Is anyone here peds pain?

[PainApp2021]

So this is actually a question I didn't expect to be asking. I'm on my peds pm&r rotation right now as a pgy3 and I'm actually loving it. Not enough to switch to peds pmr fellowships, but enough to consider peds pain programs. I also loved my peds rotation during ms3.

Is there anyone here who can comment on why they went into peds pain (or didn't go into it but considered it)? I can't tell if I'm being impulsive in my decision making. I received an email yesterday from WUSTL asking if any applicants were interested in their peds pain/adult pain track and it just seems serendipitous.

Thank you

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[BobBarker]

I liked peds anesthesia quite a bit and had plenty of thoughts about doing peds anesthesia and peds pain.

You aren’t going to have any lumbar RFA’a or ESI’s in peds pain. You will have post op, post trauma, end of life, and psychosomatic care. So in summary don’t do it.

 

[lobelsteve]

Children suffering and dying. And then munchausen. I would quit medicine before doing this.

 

[NJPAIN]

Really only viable to practice in academic setting. I did some Peds pain as early in my academic career before a Peds pain service developed. As stated it was mostly inpatient end of life and mostly medication management. No one in their right mind wants to do procedures on kids without significant experience with kids.
At the time the only place doing any significant Peds procedures was Boston Childrens where Chuck Berde was Director. I believe Chuck is still there. He is a wonderful guy. You can look his email up online. If I were you I would send him an email, explain your thoughts/situation and ask if you can call him. I have no doubt he will reply and be helpful. PM me if you can’t contact him and I will put you in touch with a buddy of mine who is Peds pain director in NY.

Remember, pain medicine can be rewarding in the right population even without procedures, implants and all of the “sexy” stuff

 

[adiradirim]

I'm currently a child psychiatry fellow at a children's hospital and I work with our pediatric pain department about 5-6 days a month and I will be doing a peds/adult combined pain fellowship next year. I applied knowing I wanted to do pediatric pain.

In my experience, most of the end of life care at my hospital is done by palliative care and there is a separate department for that. There are some inpatient consults for post-trauma/post-op but that is common for any acute pain service.

For chronic pain, the patient population is usually considered age 30 and below, but is 90% age 13-18. Our referral source is about 75% from ortho and neurosurgery and about 50% of the kids are athletes. We see mostly radiculopathy, CRPS, neuropathy, and myofascial pain. Headaches, fibromyalgia and abdominal pain come through once in a while but are often seen in Neuro, Rheum, and GI respectively. We do about 1-2 ESIs per clinic day as well as a few peripheral nerve blocks, lumbar sympathetic blocks, and celiac plexus blocks. There are some people who do implant stimulators for kids but that is not a common practice at all.

I have seen suspicious Munchausen maybe 2-3 times in the past 2 years. I see it way more in psychiatry.

Most people will do pediatric pain part time.

This is my experience, I think it is greatly hospital/location based. YMMV

Feel free to PM me if you want more specifics!

 

[cowboydoc]

Children suffering and dying. And then munchausen. I would quit medicine before doing this.

To be fair, you could mix in a few therapy referrals for pars defects.

Then there’s the conversion disorder crowd.

Don’t do it!

 

[PainApp2021]

Thanks everyone for your input, I really appreciate it. I have a lot to think about! Hope everyone has a great weekend.

 

[RooAgg14]

Thanks everyone for your input, I really appreciate it. I have a lot to think about! Hope everyone has a great weekend.

Check out the video on The Virtual Physiatry Mentors YouTube page. We hosted a couple of Peds PM&R pain physicians and discussed why they chose this subspecialty and more. They mentioned their contact info towards the end.

 

[SommeRiver]

Peds Pain during my fellowship was 100% small group discussion with 14 year olds and their parents.

Those were super long visits where we talked about PT and seeing a counselor and how the other kids at school can't see your pain and don't understand what you're going through...

At least we didn't have to talk about vaccines though.

 

[Ferrismonk]

Peds pain = 99% med management in my experience. If you're okay with that, it can be very rewarding.

 

[IlDestriero]

I liked peds anesthesia quite a bit and had plenty of thoughts about doing peds anesthesia and peds pain.

You aren’t going to have any lumbar RFA’a or ESI’s in peds pain. You will have post op, post trauma, end of life, and psychosomatic care. So in summary don’t do it.

This sums it up. I loved pain and loved peds anesthesia. I considered doing peds pain during my pediatric anesthesia fellowship, but the procedures, etc. that I enjoyed in adult pain rotations are almost completely absent in peds pain practice. Chronic peds pain is mostly med management, coordinating PT, psych, alternate medicine, etc. and the remainder is acute pain/post op pain management that’s largely run by NPs. And then there’s the dark abyss of peds end of life care. I could not do that. I’ve been doing anesthesia ~20 years and it is still painful.

 

[Laryngospasm]

I considered peds anesthesia until I did it. Seeing little helpless kids die of things like cancer and fungal infections of the sinus that invaded their brain due to immunodeficiency made me change my mind quickly. Anesthesia is a significant source of secondary trauma.. I can’t imaging peds pain being different.
You haven’t experienced sadness until you have spent a major holiday watching a family grieve over a small child dying while everyone else is out partying.

 

[geauxg8rs]

I considered peds anesthesia until I did it. Seeing little helpless kids die of things like cancer and fungal infections of the sinus that invaded their brain due to immunodeficiency made me change my mind quickly. Anesthesia is a significant source of secondary trauma.. I can’t imaging peds pain being different.
You haven’t experienced sadness until you have spent a major holiday watching a family grieve over a small child dying while everyone else is out partying.

One of my saddest and most heart ripping days was treating a kid who had been accidentally backed over by his parent.

i would rather spend a lifetime hearing fibro patients tell me about their need for oxycodone

 

[Laryngospasm]

I took care of a teenager whose parent had run over her with an outboard motor.. you don’t forget those things.. and taking care of sick kids as a father is just not something I want to do. It sounds noble and is, but until you do it and see how it affects you you just don’t know.

 

[BobBarker]

I also am permanently troubled by some of my peds anesthesia experiences. Organ harvest on what looked like a perfect 10 year old girl. She had a bow in her hair and all of her family kissed her good bye as I pushed her to the OR. Mother driving, single vehicle accident, I assume the head injury was to the back of her head. But she wasn’t puffy faced like most brain dead patients are. Looked like we intubated her for a tendon release.

 

[PainApp2021]

Thank you everyone for your input. I did reach out to some peds pain attendings and ultimately, in concert with some posts here, decided to continue with normal adult pain medicine (if I match, at least). I'm happy that this has at least maybe served as therapy for some people here. I hope you all had a nice weekend.