• Article
  • April 11, 2018

A Multidisciplinary Approach to Treating Chronic Pain in Pediatric Patients

Pediatric Rehabilitation Unit at Kennedy Krieger Institute takes pain management beyond the scale.

For most hospital patients, a pain assessment scale is an effective way to communicate their pain's intensity to the health care team. But the Pain Rehabilitation Program at Kennedy Krieger Institute in Baltimore, Maryland, takes a different approach—shifting focus away from the 1-10 scale.

"Most kids, when I tell them we're not going to ask for that number, are very happy," says Suzanne Rybczynski, M.D., medical director of the Pediatric Rehabilitation Unit at Kennedy Krieger Institute. "They don't want to focus on it anymore—they just want to get better."

Multidisciplinary approach

Patients referred to the Pain Rehabilitation Program suffer from chronic pain across a variety of medical diagnoses, pain locations and symptoms. Using a team approach, the program manages and reduces patients' pain while promoting healthy daily functioning.

First, a multidisciplinary team—made up of a pain medicine specialist, a physical therapist, a cognitive-behavioral therapist, a pain clinic nurse and a clinic coordinator—conducts the initial patient evaluation. The team then develops a treatment plan that targets the patient's individual needs and specifies the most appropriate care setting, which could include outpatient, day hospital or inpatient care.

"We like to see the whole child; it's a holistic approach to caring for the children," Rybczynski says. "That's why we have a large interdisciplinary team to get the patient back on track to being a kid."

Alternatives to opiates

The Pain Rehabilitation Program stresses an avoidance of opiate usage. It's a philosophical approach to pediatric pain management, but Rybczynski says it goes beyond that. First, dealing with the underlying issues, which in many cases include psychological concerns, can more effectively treat pain than prescribing opiates, according to Rybczynski. Additionally, Kennedy Krieger sees a number of patients who are already on opiates but want to wean off the drugs to cope with their pain.

As an alternative, the Pain Rehabilitation Program team arms its patients with several coping techniques to deal with pain:

  • Distraction. The program is heavy on activities, and patients are taught to get active when they feel pain coming on. "Keeping busy and not having the opportunity to focus on their pain is probably the number one thing we teach kids," says Rybczynski.
  • Guided imagery. Guided imagery is a meditative relaxation technique where a patient uses his or her imagination to picture a person, time or place that helps them feel relaxed.
  • Deep breathing. The program team teaches techniques to help patients breathe through the pain when it comes and work past it.
  • Biofeedback. Kennedy Krieger's behavioral psychologists use sensors to give patients immediate information about their own biological conditions. The feedback enables the patient to self-regulate their pain.

Back to their lives

In most cases, patients discharged from the program are more able to cope with pain and, most importantly, return to their lives. "These kids have a real opportunity to get back to normal, and it's very gratifying to take care of them because I know they can do it," Rybczynski says. "Self-motivation is a huge determinant for success. The kids who are super-motivated to get better—and most of them are—do great."

Send questions or comments to magazine@childrenshospitals.org.