Pain fellowships strong in pediatric pain?

[PEDIPAIN]

Last month I rotated at an inpatient pediatric rehab facility that used a multidisciplinary model for intensive inpatient pediatric pain therapy derived from the Boston (BID?), Penn (CHOP), and UCLA? models...

This really caught my attention, since it seems to be having pretty impressive success at treating pediatric CRPS, fibromyalgia, etc...

How does one go about getting further into the field of Pediatric Pain (especially if one is not a pediatrician)? Are any pain fellowships strong on Pediatric pain training? I've heard UCLA, and maybe BID... any others?

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[Tenesma]

best pain fellowship is w/ Chuck Berde at Boston Children's - nothing beats it - of course, you should realize that it may not be what you expect...

 

[mid|ine]

Combined Longwood Medical Area Pain Fellowship
http://www.childrenshospital.org/clinicalservices/Site1918/mainpageS1918P6sublevel11.html

 

[Tenesma]

the longwood fellowship isn't 100% pedi pain - it is really 33% pedi pain
but pretty well balanced...

 

[PEDIPAIN]

best pain fellowship is w/ Chuck Berde at Boston Children's - nothing beats it - of course, you should realize that it may not be what you expect...

Thanks. Not what I would expect HOW? (I suppose this is a "read my mind" question)...

 

[Tenesma]

pedi pain:

1) acute pain: post-operatively - revolves around writing PCA orders...

2) chronic pain: >95% of chronic pedi pain is due to dysfunctional family issues... 12 yo w/ chronic migraines but it really is because her parents are going through a divorece... 9 yo w/ chronic abdominal pain but it is really because she was sexually abused by a family member....

it is great to get the exposure, but in my iopinion it is really all about psych management...

 

[Rhizo]

Yeah - as a fellow I had to do a month with Berde, Sethna et. al...it was educational, but definitely not what I would want to be involved in in a daily basis. We got to take call from home, but since you basically had to come in every time an admission needed a PCA, it was often easier to stay in house. What great patient care for chronic pain though - a full day in clinic was 6 patients - 3 in the morning and 3 in the afternoon. The child and family would meet with psych, PT/OT, physician and then we'd all sit down and come up with a care plan...not exactly viable for private practice, but good care.

 

[Tenesma]

seeing 3 patients in one day was mind-numbingly boring - especially when you realize that most of the work is being done because of abnormal psychosocial issues ....

and when i was the pedi pain fellow we had to take call from in-house which was painful especially because the RNs would double check all of your calculations and then page you at 2am to tell you that they won't accept your order for Tylenol 125mg for a 4 month old, because based on weight calculations it should be 120mg....

the only reason to do the fellowship or a pedi pain rotation is to spend time with Chuck Berde - he is an absolute encyclopedia of pain knowledge and you will learn more in 5 minutes of cafeteria conversation with him then you will by reading 10 textbooks - that guy is a real genius

 

[PEDIPAIN]

Yep, it seems the psychological component is often a significant factor.

Dr. Stanton-Hicks at Cleveland Clinic (CCF) seems to have a good setup (something I would like to emulate): he does adult pain at CCF (~ 95% of his practice is adult-based), and when chronic pain kids genuinely need intervention, he does the procedures (his volume obviously is quite low - a few cases per week). He (and his fellow) are available by pager for the multidisciplinary team (led by a NP and Psychologist). He has a very wide draw - as I'm sure is the case at Boston, CHOP, and UCLA, so it seems a few more centers such as this would be beneficial to patients and their families.
Given all of this, does it really matter all that much where a person does a pain fellowship in regards to competency with pediatric procedures (PCA, Pumps, Stimulators, Blocks, etc)?

 

[Tenesma]

short of botox for spasticity and the occasional sympathetic/nerve block for CRPS - i truly believe we are doing children a dis-service by using interventions at an early age

i have seen 14 year olds get ESIs for low back pain - i think that is poor judgement...

 

[PEDIPAIN]

i have seen 14 year olds get ESIs for low back pain - i think that is poor judgement...

Yep, it boggles my mind, too...