia Weston, MSW www.mychyp.org Linkedin Twitter Facebook Instagram YouTube: Creative Healing for Youth in Pain Pedia Pain Focus Epi#62. Metaphors for Better Pediatric Pain Management Clinicians Pain Evaluation Toolkit Proactive Pain Solutions Books by Georgia Huston Weston PAIN: An Owner's Manual: Intimate conversations about pain Vienna's Waiting: A teenage girl’s battle with pain   About the Guest Georgia Weston, MSW Georgia Weston is the author of two books, Vienna’s Waiting and PAIN: An Owner’s Manual, where she provides insight into the mysterious world of chronic pain through her own story and the stories of others. In 2011, she founded the Teen Pain Help Foundation, a 501(c)3 charitable corporation created to help children and adolescents with chronic pain. Since founding the Teen Pain Help Foundation, Georgia has served as the Executive Director, raising funds for treatment, research, education, and increased public awareness of pediatric chronic pain. She also co-founded and was the Director of Programming for Art Rx, strengthening the partnership between the USC Suzanne Dworak-Peck School of Social Work and the USC Keck School of Medicine, specifically to better understand how art impacts pain. Georgia has experience creating and leading programs for organizations that provide therapeutic services for struggling individuals and families. She also has clinical social work experience, both as an outpatient therapist and residential therapist, for youth dealing with complex cognitive, behavioral, and social needs. In addition to her work with chyp, Georgia is a Research Associate on a Rally grant for an adolescent/young adult cancer pain telemedicine intervention study with the UCLA Pediatric Pain Research Program. Georgia has a Bachelor of Arts in psychology, with a minor in art, from St. Edward’s University. She has a Master of Social Work degree from the University of Southern California, with a concentration in Children, Youth, and Families, as well as a focus in Child and Adolescent Mental Health. In recognition of her humanitarian services, Georgia received the David Chow Humanitarian Foundation Award for 2019. Georgia is dedicated to empowering youth with chronic pain and their families through creative healing techniques and social support.

Every child inevitably would experience pain in the course of their life, but if not addresses appropriately, these experiences can have long-lasting and detrimental effects which carry into adulthood. What's even more remarkable is that healthcare experiences including what we do  as part of healthcare as professionals is often a significant part of what causes pain and anxiety  for children.  Efforts to minimize distress, discomfort, pain and related anxiety  should be a priority in healthcare. What can healthcare professionals do to prevent, minimize, and ease a child’s fear, anxiety and pain over the medical procedures that they need to undergo as part of their treatment and care?   Join me in this episode as I talk about the prevention and treatment of pain caused by procedures within the hospital and healthcare settings with Stefan Friedrichsdorf, MD, medical director of the Center of Pain, Palliative and Integrative Medicine at the UCSF Benioff Children’s Hospitals in Oakland and San Francisco!   Dr. Stefan Friedrichsdorf, MD, FAAP is a Professor of Pediatrics at the University of California at San Francisco (UCSF).    Find out about his "Comfort Promise" and 4 simple steps that every healthcare professional should ensure to relieve or decrease pain and anxiety among kids who are undergoing treatment and minor or major procedures.  Dr Friedrichsdorf shares his experiences, findings, outcomes, implementation plan and even some of the common barriers as well as ways to address them often overlooked   Takeaways In This Episode: How Dr. Stefan got involved in pediatric pain Dr. Stefan talks about the prevention and treatment of pain caused by procedures in our hospital, and the staffs Situations where children in hospitalized settings are experiencing pain and anxiety from their treatment procedures The prevention and treatment of pain and anxiety caused by needles What is the “comfort promise”? The four steps to decrease pain and anxiety caused by vaccinations? How to get past the barrier of having our colleagues recognize that this issue of fear and anxiety brought about by treatment procedures is an important issue?   Links  Stefan Friedrichsdorf, MD FAAP LinkedIn Twitter His paper Clinicians Pain Evaluation Toolkit Proactive Pain Solutions   About the guest: Stefan Friedrichsdorf, MD FAAP   Stefan Friedrichsdorf is the medical director of the Center of Pain Medicine, Palliative Care and Integrative Medicine at the UCSF Benioff Children’s Hospitals in Oakland and San Francisco. He's a Professor of Pediatric at the UCSF.     Dr. Friedrichsdorf received the 2016 “Elizabeth Narcessian Award for Outstanding Educational Achievements in the Field of Pain” by the American Pain Society and the 2011 “Hastings Center Cunniff-Dixon Physician Award”. He was the medical director of the department of pain medicine, palliative care & integrative medicine at Children’s Minnesota from 2005-2020 and under his leadership the department grew into one of the largest and most comprehensive in the country. It received the “Circle of Life Award” by the American Hospital Association in 2008 and was the 2013 recipient of the “Clinical Centers of Excellence in Pain Management Award” by the American Pain Society and in 2018 the Albert Bandura Influencer Award from VitalSmarts.   He was the associate editor of the Journal of Pain and Symptom Management until 2020, the principal investigator of a National Institutes of Health (NIH) / National Cancer Institute (NCI) multisite study on the creation, implementation and evaluation of the Pediatric Palliative Care Curriculum “Education in Palliative and End-of-Life Care (EPEC)-Pediatrics”. In 2008 he founded and since then directs the annual Pediatric Pain Master Class, a unique week-long intensive course for interdisciplinary health professionals.   Dr. Friedrichsdorf has presented more than 750 lectures about pediatric pain medicine, palliative care and integrative medicine and has a track record of research and publications in the field, including more than 60 peer-reviewed articles and contributions to more than 25 books on the subject. He is president-elect of the Special Interest Group on Pain in Childhood of the International Association for the Study of Pain (IASP).   Dr. Friedrichsdorf received his MD degree from the Medical University of Lübeck, Germany, completed his pediatric residency at the University of Witten/Herdecke, Germany (Children’s Hospital Datteln), and undertook his fellowship in Pediatric Pain Medicine and Palliative Care at the University of Sydney, Australia (Children's Hospital at Westmead). He is double boarded in Pediatrics in Germany and the United States, a Diplomate of the American Board of Pediatrics, and trained in pediatric clinical hypnosis.  

Chronic pain is the result of dynamic interactions between psychological, biological, and social factors. In this episode, Dr. Lonnie Zeltzer, a veteran and pioneer of the best practices in pediatric pain medicine talks about the approaches you can take in assessing and treating complex chronic pediatric pain issues to ensure best outcomes!   Dr. Zeltzer has shared her decades of experience, research and wisdom in this episode. It's like getting a masterclass in all you want to know about taking acre of a pediatric pain patient.    There are many barriers when it comes to treating children’s pain. However, Dr Zeltzer shows you how to overcome them and how to choose the appropriate approaches that will be embraced by your patients and families when treating complex chronic pain in children.   Tune in to this episode as Dr. Lonnie talks about the integrated approach to pediatric pain management with a cohesive team of clinicians regardless of their geographic proximity.    Takeaways In This Episode: What integrative medicine is and how it differs from the alternative medicine What an integrated medical model looks like What therapies are appropriate for your patient How to decide which ones to pick when there are competing priorities and issues of cost, effectiveness, and beliefs Harnessing the power of mind for pediatric pain care The importance and practice of rebalancing your autonomic nervous system The differences between complementary alternative therapies and integrative therapies Dr. Zeltzer explains how to create an integrative pain care team   The framework Dr. Zeltzer  use to decide which patients may need therapies with seemingly similar impact ( e.g. yoga vs. PT or CBT versus hypnotherapy)   Links  Lonnie Zeltzer, MD Linkedin Complementary, Alternative or Integrative Medicine: NCCIH Definitions Conquering Your Child's Chronic Pain: A Pediatrician's Guide for Reclaiming a Normal Childhood Clinicians Pain Evaluation Toolkit Proactive Pain Solutions   About the Guest: Dr. Lonnie Zeltzer   Dr. Zeltzer is a Professor of Pediatrics, Anesthesiology, Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA, Director of the Pediatric Pain Program at UCLA Mattel Children's Hospital, and Past-Medical Director of Trinity KidsCare pediatric hospice.    She is also Associate Director of the Patients and Survivors Program in the UCLA Jonsson Comprehensive Cancer Center, on the steering committee of the UCLA Centers for Integrative Medicine, the UCLA Psychoneuroimmunology Program, and the Center for Neurovisceral Sciences.    Dr. Zeltzer’s pain program integrates complementary and traditional therapies for the treatment of chronic and cancer pain in children, and she studies the development of chronic pain, mind-body-pain connections, and the impact of complementary therapies on chronic pain.    She has over 200 publications, including her book, "Conquering your Child's Chronic Pain: a Pediatrician's Guide for Reclaiming a Normal Childhood,"(HarperCollins, 2016).  

Metaphors have long been used to explain complicated and unfamiliar subjects. Use of metaphors, especially in pain management lends itself naturally to  improved understanding, patient empowerment, treatment engagement and ultimately better outcomes.   In this episode, I review the concept of metaphors in pediatric pain management, along with giving you several metaphors to get you started right away, on the road to efficient and effective pediatric pain management.   Takeaways in This Episode What are metaphors and why they matter Who are the metaphors relevant to and who all should use them Why are they uniquely suited to pediatric pain management Whether all metaphors good in pain management and how language plays an essential role 3 essential areas to use metaphor sin when dealing with pediatric pain Specific examples of metaphors in these 3 areas Additional resources   Links Clubhouse  Episode #49. Putting Pain Care Skills in Your Patients and Families' Hands. Episode #53. Are You Making the Most of Your "Golden Half-Hour" with Your Pediatric Pain Patients? Episode #27. InterDisciplinary Pain Education is Necessary to Change the Face of Pediatric Pain Care Clinical use of metaphors in the treatment of chronic pain in children. Clinicians Pain Evaluation Toolkit Proactive Pain Solutions

Have you ever judged yourself even before letting anyone else even have a glimpse at your capabilities? Or talked yourself out of something that later you've felt you could've or should have done. You're not alone! As you'll hear Asha Padmanabhan, MD, FASA discuss how even the most accomplished professionals create labels and barriers for their own progress, often unwillingly and subconsciously.  More importantly, though, she walks you through how to recognize when we do that and how to turn those upside down and shake them out to reveal whether they are a reality or an assumed identity.  She talks about  how NOT to let us get in our own way! She especially mentions some of the unique challenges faced by the women physicians and healthcare professionals. Despite the increasing numbers of women entering the medical profession, this hasn’t actually translated into more females in leadership roles.   Be the successful and resilient professional (or person) you are meant to be as Dr. Padmanabhan, a Board Certified Anesthesiologist and a physician coach, who has been in leadership roles for many years, joins us to talk about the challenges real or perceived and how to tap into your success potential and thrive!   Takeaways In This Episode: Her experience and perspective on the challenges of being in a leadership role as a woman How she landed in the leadership role and the experiences in navigating these leadership positions The internal versus external challenges The uniques challenges that women physicians and healthcare professionals face Dr. Padmanabhan talks about the limiting beliefs, where they come from, and what to do with them Getting past the limiting beliefs and getting out of your own way Differentiating limiting beliefs and false bravado Dr. Padmanabhan's experience with coaching and how it had been critical to her own progress through limiting beliefs   Links  Asha Padmanabhan, MD, FASA Connect with Dr. Padmanabhan LinkedIn, Facebook, Website The Leadership Rx for Women Physicians Podcast  Work Life with Adam Grant Clinicians’ Pain Evaluation Toolkit Proactive Pain Solutions   About the Guest: Asha Padmanabhan, MD, FASA   Asha Padmanabhan, MD, FASA is a Board Certified Anesthesiologist juggling a full-time clinical career with Administrative responsibilities, while being active in leadership at the State and National levels in anesthesia. Having been in leadership for over 10 years, she realized that women physicians in leadership or aspiring to be leaders have a unique set of challenges. After years of running workshops and mentoring young women physicians, being coached helped her realize coaching was the very foundation to building skills to achieve career fulfillment and be a resilient leader.    She is passionate about empowering women physicians to be the leaders they can be, whether it’s with a title or not.She coaches women physicians in leadership development, career transformation and career resilience. She is also an entrepreneur with a thriving side gig in online retail. 

Dr. Jennifer Rabbitts, MD a Board certified pediatric anesthesiologist and prolific pain researcher studies pain and health outcomes including the influence of sleep and other factors on pain outcomes in the short and long term. Sleep and pain have a bidirectional relationship, but it appears that sleep has the upper hand determining the sensitivity, intensity and duration of pain. Sleep as an important pillar of health, exerts its influence in many domains and many ways. In this episode she discusses her findings on the salient ways in which sleep influences pain and other health outcomes of children undergoing surgery, both in the immediate peri-operative and post-operative period.   Takeaways in This Episode How Dr. Rabbitts became interested in children's pain management Why it is important to be studying the relationship between sleep and pain Host of factors in the hospital which influence the quantity and quality of sleep during the peri-operative period The American Academy of Sleep Medicine recommendations on the optimal amount of sleep for children and adolescents and whether it should be altered around surgery Duration and stages of the impact of sleep disruptions after surgery Whether and how sleep may play a role in development of persistent and chronic pain How much reduction in sleep is needed for impacting the pain outcomes after surgery A surprising finding that completely surprised me about sleep disruption and opioids in adolescents  Recommendations for change in clinical practice around sleep and surgery Differences in the peri-operative outcomes of children with sleep disordered breathing/sleep apnea and children with acute sleep disruptions Dr Rabbitts' recommendations for clinicians around sleep in the peri-operative period   Links Jennifer Rabbitts, MD Contact Dr. Rabbitts : Email, twitter  American Academy of Sleep Medicine Clinicians Pain Evaluation Toolkit Proactive Pain Solutions   About the Guest Jennifer Rabbitts, MD Jennifer Rabbitts, MD is a board certified pediatric anesthesiologist and pediatric pain researcher at Seattle Children’s Hospital. She’s an Associate Professor of Anesthesiology at the University of Washington. Dr. Rabbits completed her medical school in South Africa and her residency and fellowship training at the Mayo clinic. Her work is focused on prevention and management of acute postoperative pain in children. Studying risk factors that predict which children will develop severe and longer lasting postoperative pain and investigating ways to modify them. Her research has earned her several awards even from her residency days and she’s also been the recipient of the young investigator award, the future leaders in Pain research award from the American Pain Society.

Today most of us conduct major chunks of our lives digitally and social media has now become a major tool for people to consume news, health information and even create community and connections.  For us as physicians and Healthcare Professionals, this tool can connect us with peers from around the world to share information, collaborate, and make an impact, but it can also make or break our professional credibility, with or without our participation. Join me in conversation with Dr. Jay-Sheree Allen, MD, a practicing Family Medicine Physician and learn the ins and outs of social media engagement, it's impact on healthcare professionals professional and person lives and how to own your digital footprint.   Social media is not all good and it's not all bad either, but one needs to be aware of the power and pitfalls of this powerful tool in today's world. Listen to Dr. Allen as she drops many beautiful gems throughout the interview and that you NEED to know to successfully navigate social media as a healthcare professional.   Takeaways In This Episode The different Social Media platforms, and how to use the them effectively. The unique offerings of Facebook that make it  the tool of communication, connection and influence for one-third of the world's population. Whether physicians and healthcare professionals have a preference of any particular social media platform(s) and why Influence of social media on medical education and professional collaborations The uniques aspects of LinkedIn, why physicians NEED it and how to maximize it for best outcomes What social media uniquely offers for healthcare professionals What is your digital footprint and narrative, how and why it is important to take ownership and control of your digital footprint for your professional and personal well being  The common pitfalls to be aware of in successfully navigating social media Dissemination of credible information on social media, while maintaining the primary focus on excellent clinical care and avoiding unproductive landmines and the  gaslighting culture.  Using social media to make a larger impact, efficiently Best practices and what not to do when you’re on social media Resources and ways to get started and effectively navigating the social media quagmire. Dr Allen's advice to social media novices as well as experts.   Links Jay-Sheree Allen, MD Connect with Dr. Allen on ; Twitter, Instagram, LinkedIn Pedia Pain Focus Episode # 56. Making Pediatric Pain Matter: Delivering a Transformation Action #Medtwitter Canva - Free Graphic Creation Tool About the Guest Jay-Sheree Allen, MD Dr. Jay-Sheree Allen is a Board-Certified Family Medicine Physician and National Health Service Corps Scholar currently practicing in Central Minnesota. Dr Allen is committed to improving the health of millennials, both locally and globally, through the promotion and practice of Primary Care and Preventive Medicine. Recognizing the power of media to deliver relevant and timely health messages, she has published with ABC News Health, she is a contributor on Hippo Education’s Primary Care Reviews and Perspectives podcast and co-host of the new series Race and Medicine. She is also the creator and host of the Millennial Health Podcast. She completed her residency training at the Mayo Clinic. While there, she was a member of the Mayo Clinic Alumni Association Board of Directors, President of the Mayo Fellows Association and recipient of one of the Mayo Clinic’s highest student honors: The Barbara Bush Award. She graduated from Meharry Medical College in Nashville Tennessee where she was the recipient of the Family Medicine Leadership Award and served as Miss Meharry, the institution’s community ambassador. She received her Bachelor’s degree in Psychology, Magna Cum Laude, from The City College of the City University of New York where she was a Colin Powell Fellow. She founded Women of Excellence, Strength & Tenacity (WEST) an organization dedicated to empowering young women to live up to their highest potential. She continues to support philanthropic efforts in medicine, through volunteering locally and abroad. She serves on the American Academy of Family Physicians Foundation Board of Trustees, the Center Clinic Board of Directors and is the West/Midwest Regional Leader for the Global Jamaica Diaspora Youth Council. She was named a 40 under 40 Leader in Health by the National Minority Quality Forum, she was featured in the book Against All Odds: Celebrating Black Women in Medicine and most recently was awarded the 2020 Townsend Harris Medal by the Board of Directors of the Alumni Association of the City College of New York. Dr. Jay-Sheree Allen is Jamaican born and New York raised. She lives with her husband Dr. Joseph Akambase in Minnesota.

The highest goal in healthcare is to provide high-quality care, safe and effective care for our patients that facilitates the best possible outcomes be it after their surgery or any other part of their healthcare journey. Pain and its management is one of the top determinants of quality of care, speed of recovery and the patient/families satisfaction.    Join me in this episode with Dr. Elizabeth Ross. MD as we talk about  how ERAS (enhanced recovery after surgery) pathways have not just revolutionized the peri-oprative care of patients, but their pain  and entire healthcare experience throughout the system!   Dr. Elizabeth is a pediatric regional and acute pain service anesthesiologist at the University of North Carolina Children’s Hospital.   She explains what ERAS is all about, how to get started, identify partners, increase team engagement, collaboration and the widespread quality, efficiency and financial gains as result.  Ultimately, it improves satisfaction for patients/families and healthcare professionals, alike.   Takeaways In This Episode: What ERAS is. How Dr. Ross became involved in the ERAS work. The difference between a protocol and a pathway What the standardization of pathways/ERAS mean for clinical judgement and hoe it affects clinicians' autonomy in caring for their unique patients A step by step breakdown of the ERAS pathway process Engaging the multidisciplinary team members in coordination and delivery of consistent, high quality, safe and cost-effective care Other areas of healthcare which benefit from the ERAS approach Measuring the right outcomes when utilizing and assessing the impact of ERAS How to get started with implementation of ERAS in your area of care How ERAS is great for building team collaboration between interdisciplinary teams of healthcare professionals   Links Elizabeth Ross, MD ERAS FREE Clinicians Pain Evaluation Toolkit Proactive Pain Solutions   About the Guest Elizabeth Ross MD Dr. Elizabeth Ross is a pediatric anesthesiologist at UNC-Chapel Hill where she has been on the faculty for the past 7 years.  She's a member of the Pediatric Acute Pain Service, and specializes in regional anesthesia.  She leads the ERAS efforts at UNC and also serve as the Trauma Liaison for pediatric anesthesia.  She's also active in her department's Diversity, Equity and Inclusion committee, and serves as a University Ally.  She plays a key role in  the medical student, resident and fellow interviews, selection and education.      

Sink or swim or trial and error may be acceptable strategies in some situations, but they are hardly applicable when considering a much needed radical transformation in culture of health and wellness.  Instead what we need to adopt is what many other fields have clearly relied upon for going from good to great; Coaching! Somehow coaching has been conspicuously missing from a field that is high stakes, high stress and also high yield.  Physicians, and clinicians for that matter, are left to figure out everything all on their own once they finish their clinical training.  In this episode, Dr. Elizabeth Brill, MD MBA, a highly successful clinician, a Physician Executive and a certified coach shares her own experience with coaching, the integral role it plays in a physician or  clinician's professional and personal life. Takeaways in This Episode Dr. Brill's journey as a physician, an Physician Executive and as a coach The benefits coaching offers in healthcare and for the  healthcare professionals The different types of coaching in healthcare  Qualities that make one ideally suited for coaching and the kinds of situations which particularly benefit from coaching. The difference between mentorship and coaching Can or should mentorship and coaching combined and what the effects would be. Why coaching seems to be restricted at the executive and the "C suite" level in healthcare Elements of the physician/executive coaching, what it entails, and what the sessions look like  Qualities to look for in a coach look for in a coach   Links Elizabeth Brill, MD, MBA, FACOG Hudson Institute of Coaching  FREE Clinicians' Pain Evaluation Toolkit Proactive Pain Solutions Women's Empowerment and Leadership Initiative   About the Guest Elizabeth Brill, MD, MBA   Elizabeth Brill MD, MBA, FACOG serves as the Chief Medical Officer,  at the Office of Community Care  and Senior Advisor to the Acting Assistant Undersecretary for Health for Community Care at the United States Dept. of Veterans Affairs.   An Obstetrician and Gynecologist by training, Dr. Brill has not only been a highly successful clinician, she has successfully held many executive and administrative roles serving as the Vice President of Surgical Services, the Chief of Staff at the Cincinnati VA Medical Center and the COO at Ohio Health.   She is also a Certified Coach through the Hudson Institute of Coaching, has been coaching physicians both through  a national initiative, Women's Empowerment and Leadership Initiative, and also coaches physicians and executives independently.   With decades of experience as a clinician and having served in many administrative and executive roles, she understands the landscape and the unique needs of physicians at all levels.  

Frequent does not mean trivial and simple does not mean easy!  Says Dr. Chris Eccleston, PhD, director Center for Pain and Research at the University of Bath. A primary goal of medicine is to relieve pain and suffering. Sadly though, this is poorly achieved, especially when it comes to pediatric patients, despite ample evidence for the detrimental longitudinal effects of poorly managed pain in kids. Children’s pain should also be prioritized, yet why is is so hard to do that? How then do we make pediatric pain matter, visible, understood and better? In this episode, Dr Eccleston joins us to talk about how we can deliver transformative action in pediatric pain and make it matter. Dr. Chris is a Professor of Pain Science at the University of Bath in the UK, and he runs the Center for Pain and Research at the university. His contributions to clinical and research aspects of pediatric pain medicine  are immense. He has extensively written and published scientific and educational articles and stories that help the reader think from a new perspective. And today, we’re discussing the paper/commission he wrote for the Lancet Child and Adolescent Health, including the behind the scenes story of that commission, and what inspired them to write it! Takeaways In This Episode:   How Dr. Eccleston got interested in pediatric pain management Reasons why for pediatric pain (or chronic pain in general) does not get acknowledged and therefore not addressed Factors that contribute to sustained conversations and attention to an issue. Why we may have a propensity to diminish others' pain The starting point for making improvements to pediatric pain. Discussion about the Lancet Commission paper on pediatric pain and what inspired Dr. Eccleston to write this about pediatric pain How we deliver transformative action in pediatric pain The 4 transformative goals  What does equity  mean when it comes to pain and how must we work on making it an important issue What to expect from this Lancet Commission article and what Dr Eccleston's hopes are. Dr Eccleston' advice for healthcare professionals, the importance of serendipity, community and connection Links Christopher Eccleston PhD The Lancet Commission - Delivering Transformative Action in Pediatric Pain Center for Pain Research IASP  PICH (Pain in Child Health) research training  Cochrane Pain, Palliative and Supportive Care  Leadership Rx for Women Physicians FREE Clinicians' Pain Evaluation Toolkit Proactive Pain Solutions   About the Author Christopher Eccleston PhD Christopher Eccleston PhD is a Professor of Pain Science at the University of Bath in the UK and the Director of the multidisciplinary centre for pain research.   His work has been focused on evidence based pain management, therapy development, technology innovation, and behavioral science.  He has authored over 280 peer reviewed scientific publications and 3 books in the general field of pain, interoception, evidence based medicine, pain management, and digital therapeutics.   He was awarded the British Pain Society Medal in 2012, the Pain Champion Award for Contributions to European Pain Policy from the European Pain Federation in 2018, and the ‘Ronald Melzack’ award for pain science from the International Association for the Study of Pain in 2018.   He has chaired the University of Bath ethics and integrity committee (2018-) , and have held key editorial positions as a senior editor in Cochrane (2010-2020), and as the field editor for psychology in the journal PAIN (2010-2020).    His work is rooted in his beliefs; "I aim to put the body back into psychology and psychology back into medicine. I’m interested in ensuring that the science we do is rigorous, and that integrity is assured in research and publication practice."       

Neuropathic pain, especially in children can be extremely challenging to recognize and treat. Dr. Alyssa Lebel MD, a dually trained pediatric neurologist and pain physician, provides a step by step explanation of neuropathic pain across the pediatric age groups and provides practical tools for how healthcare professionals can recognize and treat it effectively.   Takeaways in This Episode Dr. Lebel's personal connection to and her journey into becoming a pediatric neurologist and pain physician The unique features of pediatric nervous system and neurocognitive development Features distinguishing pediatric neuropathic pain from that among the adults What are functional neurological disorders or pain presentation of these disorders, and the findings on imaging (Hint: it’s not just made up or feigned symptoms) Why and when neonates and infants develop neuropathic or chronic pain  Correlation between colic, headache, and/or abdominal pain Ways to prevent the triggering of the central nervous system  Guide to an early recognition of neuropathic pain  Strategies to treat children's neuropathic pain What the family/patient needs in addition to the treatment options. Links Alyssa Lebel MD FREE Clinicians'Pain Evaluation Toolkit Proactive Pain Solutions   About the Guest Speaker Alyssa Lebel MD Dr. Alyssa Lebel is the Co-Director of Headache Program, and a Senior Associate in Pain Medicine in the Department of Anesthesiology, Critical Care and Pain Medicine at Boston Children's Hospital. She's an Associate Professor of Anesthesia at the Harvard Medical School.   Dr. Lebel is fellowship trained in pediatric neurology and pain medicine. After her training Dr. Lebel chose to devote her clinical practice primarily to the treatment of patients with significant pain, initially in both adults and children with cancer, and then in patients of all ages with intractable neuropathic pain. Early in her career, she sought additional training in regional anesthesia and rehabilitative medicine to provide a comprehensive service for challenging referrals. Concurrently, she maintained a general pediatric neurology outpatient clinic and served as a teaching attending for the Department of Neurology. In Philadelphia, she continued to work for the Departments of Anesthesiology, Pain Division, and Neurology, on the inpatient and outpatient services as well as within a partial hospital program for pain rehabilitation, ultimately focusing on pediatric care while at Children's Hospital of Philadelphia. Currently, at Boston Children's Hospital, she has increasingly focused on patients with chronic headache. She has written extensively and lectured nationally and internationally on both the mechanisms and treatment of pediatric headache. She established and directs a multidisciplinary pain-management program for patients with chronic head pain. She is recognized by her colleagues as an expert in the comprehensive assessment and management of pediatric and young adult patients with headache and cranial neuralgia.    

COVID-19 led to closure of nearly all schools in the United States, affecting more than 55 million students. Efforts to continue children's education have been highly variable, ranging from remote learning, hybrid and modified in-person instructions. Return to school safely for children and staff is being implemented, again variably. Along with the safety concerns, there are significant concerns about the disruption to the learning process, mental health, nutrition and even safety. I'm in conversation with Dr Anita Gupta, DO, PharmD examining the challenges, risks and considerations in ensuring safe return to school of children nationwide.   Takeaways in This Episode Why it is important to weigh the risks, benefits and challenges to safe return to school.  Factors integral to ensuring safety of children, school staff and the community Who needs to be involved in the planning to ensure a safe and expeditious The CDC's policy to guide opening schools safely. What mitigation measures should be required What parents can do to support their children's physical and mental health. How parents can ensure a good learning experience for their children. Collective responsibilities to educate and ensure safety Who are the children at even higher risk even beyond the learning challenges.   Links Dr. Anita Gupta DO, PharmD JAMA article on Data & Policy to Guide Safe Opening of Schools FREE Clinicians' Pain Evaluation Toolkit   About the Guest Speaker Dr. Anita Gupta DO, PharmD Dr. Anita Gupta is a globally recognized leader, Hopkins anesthesiologist, pharmacist & policy expert. She's the first appointed woman physician anesthesiologist to pioneer the expansion of the only opioid overdose antidote, naloxone, at the U.S. FDA. Also, the first woman physician anesthesiologist to Co-Chair the American Society of Anesthesiologist Committee on Prescription Opioid Abuse. First woman anesthesiologist-pharmacist alumnae of both Princeton University School of Public and International Affairs and Harvard University School of Business. She is committed to addressing global public health, drug safety and policy.  She's been appointed as an advisor to the U.S Food and Drug Administration and the U.S. Department of Defense. Dr. Gupta has been featured on the cover of Philly Biz magazine as Top in Healthcare, international editor of three books by Oxford University Press. Featured as a recognized healthcare thought leader for the Washington Post, Forbes, CNN, on emerging threats including the Coronavirus crisis, the Opioid crisis, Zika crisis, catastrophic train crashes, and high profile expert medical cases involving: Tiger Woods, Bill Cosby, Jolie, Prince, Lady Gaga, Beyonce and others. She completed her pain fellowship from Johns Hopkins University, medical residency in anesthesiology at Georgetown University School of Medicine, and clinical physician scientist training during her medical residency at National Institutes of Health, NHLBI, doctorate in pharmacy at Rutgers University, medical school from Rowan University (formerly University of Medicine and Dentistry of New Jersey) and professional education from MIT in drug technology, masters in public policy and certificate in health policy from Princeton University and general management from Harvard Business School.

Dr. Neil Schechter, MD, shares what the patients and families report as the most important and helpful elements during their pain care visit and what they desire from clinicians. Additionally, he shares the practical tips to engage patients and families and how to effectively provide feedback during a pain evaluation even for the most complex patients. Takeaways in This Episode Dr. Neil Schechter's journey from developmental pediatrics to pediatric pain management. What parents of children with chronic pain report as the most important  and helpful elements in their pain care visits Why these elements are felt to be equally if not more important than any medications, procedure or treatments modalities Providing context of pain and its nuances for parents and healthcare professionals. The impact of what healthcare professionals say to patients and families. Importance of feedback during a pediatric pain care visits 3 Key components of feedback for patients and families during a pediatric pain care evaluation Ways to create a lasting impact from your feedback Keys to professional longevity with particular tips for pediatric pain professionals. Dr Schechter's advice for healthcare professionals caring for children's pain Links Neil Schechter, MD Pedia Pain Focus Episode #8. What Patients Want More Than Any Scripts or Tests The Golden Half Hour in Chronic Pediatric Pain-Feedback as the First Intervention ChildKind International Chronic Pain & Illness Workbook for Teens When Your Child Hurts Clinicians' Pain Evaluation Toolkit Proactive Pain Solutions   About the Guest Speaker Neil Schechter, MD Neil Schechter, MD is the Director of Chronic Pain Clinic; Senior Associate in Pain Medicine, in the Department of Anesthesiology, Critical Care and Pain Medicine at Boston Children's Hospital. He's an Associate Professor of Anesthesia at Harvard Medical School. Dr. Schechter received his medical degree from the University of Connecticut. He completed pediatric training at the University of Connecticut and fellowships in psychosomatic pediatrics and developmental pediatrics at Children’s Hospital and Harvard University in Boston. He has authored over 120 articles and is the senior editor of Pain in Infants, Children, and Adolescents, the major multi-disciplinary textbook in the area of pediatric pain. He has served on a number of editorial boards and expert committees in the area of pediatric pain including the World Health Organization Expert Committee on Pediatric Pain and Palliative Care, the Task Force on Chronic Pain in Children of the American Pain Society, and the Rome IV Committee on Pediatric Functional Gastrointestinal Disorders. He has given numerous named lectureships and received the Jeffrey Lawson Award for Advocacy in Children’s Pain Relief from the American Pain Society. Dr. Schechter’s initial research focus was on documenting the under-treatment of pain in children and attempting to understand its origin. He then became involved in issues of pain associated with chronic disease where his research focused on sickle cell disease and on painful procedures in children with chronic disease. Most recently, he has become interested in the more common pains associated with pediatric practice such as injection pain and functional pain syndromes as well as developing strategies to alter pain-related practice patterns in health care providers and institutions. He is the President & CEO of ChildKind, a global initiative to reduce pain in children’s healthcare institutions.

Rare diseases are...well rare, but pain and suffering associated with them is not!  It requires early recognition or even preempting the pain inoder to prevent development of chronic an drefractory pain. In commemoration of the International Rare Diseases Day, I bring you an episode focused on promptly identifying and managing the pain associated with pediatric rare diseases and the challenges associated with that.   Takeaways in This Episode Why we should talk about rare diseases. What makes a disease rare and what is an orphan disease Which rare diseases are commonly encountered amongst children  How big an issue is pain management for these children Common causes leading to pain experiences in a rare disease Common challenges to managing pain in a rare disease What should a healthcare professional know and do about managing pain for these children Links Pedia Pain Focus #51. Digital Interventions for Self Management of Pediatric Pain National Organization for Rare Disorders American Syringomyelia and Chiari Alliance Project The Ehlers-Danlos Society Society for Pediatric Pain Medicine IASP - Pain in Childhood Pediatric Pain Listserve Proactive Pain Solutions  

Since the COVID-19 pandemic, use of digital technology in healthcare has become commonplace, but Dr. Tonya Palermo, PhD has spent more than 2 decades researching and developing digital interventions for management of children's pain. In this episode she discusses the origin and development of her free app for self management of pediatric pain, WebMAP, its components, who its applicable for and how healthcare professionals can use it in their clinical practice to empower and equip their patients and families with self management strategies.      Takeaways in This Episode How serendipity got Dr. Palermo on the path to becoming the most prolific researcher in pediatric pain Dr. Palermo's first foray into digital interventions for accurate measurement of pediatric pain using a palm pilot, for patterns of pain and patterns of activity limitation. Use of website to collect data and offer simple interventions for kids and families living in remote areas. Surprising finding she saw in relation to acceptance and outcomes from these interventions The platform to deliver interventions designed to improve pain care and lifestyle interventions that promote wellness and change in behaviors (Hint: Psychology based interventions). Precursor to the WebMAP program and its progression What WebMAP is, who it is for, and how HCPs can integrate it in clinical care. (Tips Sheet included in the links link) What they did to ensure and drive patient/parent engagement Uniques feature and opportunities for improvement of WebMAP Challenges  associated with use of m-health and digital interventions in healthcare Whats working and what she’s focused on now and in future How she manages to do it all and what advice she has for the aspiring professionals Links Tonya Palermo, PhD Contact Dr. Tonya Palermo Pediatric Pain and Sleep Innovations Lab WebMAP Mobile App Tip Sheet for Healthcare Professionals Solutions for Kids in Pain (SKIP) Proactive Pain Solutions Physicians Academy Cognitive Behavioral Therapy for Chronic Pain In Children and Adolescents Managing your Child's Chronic Pain About the Speaker Tonya Palermo, PhD Dr. Tonya Palermo is a professor of anesthesiology, pediatrics and psychiatry at the University of Washington School of Medicine. She serves as associate director for the Center for Child Health, Behavior and Development. Palermo’s longstanding NIH-funded research program has focused on assessment and treatment of chronic pain in children and adolescents. She is specifically interested in cognitive-behavioral interventions; delivery of psychological treatment via eHealth and mHealth interventions; sleep disturbances; and parent/family factors as they relate to pain treatment. Through her work as program director for the University of Washington Anesthesiology T32 program and for the Psychology Postdoctoral Fellowship Program in Pain Research, Palermo is active in training clinician–scientists at the postdoctoral and junior faculty level. Palermo serves on the executive boards of the Society of Pediatric Psychology and the American Pain Society, serves as editor of the Journal of Pediatric Psychology and has been elected a fellow of the American Psychological Association. She also serves as a member of the advisory council for the Center for Scientific Review at NIH.

Up to 50 percent of medical professionals, like the lay people, believe there are biological differences between the Caucasian and African-American patients' bodies when it comes to pain perception. How much of that is truth and how much is myths and misconceptions is debunked in this episode. I also explore the factors contributing to the well documented disparities in assessment and management of pain amongst the African-American and black populations. More importantly, I recommend solutions at the individual and broader systems level to improve the pain care for these patients. Takeaways in This Episode Factors that may determine the quality and quantity of care a black patient may receive. Racial disparities in pain care and how they show up Historic perspective on pain perception, threshold and tolerance of pain among African American and black population  Factors contributing to pain care disparities for African American and black patients In-group bias and how it impacts pain care Why everyone in healthcare should take the Implicit Association Test and what that means Ways to address pain care disparities at individual and systems level   Links Pedia Pain Focus Episode # 47. Reliving or Relieving Children's Pain Pedia Pain Focus Episode # 48. Making Best Pain Care Everywhere Achievable Enroll in Proactive Pain Solutions Physicians Academy CDC Guidelines for Prescribing Opioids Implicit Association Test IASP Proactive Pain Solutions    

Treatment interventions based in psychology form the mainstay of pain management, particularly for children's pain. Yet, these may not receive the due priority and/or many not be easily accessible for patients and families. Use of psychological based treatments for pain may inadvertently create stigma around the nature of the child's pain diagnosis, for patients, families and even the healthcare professionals who may not be familiar with pain management.  The end result being, inadequate pain care, mistrust, and frustration for all involved. Dr. Rachael Coakley, PhD. of the Boston Children's Hospital shares the role of, challenges to and her innovative solution, the Comfort Ability Program, to address this gap.  Takeaways in This Episode The reasons for a gap in access to psychological based pain care interventions Stigma around psychological treatments and what might propagate it. Things healthcare professionals do and implement to change the perception around role of psychological treatments Use of metaphors for explanation of the pain conditions, and role of various treatments. The real hurdle in healthcare right now The message that healthcare professionals  can and should be giving the pain patients and their families Why Dr. Coakley chose to pursue pediatric pain management and the formative experience that lead her career path.  The tight rope that parents walk with their children's pain The driving force behind creation of the Comfort Ability program Elements of the Comfort Ability program, who it's for and how healthcare professionals can access and utilize it for their patients and families The mission and goal of the Comfort Ability program Dr Coakley's message for healthcare professionals Links  Rachael Coakley, PhD. Connect with Dr. Rachael Coakley on twitter The Comfort Ability Program Contact the Comfortability Program When Your Child Hurts Pedia Pain Focus Episode # 27 Join the Proactive Pain Solutions Academy Proactive Pain Solutions About the Guest Speaker Rachael Coakley, PhD. Dr. Rachael Coakley is pediatric pain psychologist in the Department of Anesthesia, Critical Care and Pain Medicine at Boston Children’s Hospital, where she serves as the Director of Clinical Innovation and Outreach in Pain Medicine and the Associate Director of Psychological Services.  Additionally, she is Founder and Director of The Comfort Ability Program, an internationally disseminated program that teaches evidence-based pain management skills to adolescents with chronic pain and their parents.  Dr. Coakley is an Assistant Professor of Psychology, Harvard Medical School and holds national and international leadership positions.   Dr. Coakley completed her undergraduate work at The University of Pennsylvania and her doctoral studies at Loyola University in Chicago.  She completed fellowship at Boston Children’s Hospital and joined the Pain Treatment Service in 2006.     Dr. Coakley’s career focuses on translational research of evidence-based psychological intervention for pediatric pain management. For her work in program development and for enhancing access to clinical care for patients with chronic pain, she was honored with the 2016 David Weiner Award for Leadership and Innovation in Child Health and with the American Psychological Association’s 2020 Carolyn Schroeder Award for outstanding clinical practice.     Outside her work in program development, Dr. Coakley enjoys writing and lecturing to help educate parents and providers about chronic pain.  Her 2016 book, "When Your Child Hurts: Effective Strategies to Increase Comfort, Reduce Stress and Break the Cycle of Chronic Pain"(Yale University Press), won a national book award for best parenting book (NAPPA).  Her writing is also featured in her ongoing Psychology Today column, the Washington Post, and numerous other publications.   

Appropriate and timely pain care, especially for children, is a necessity and every clinician's responsibility. Yet our training system fails to provide the clinicians with those necessary skills and tools. In this episode, Dr Tracy Harrison, MD from the Mayo Clinic, discusses the importance, knowhow of necessary skills and leaves you with practical skills you can put into practice right away! Takeaways in This Episode Dr. Harrison's interest and work in pediatric pain medicine Reasons for the discrepancy in pediatric pain care across institutions and geographical locations Implications and impact for pain care discrepancy in pediatric pain Whose responsibility is it to ensure "best pain care everywhere" Barriers to best pain care everywhere What can you as a clinician do to contribute to best pain care for children under your care Dr. Harrison's advice to all clinicians caring for children's health. Dr. Harrison's advice for pediatric pain specialist and what our responsibility is in achieving this goal.   Links Tracy Harrison, MD Connect with Dr. Harrison on Twitter Pedia Pain Focus Episode # 38. Why Pediatric Pain Education is Failing and How to Fix It  Pedia Pain Focus Episode # 26. Manage Memory Manage Pain! Join the Proactive Pain Solutions Physicians Academy Proactive Pain Solutions   About the Speaker Tracy Harrison, MD Tracy Harrison, MD is a board certified pediatric anesthesiologist, pain medicine, palliative care and hospice care physician. She’s an Assistant Professor, Dept of Anesthesiology and Perioperative Medicine at the Mayo Clinic in Rochester, MN. She is the co-director of the Pediatric Pain Rehabilitation Center that treats some of the most complex chronic patients who are significantly disabled by their pain, from all over the globe. She has many publications to her credit and is an invited speaker at national and international pediatric pain meetings. She chairs the Patient and Family Advocacy Council at the Mayo Clinic’s Children’s Center.  

For most clinicians thinking about policy conjures up images of legislative or regulatory work that goes on "over there", but the truth is that our daily work is the very foundation of the policies. How we conduct the business of our daily work drives the quality, safety, evidence and ultimately the policy and guidelines for appropriate pediatric pain care. Dr. Fiona Campbell, MD, FRCA, the co-chair of the Canadian Pain Task Force, shared her experience and advice around policy work to improve pediatric pain care.   Takeaways in This Episode How Dr Fiona Campbell, MD, FRCA got engaged in pediatric pain management and then on to chairing the Canadian Pain Task Force. What Policy work entails and how you may already be doing it. How you can get started and influence the quality of pediatric pain care How to drive engagement  from decision makers Determining what is the purpose of your work The 5 pillars of the Canadian Pain Task Force and its implications globally Dr. Campbell's advice to pediatric pain care professionals How Dr. Campbell is a complete rockstar both in her personal and professional lives (ok, that's my assessment of the situation, but I'm sure you'll agree with me too!)   Links Fiona Campbell, MD, FRCA Connect with Dr Campbell on Twitter Canadian Pain Society Canadian Pain Task Force Solutions for Kids in Pain (SKIP) Childkind International Working together to better understand, prevent and, manage chronic pain: What We Heard Chronic pain in Canada, laying a foundation for action. Proactive Pain Solutions Physicians Academy Proactive Pain Solutions   About the Author Fiona Campbell, MD FRCA Dr. Fiona Campbell is a Professor at the University of Toronto, and Medical Director of the Chronic Pain Program in the Department of Anesthesia & Pain Medicine at the Hospital for Sick Children. She is the Co-Director of the SickKids Pain Centre, co-chair of the Ontario Chronic Pain Network in partnership with the Ministry of Health and Long-term Care.  Dr. Campbell served as the President of the Canadian Pain Society and has been appointed by Health Canada as Co-chair of the Canadian Pain Task Force - a national strategy for pain for all Canadians of all ages.  Dr. Campbell’s research contributions involve utilizing quality improvement methodology to improve pain outcomes for hospitalized children, and identifying risk factors involved in the transition from acute to chronic pain. Dr. Campbell has also won a SickKids Centre for Innovation competition, and developing an app for tracking chronic pain in kids. She is involved in pain education initiatives for both Health Professionals, and children and families. Fiona is Senior Editor on the Pain Editorial Board of www.Aboutkidshealth.ca/pain a SickKIds website for children and families that contains a wealth of information about pain. She is also the medical lead on the development of an online pediatric pain curriculum for prelicensure students and entry level health professionals, based on the International Association for the Study of Pain (IASP) Curriculum.

Appropriate pain management is a key driver for both the patient's and healthcare professional's satisfaction. With the recent healthcare crisis and changes to how outcomes and patient satisfaction is evaluated, pain care skills have become paramount. Pediatric pain management impacts every healthcare professional's practice and IS everyone's responsibility. Yet pain care skills and pain education is sparse and inconsistent.    In this episode we discuss the scope of pediatric pain issues, why it is important to address them and why and how each healthcare professional plays a key role in children's pain management and therefore must  consider honing, at a bare minimum, their basic pain management skills.   Takeaways in This Episode Changes in in the healthcare practice and role pain management plays Scope of pediatric pain Impact of children's pain How pediatric pain care affects delivery of healthcare How healthcare costs, reimbursement and productivity are related to pain management What does healthcare professionals' satisfaction have to do with appropriate pain management or honing pain care skills? Drivers of healthcare professionals' satisfaction Drivers of patient satisfaction How pediatric pain management skills will ensure job satisfaction, and job security? Links Proactive Pain Solutions Physicians Academy Proactive Pain Solutions HCAHPS Press Ganey Scores  

Undertreatment of children's pain is pervasive despite scientific advances, and national guidelines. Some of that is a result of common mistakes healthcare professional are making, often unknowingly. This episode explores the 5 of the most common and what I call the most nefarious but easy to address mistakes when dealing with pediatric pain management. Takeaways in This Episode A common challenge faced by most healthcare professionals A conceptual fallacy around pain How even acute presentation of pain may not simply be a symptom of another disease or cause and how that impacts its management Multiple benefits of prioritizing pediatric pain management (Hint: Benefits for the HCPs) Role played by regulatory bodies like JCAHO, CMS in negatively impacting pediatric pain management Role of diagnostic tests, and parents involvement  The widespread impact of pediatric pain   Links IASP Wait Times Guidelines Pedia Pain Focus Episode #41  Pedia Pain Focus Episode #42. There are No "Difficult" Patients Pedia Pain Focus Episode #38. Why Pediatric Pain Education is Failing and How to Fix It. Proactive Pain Solutions Physicians Academy FREE Pediatric Pain Management Masterclass Proactive Pain Solutions    

Most people start the new year with new resolutions, but 80% of them fail by February. That's not to say that one shouldn't cross the threshold into the next year with some goals and intentions. On the contrary, that is exactly what one must do. However, like intenstions, goals too fail if not considered carefully.   In this episode, we provide a sound framework to help you not just set meaningful and effective goals, but also  strategies to ensur ethat you knock them out of the park  over the next 12 months.   Takeaways in This Episode Why it is important to create goals Benefits of goal setting What should you include and consider when you set goals What makes your goals effective and appropriate The "Purge" and "Prune" strategy for goal setting How to refine your goals How to ensure you stay on track and turn your year into a resounding success Links Pedia Pain Focus Episode 40. Owning Your Role as a Physician Leader in Today's Healthcare. Proactive Pain Solutions Physicians Academy Proactive Pain Solutions Goal Setting with Confidence   

What an incredible year 2020 has been. We've seen the lowest of lows, "once in a life time" experiences and hardships. Yet there have been glimmers of positivity and progress all along and it seems to be concluding with the triumph of science and hope over a pandemic that had brought the world to its knees.  Despite the challenges of this year, we have had amazing pediatric pain experts sharing their expertise here and it's been an incredible pleasure to compile some of the highlights from some of our most popular and episodes! Takeaways in This Episode The reason behind the creation of this "Best of" episode. What is a "opposite pain scale" and why that is a better way to assess your patients pain issues and treatment outcomes? How shifting your mindset can completely alter the treatment outcomes for your patients? Addressing the opioids and substance abuse/addiction issues amongst children and youth. Elements of opioid stewardship and responsible pain management How spinal analgesia helps health outcomes for children and elements for developing a spinal analgesia program. Impact of memory, language and reframing in the pain experience of children, persistence of pain and how to reframe it for optimal outcomes. Metaphors for explanation of pain to children and families and a highly effective framework you can use in your practice today. Creating engagement and empowerment of patients and families in multidisciplinary treatment of their pain. Links Pedia Pain focus Episode #20. You may be Perpetuating your patients' pain instead of treating it Pedia Pain focus Episode #35. Managing Pain in Children and Youth with Addiction and Substance Use Disorder Pedia Pain focus Episode #29. Opioid Stewardship: Responsible Pediatric Pain Care! Pedia Pain focus Episode #31. Spinal Analgesia for Babies: What's All That Fuss About? Pedia Pain focus Episode #26. Manage Memory, Manage Pain! Pedia Pain focus Episode #27. Interdisciplinary Pain Education is Necessary to Change the Face of Pediatric Pain Management Proactive Pain Solutions Physicians Academy Proactive Pain Solutions      

With 15% of all healthcare encounters classified as "challenging", it is likely that you will or have already  experienced one. It's easy to pin that on a "difficult" patient or family. Listen to find out why there's no  such thing as "difficult" patients or families.   Takeaways in This Episode Dr. Groves' classification for"Hateful" patients Why there are no difficult patients Contributing factors to challenging or difficult patient-clinician encounters Why root cause analysis is necessary to have a smooth patient care visit and positive outcomes Clinicians role in the challenging patient encounters How to effectively manage these difficult clinician-patient encounters   Links Managing Disagreements and Misalignment  of Opinions in Pediatric Pain Care Taking Care of the Hateful Patient You Might be Perpetuating Your Patients Pain instead of Treating it Owning your role as a Physician leader in Today's Healthcare Storytelling in Pediatric Pain Medicine (Part 1 and Part 2) Proactive Pain Solutions Physicians Academy Proactive Pain Solutions  Therapeutic Triangle