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.

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

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.

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.

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.

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.

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

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.

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

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.

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

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.

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