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Analysis

Adopt This Program to Treat Pediatric Chronic Pain Without Opioids

By Christopher Cheney  
   May 02, 2019

In this inpatient program, patients are weaned off opioid medications while participating in a wide range of therapy and coping skills training.

An inpatient chronic pain program for children and adolescents in New Jersey has been adopted by Rady Children's Hospital-San Diego.

More than 10% of hospitalized children show signs of chronic pain, and approximately 3% of pediatric chronic pain patients need intensive rehabilitation. The annual total costs to society to care for children and adolescents with moderate to severe chronic pain has been estimated at $19.5 billion.

In April, the Rady Children's inpatient program was launched in partnership with New Brunswick, New Jersey-based Children's Specialized Hospital. The RWJBarnabas Health children's hospital has had an inpatient program for children and adolescents with chronic pain for six years.

"The goal of our program is to increase function, decrease pain, and promote the use of adaptive coping skills so our patients can return to functioning lives. We work on reducing the use of pain medications—any pain medications but specifically opiates," says Katherine Bentley, MD, director of the pain program at Children's Specialized Hospital.

The chronic pain program, which is targeted at patients age 11 to 22, has generated positive results at Children's Specialized Hospital:

  • In a 2016-2017 patient survey, participants reported knowledge of their condition improved 81%, quality of life improved 41%, compliance with care improved 89%, and depression improved 57%.
     
  • A Children's Specialized Hospital outcomes report found that from admission to discharge patients' average pain level dropped from 6.6 to 3.9 on a 10-point scale.

"We evaluate the patient before they enter the program. We have an open and honest discussion—our program is a functional program where we use the body to get better as opposed to outside factors," Bentley says.

Treating chronic pain in children and adolescents
 

Broad scope has been the key to success of Children's Specialized Hospital's chronic pain program, Bentley says. "It's interdisciplinary and comprehensive."

The inpatient program offers a wide range of therapy and training in coping skills:

  • Physical therapy
     
  • Occupational therapy
     
  • Child, life, and recreational therapy
     
  • Meditation
     
  • Yoga
     
  • Aqua therapy, with pool activities and games offered five days a week

"We work on diaphragmatic breathing. We have biofeedback in our program, so patients can see the mind-body connection. We work on coping strategies. We work a lot on home exercise programs—for many people with amplified pain or who have a bad pain day, exercising is the best thing for them," Bentley says.

The inpatient program takes a sophisticated approach to weaning patients off pain medications, she says.

"What we do is develop a safe weaning schedule, but the great part of the program is weaning is not done in a vacuum. Patients get physical therapy, occupational therapy, coping strategies, and meditation. So, weaning is done in a safe way that is both physiologically safe and psychologically safe."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

For children and adolescents, the estimated annual cost to society for chronic pain care is $19.5 billion.

Children's Specialized Hospital in New Jersey has developed an effective interdisciplinary inpatient program for children and adolescents with chronic pain.

The inpatient program includes physical therapy, occupational therapy, meditation, and coping skills training.


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