Programme no: 101
OPIOID THERAPY IN NEONATES: LONG-TERM EFFECTS & FUNCTIONAL OUTCOMES Workshop organizer: Kanwaljeet J. S. “Sunny” Anand, UTHSC, Pediatrics, United States
Workshop speakers: Ruth E. Grunau, University of British Columbia, Canada, Dick Tibboel, Erasmus University, Netherlands, Richard W. Hall, UAMS, United States
Morphine and Fentanyl analgesia are used routinely for term and preterm neonates receiving mechanical ventilation. Large randomized controlled trials failed to show significant clinical benefits from the short-term neurologic or clinical outcomes of preterm/term neonates receiving morphine analgesia. Animal studies suggest detrimental effects of morphine analgesia on brain development, although most experiments exposed newborn animals to high doses, given in the absence of painful stimulation. The few experiments that used opioids for surgical or inflammatory pain showed no detrimental effects from morphine exposure in the neonatal period. Participants in this workshop will: 1. Examine the long-term effects of morphine therapy in term/preterm neonates from three different countries. 2. Review correlations between cognitive/behavioral outcomes and neuroimaging studies in pre-school and school children exposed to neonatal morphine. 3. Discuss the mechanisms underlying the dose-related and gestation-related effects of morphine exposure on subsequent neurodevelopment. 4. Develop a scientific framework for future studies exploring this area.
Programme no: 102
DEVELOPMENTAL AND CULTURAL PERSPECTIVES ON POSTOPERATIVE PAIN MANAGEMENT AT HOME
Workshop organizer: Jill MacLaren Chorney, Dalhousie University, IWK Health Centre, Anesthesiology and Psychology, Canada
Workshop speakers: Jill MacLaren Chorney, Dalhousie University, IWK Health Centre, Canada, Michelle Fortier, University of California, Irvine, United States, Rachel Yaffa Zisk-Rony, Henrietta Szold School of Nursing, Israel
Recent shifts to day surgeries and shorter hospital admissions have lead to the majority of children’s postoperative pain being managed at home. Recent studies have suggested that children’s pain may be under managed at home with parents providing fewer doses and less potent analgesics than recommended. Little is known about factors that influence how parents and children manage pain at home. In this workshop, we will present data from three international cohorts of patients that explore diverse influences on children’s postoperative pain management including culture, health disparity, and youth development. Learning objectives: 1) To increase understanding of the problem of postoperative pain management at home. 2) To learn about the impact of attitudes, culture and health disparities on how pain is managed. 3) To appreciate developmental and cognitive influences on youth and parents’ use of pain management strategies.
Programme no: 103
PAIN MANAGEMENT IN CHILDREN WITH LIFE-LIMITING CONDITIONS: BEYOND THE WHO LADDER.
Workshop organizer: Boris Zernikow, Children’s and Adolescents’ Hospital, German Paediatric Pain Centre, Germany
Workshop speakers: Boris Zernikow, German Paediatric Pain Centre, Germany, Ross Drake, Starship Children’s Hospital, Auckland, New Zealand, Charles Berde, Boston Children’s Hospital, United States
In paediatric palliative care pain therapy is much more than prescribing analgesics according to the WHO analgesic ladder. On the one hand the psychological, social and spiritual dimensions have to be addressed. On the other hand there are situations where oral or/and parenteral analgesics are not sufficient for controlling pain symptoms or symptoms closely interacting with the pain experience such as starvation and sleep disturbance Learning objectives The learning objectives are to understand the interactions between pain and sleep as well as starvation in children with life limiting diseases. Participants will be actively involved in a discussion about the advantages and disadvantages of interventions in this group of children. Challenges in making decisions for individual patients will be discussed.
Programme no: 104
SWEET TASTE ANALGESIA: MECHANISMS, EVIDENCE, UTILIZATION IN PRACTICE
Workshop organizer: Denise Harrison, University of Ottawa, School of Nursing, Canada
Workshop speakers: Vanessa Anseloni, University of Maryland, United States, Denise Harrison, University of Ottawa, Canada, Ricardo Carbajal, Universite Pierre et Marie Curie, France
This bench to bedside workshop presents the mechanisms of sweet taste analgesia, clinical evidence from systematic reviews and meta-analyses, and utilization of sucrose or glucose in diverse neonatal and pediatric settings. Objectives 1. Understand the mechanisms of action in animals and humans 2. Understand the evidence from systematic reviews and meta-analyses 3. Gain an appreciation of the knowledge translation efforts to implement sucrose in clinical care.
Programme no: 105
DEBATE: SELF-REPORT OF PAIN – THE GOLD STANDARD ON WHICH DECISIONS SHOULD BE MADE.
Workshop organizer: Alison Twycross, Kingston Univ & St George’s Univ of London, Faculty of Health & Social Care Science, United Kingdom
Workshop speakers: Alison Twycross, Kingston Univ & St George’s Univ of London, Faculty of Health & Social Care Science, United Kingdom, Catherine Vincent, Univ of Illinois at Chicago College of Nursing, Linda Franck, UCSF School of Nursing, Terri Voepel-Lewis, University of Michigan Health Systems, United States, Carl von Baeyer, University of Saskatchewan, Canada
Clinical guidelines and some researchers consider that children’s self-report of pain should be the primary measure on which treatment decisions are based. However, others argue this does not reflect the complexity of pain management. The results of several studies indicate that:
?Pain assessments are not carried out consistently or always recorded ?Reassessment does not routinely take place ?Self-reported pain scores are not always used to guide choices about pain-relieving interventions .Pain medications administered do not always correlate to children.?s self-reported pain score. ?Nurses struggle to reconcile children’s behavior with self-reported pain scores
This workshop will be run as a debate to facilitate further discussion about this important area.
By the end of the debate participants will have:
1. Reflected on arguments for and against a child’s self-report being considered the gold standard. 2. Participated in a debate about the complexity of pain assessment in practice.
Programme no: 106
HOW TO BUILD A BRIDGE: COMMUNICATING FROM BENCH TO BEDSIDE
Workshop organizer: Tracy Wilson-Gerwing, University of Saskatchewan, Pediatrics, Canada
Workshop speakers: Stephen Spielberg, U.S. Food and Drug Administration, Elliot Krane, Stanford University School of Medicine, United States, Maria Fitzgerald, University College London, United Kingdom, Tracy D. Wilson-Gerwing, University of Saskatchewan, Canada
Since the beginning of the modern era of pain research, there has been much discussion about the undertaking of research that will easily translate “from bench to bedside”. Recently, this same sentiment has emerged with respect to paediatric pain. There is, however, a significant gap between basic scientists and clinicians when it comes to paediatric pain research. We are making advances at the bench. We are making advances at the bedside. This workshop will discuss the importance of bridging the gap between bench research and bedside practise and foster discussion about how we might begin to build collaborations that will aid in this task. Learning Objectives: 1) Encourage discussion between basic scientists and clinical researchers. 2) Identify the best opportunities for close collaboration as typified by clinical syndromes.
Programme no: 111
INTERPROFESSIONAL PAIN EDUCATION STRATEGIES FOR CLINICIANS AND RESEARCHERS
Workshop organizer: Bonnie Stevens, The University of Toronto, Centre for the Study of Pain (UTCSP), Canada
Workshop speakers: Bonnie Stevens, The University of Toronto, Jennifer Stinson, The Hospital for Sick Children, Patrick McGrath, Dalhousie University, Canada
Current reviews examining pain content within educational curricula reveal that health care professionals receive minimal education about pain with little on pediatric pain. As pain is a significant issue for children, with detrimental consequences, novel strategies to enhance pain knowledge and practice are required. The overall aim of this interactive workshop is to familiarize attendees with recent local and international educational and research initiatives undertaken to enhance interprofessional education (IPE) in this area. The workshop will lay the groundwork for improving pain practices and clinical outcomes and guiding future research. Learning objectives: 1) To examine the principles of IPE and their application in an interfaculty pain curriculum within an academic setting. 2) To explore the effectiveness of a pediatric pain interprofessional clinical placement and an international web-based IPE initiative. 3) To learn about a strategic interprofessional research training program for basic and clinical pediatric pain researchers offered nationally and internationally.
Programme no: 112
PAIN MANAGEMENT IN THE EMERGENCY DEPARTMENT
Workshop organizer: Sylvie Le May, University of Montreal, Faculty of Nursing, Canada
Workshop speakers: Daniel Tsze, NY-Presbyterian Morgan Stanley Children’, Lindsey Cohen, Georgia State University, United States, Sylvie Le May, University of Montreal, Canada
Pain management of children presenting to the Emergency Department is suboptimal even though pain is the major symptom for consultation. Few studies have focused on the efficacy of interventions to control pain in children from this clinical area. We propose a workshop presenting two different interventions (pharmacological and non-pharmacological) to relieve pain as well as a systematic review of the interventions performed to manage children’s pain in the Emergency Department. Objectives: 1- To demonstrate the effects of multimodal interventions to relieve pain in the pediatric emergency department; 2- To present a systematic review of the interventions performed for pain management of children presenting with a musculoskeletal trauma to the Emergency Department.
Programme no: 113
INTERVENTIONAL TREATMENTS FOR CHILDREN WITH CHRONIC PAIN
Workshop organizer: Danielle Ruskin, Hospital for Sick Children, Anesthesia and Pain Medicine, Canada
Workshop speakers: Danielle Ruskin, Lisa Isaac, Anne Ayling Campos, Hospital for Sick Children, Canada, Kenneth Goldschneider, Cincinnati Children’s Hospital Medical Center, United States
Nerve blocks are a controversial treatment for children’s chronic pain because of risks associated with invasive procedures, a paucity of evidence supporting their practice and the possibility of medicalizing a child’s condition when the goal is to reduce medical testing and interventions. Yet, for some children, nerve blocks aid in diagnosis and provide sufficient pain relief to permit a child’s engagement in critical treatments, such as physiotherapy. Few studies document outcomes of nerve blocks in children so that pediatric specialists lack information to guide their practice. Our interdisciplinary chronic pain clinics, in two tertiary care centres in North America, provide care to approximately 400 newly referred pediatric chronic pain patients yearly. In this workshop participants will 1. review evidence for nerve blocks in pediatric chronic pain; 2. examine clinical profiles and outcomes of our patients receiving nerve blocks; 3. discuss recommendations for measuring outcomes of nerve blocks in pediatric chronic pain.
Programme no: 114
NOT JUST A POKE: PREVALENCE, DEVELOPMENT, AND CONSEQUENCES OF NEEDLE FEARS IN CHILDHOOD
Workshop organizer: C. Meghan McMurtry, University of Guelph, Psychology, Canada
Workshop speakers: Anna Taddio, University of Toronto, C. Meghan McMurtry, University of Guelph, Canada, Melanie Noel, University of Washington, United States
Needle procedures (e.g., immunizations) are a common source of pain and distress during childhood. Unmanaged procedural pain and fear have short and long-term consequences. Needle phobia, an extreme form of needle fear, affects 10% of the population but little is known about the prevalence and consequences of less extreme fear. Understanding children’s needle perceptions and the prevalence of needle fear is important for effective intervention, as fear can increase pain perception. Furthermore, anxiety and fear have been related to distorted pain memories and health care avoidance. This workshop will explore evidence from community, clinical, and laboratory-based examinations of fear and anxiety in the context of needle pain. Upon completion of the workshop, participants will be able to: 1) identify the prevalence of needle fear; 2) describe the family context of needle fear; and 3) explain the role of fear/anxiety in experienced pain, memories for acute pain, and avoidance of immunization.
Programme no: 115
SLEEP PROBLEMS IN YOUTH WITH CHRONIC PAIN: PREVALENCE, TREATMENT, AND OUTCOMES.
Workshop organizer: Bruce Dick, University of Alberta, Anesthesiology and Pain Medicine, Canada
Workshop speakers: Tonya Palermo, University of Washington, United States, Manisha Witmans, Bruce Dick, University of Alberta, Canada
This workshop will discuss key issues related to the prevalent sleep difficulties experienced by children and teens with chronic pain. Current best practice recommendations for managing this complex problem will also be presented. Key research will be discussed from the existing literature along with outcome and developmental trajectory data collected by the presenters. Relevant case presentations from the presenters’ clinical practices will be shared to contextualize the data. Recommendations for research needed to address knowledge gaps will also be discussed.
1) To consider the role of pharmacological and behavioral treatment for sleep problems in children who suffer from chronic pain. 2) To discuss the prevalence, trajectory, and outcomes of sleep disturbances in young people with chronic pain. 3) To present a current best practice team approach for managing sleep problems in youth with chronic pain.
Programme no: 116
THE DEVELOPING BRAIN AND PAIN RESPONSE
Workshop organizer: Hugo Lagercrantz, Karolinska University Hospital, Dep of Pediatrics, Sweden
Workshop speakers: Sampsa Vanhatalo, Department of Clinical Neurophysiology, Finland, Rebeccah Slater, Oxford University, Marco Bartocci, NICU, Karolinska Hospital, Sweden
The knowledge on the development of the brain throughout pregnancy is growing, but still some of the neonatal brain functions are not fully understood, such as experience of pain and pain response. Several studies have been focusing on neurophysiological aspects on neonatal pain and pain response registration. Near infrared spectroscopy (NIRS) and electroencephalography (EEG) data have been used in different studies to register cortical activity with sometimes divided findings.
In this workshop we aim at presenting the wonders of neonatal brain development and discuss the recent knowledge and future aspects on the evidence of neonatal pain experience and pain response with and without the influence of analgesia.
Programme no: 201
USE OF EXPERIMENTAL PAIN IN CHILDREN: ETHICS, METHODS, AND APPLICATIONS
Workshop organizer: Christine Chambers, Dalhousie University, Departments of Pediatrics and Psychology, Canada
Workshop speakers: Kathryn Birnie, Dalhousie University, Canada, Line Caes, Ghent University, Belgium, Lynnda Dahlquist, University of Maryland, United States
Experimental pain paradigms are increasingly being used in pediatric pain research. This workshop will provide an overview of the most commonly used experimental pain paradigms in children (i.e., the cold pressor task, heat pain). The workshop will explore ethical and methodological issues associated with the use of experimental pain in children. The workshop will also showcase how studies using experimental pain in children can be used to investigate clinical issues and interventions. Future applications and directions for the use of experimental pain in children will be discussed.
Learning Objectives: 1) To describe different types of experimental pain tasks and how they are used in pediatric pain research 2) To identify common ethical and methodological issues associated with use of experimental pain in children and strategies for dealing with these issues 3) To consider how experimental pain research in children can be used to investigate clinical issues and interventions
Programme no: 202
WHEN SCHOOL HURTS: UNDERSTANDING AND MANAGING PAIN IN THE CLASSROOM
Workshop organizer: Sara King, Mount Saint Vincent University, Education (School Psychology), Canada
Workshop speakers: Sara King, Mount Saint Vincent University, Canada, Deirdre Logan, Harvard Medical School, United States, Jessica Boutilier, Mount Saint Vincent University, Canada
Chronic and recurrent pain is prevalent in school-aged children and can have detrimental effects on both academic and social aspects of school functioning. Since school is the site in which so many developmental milestones are met,, it is important to understand how pain impacts school functioning. The objectives of this workshop are to (1) provide an introduction to the impact of pain on school functioning; (2) to disseminate results of empirical studies of child and teacher experiences and perceptions of pain and pain management in the school setting; (3) to present preliminary results from a feasibility study of a new electronic tool designed to translate research from the lab to the classroom teacher to close gaps in training and communication; and (4) to discuss future research and clinical directions. Research will be presented both quantitatively and qualitatively by an international panel of professional and trainee psychologists.
Programme no: 203
HERITABILITY OF NECK, BACK AND OTHER COMMON FUNCTIONAL PAIN DISORDERS
Workshop organizer: David Champion, Sydney Children’s Hospital, Department of Anaesthesia and Pain Medic, Australia
Workshop speakers: David Champion, Matthew Crawford, Sydney Children’s Hospital, Australia, Minna Stahl, Dept of Physical & Rehabilitation Medicine, Hatanpaa Hospital & University of Turku, Marja Mikkelsson, Paijat-Hame Social and Health Care Group, Rehabilitation Centre, Finland
This session will review recent twin studies on the genetic influence on common functional pain disorders of childhood and adolescence. Cindy Chapman will present a broad overview of an Australian twin family case-control study covering growing pains, restless legs syndrome, migraine, non-migraine headache, and recurrent abdominal pain and their associations. David Champion will present back pain results from the same twin registry and Minna Stahl will present her recent Finnish twin study on neck pain, both studies suggesting relatively strong genetic influence of the conditions.
Learning objectives: 1. To learn about genetic influence on common functional pain syndromes, such as spinal pain, growing pains, headache and abdominal pain, in childhood and adolescence. 2. To learn about twin methodology in determining the influence of genetic and environmental factors on these primary pain disorders. 3. To investigate the comorbid associations of the functional pain syndromes and discuss the concept of pain vulnerability.
Programme no: 204
PATIENT CONTROLLED ANALGESIA (PCA) – FROM EVIDENCE TO HOME CARE
Workshop organizer: Boris Zernikow, Witten/Herdecke University, German Paediatric Pain Centre, Germany
Workshop speakers: Boris Zernikow, Witten/Herdecke University, Germany, Richard F. Howard, Dilini Rajapakse, Great Ormond Street Hospital, United Kingdom
Patient controlled analgesia (PCA) is established technic for postoperative pain control both in children and adults. But what about the evidence of this approach? Based on systemic reviews performed by the speakers and integrating broad self- experience the workshop offers a solid overview on the use of PCA in children. Institutional requirements for planning, building and running PCA pumps in hospital and in the patient’s home will be presented.
Learning objectives The participant will gain knowledge on the evidence of PCA used in paediatric postoperative and cancer pain. For clinical practice, participants will learn to individualize the PCA parameters (background infusion, lockout time, day and night settings, etc.) and how to meet safety requirements.
Programme no: 205
ACCEPTANCE AND MINDFULNESS-BASED INTERVENTIONS FOR PEDIATRIC PAIN.
Workshop organizer: Rikard Wicksell, Karolinska Institutet, Sweden
Workshop speakers: Mark Petter, Dalhousie University, Canada, Lindsey Cohen, Georgia State University, United States, Rikard Wicksell, Karolinska Institutet, Sweden
In recent years there has been a call for researchers and clinicians in the field of pediatric pain to expand beyond traditional cognitive-behavioural modalities and to consider the use of “third wave” therapies. This has led to a growing evidence base for the use of acceptance and mindfulness-based interventions. This workshop will present three examples of current research in this field: a brief mindfulness-based intervention for acute pain for teens, an acceptance-based intervention for youth with sickle cell disease, and a comparison of acceptance and commitment therapy administered in group versus individual formats.
Learning Objectives: 1. To review the current state of literature on acceptance and mindfulness-based interventions for pediatric pain. 2. To learn about unique applications of acceptance and mindfulness-based interventions for pediatric pain. 3. To discuss potential implications of recent studies as they related to psychological models of pain and future interventions.
Programme no: 206
FUNCTIONAL PLASTICITY IN THE CNS: CONSEQUENCES OF EARLY INJURY
Workshop organizer: Simon Beggs, Hospital for Sick Children Toronto, Program in Neuroscience & Mental Health, Canada
Workshop speakers: Mark Baccei, University of Cincinnati, United States, Simon Beggs, Hospital for Sick Children, Canada, Suellen Walker, UCL Institute of Child Health, United Kingdom
Effective treatment of surgical injury in neonates requires an understanding of the impact of early noxious stimulation on the developing nervous system and how it affects subsequent responses to painful stimuli in later life. Here we present evidence from animal models that surgical injury during a critical postnatal period produces long-term changes in nociceptive processing, mirroring the changes seen clinically. Using electrophysological, imaging and behavioural techniques we will explore mechanisms underlying neuronal excitability in spinal nociceptive networks following neonatal injury and the subsequent changes in behavioural sensitivity to painful stimuli, as well as the role of neuro-immune interactions in maintaining these changes. We will further emphasise that understanding these long-term alterations requires knowledge of the normal postnatal development of neuronal and immune systems. This symposium will also highlight the importance of using appropriate animal models and multimodal experimental approach to drive the transition from pre-clinical to clinically appropriate therapeutic strategies.
Programme no: 211
MECHANISMS OF CHANGE IN PEDIATRIC CHRONIC PAIN: WHAT WORKS FOR WHOM AND HOW?
Workshop organizer: Tanja Hechler, Witten/Herdecke University, German Paediatric Pain Centre, Germany
Workshop speakers: Tonya Palermo, Univ of Washington and Seattle Children’s, United States, Rikard Wiksell, Behavior Medicine Pain Treatment Service, Sweden, Tanja Hechler, German Paediatric Pain Centre, Germany
Recent evidence indicates that psychological therapies for children with chronic pain result in improvement in pain, disability and functioning. These therapies differ in their therapeutic focus (education-based to CBT-based), treatment setting (outpatient versus inpatient format) and in the children they address who vary in severity of their pain conditions. The present workshop focuses on mechanism of change of 3 psychological therapies and on individual differences predicting benefit from these therapies. All 3 presentations include data from randomized-controlled trials. There are three objectives: First, to provide a detailed overview of the three psychological therapies ? 1) internet-based intervention for youth presenting for chronic pain treatment, 2) ACT for children with chronic pain, 3) intensive interdisciplinary treatment for severely affected children. Second, we aim to provide data on moderators and mediators of treatment response and third, we will discuss for whom the therapies will work best, and how to disseminate the therapies.
Programme no: 212
THE NEED TO BEFRIEND: PEER SUPPORT FOR ADOLESCENTS PAIN PATIENTS
Workshop organizer: Paula Forgeron, University of Ottawa, School of Nursing, Canada
Workshop speakers: Paula Forgeron, University of Ottawa, Canada, Ellen Henderson, University of Bath, United Kingdom, Jennifer Stinson, Hospital for Sick Children, Canada
At a crucial time of social development, adolescents with chronic pain experience school absences and a decrease in leisure activities, leading to constriction of their social group. However, school absences and decreased leisure activities are not the sole challenges to their friendships. Research suggests they develop new friendship needs but their friends may not meet these needs for various reasons. Group therapy assumes a therapeutic advantage from peer-to-peer interaction but the value of these interactions has rarely been studied. We will focus on adolescent perceptions of the importance of their friends, the value of pain-to-pain friendships in therapy, and adolescent perceptions of online social support. Learning objectives: a. Describe the importance of friendships both outside and within the pain group; b. Identify the benefits and challenges of fostering social support in chronic pain; c. Understand the lessons learned from users of online support groups; d. Discuss directions for future research.
Programme no: 213
THE LONG-TERM IMPACT OF PEDIATRIC PAIN: NEUROBIOLOGY, MODELS, AND FUTURE DIRECTIONS
Workshop organizer: Melanie Noel, University of Washington, Psychiatry and Behavioral Sciences, United States
Workshop speakers: Christiane Hermann, University of Giessen, Germany, Maria Fitzgerald, University College London, United Kingdom, Melanie Noel, University of Washington, United States
The impact of pain in the developing child can persist long after the nociceptive stimulus is removed. The field of pediatric pain is establishing the deleterious long-term effects of inadequately managed pain across the lifespan; however, underlying mechanisms and predictors are only beginning to be understood. This workshop will present the current state-of-the-science on the long-term impact of pain experienced in infancy through adolescence. It will consist of a panel of international scientists from multiple disciplines examining this research area using a variety of innovative methodologies and perspectives (neurobiological, developmental, cognitive-behavioral). Learning objectives are to 1.) Summarize the evidence on the long-term consequences of pain in humans and the challenges inherent in conducting this line of research; 2.) Explain the long-term consequences of early pain and analgesia on the developing CNS; 3.) Understand the role of cognitive-affective factors and memories in trajectories of pain chronicity and resilience in childhood.
Programme no: 214
THE BIRTH AND INFANCY OF THE PEDIATRIC RESEARCH NETWORK FOR PAIN (PRN-PAIN)
Workshop organizer: Gary Walco, University of Washington, Anesthesiology & Pain Medicine, United States
Workshop speakers: Charles Berde, Harvard Medical School, Elliot Krane, Stanford University, Steven Weisman, Medical College of Wisconsin, United States
Unique ethical and pragmatic challenges in conducting clinical trials for preventing and treating pain in infants and children have limited progress. Clinical investigators, regulatory agencies, and industry have all recognized the need for reform so that clinical trials may be of higher quality, greater generalizability, and more clinically relevant. In order to facilitate this process, the Pediatric Research Network for Pain (PRN-Pain) was established in November 2011. By presenting the conceptual underpinnings and progress to date, this symposium, presented by the current executive committee of PRN-Pain, will fulfill two learning objectives:
1. To analyze the ethical and pragmatic challenges of conducting clinical trials for pain in infants and children 2. To demonstrate how an international research consortium may address these challenges.
Programme no: 215
PROCEDURAL SUPPORT MUSIC THERAPY: REDUCING PEDIATRIC PAIN AND DISTRESS
Workshop organizer: Olivia Yinger, University of Kentucky, College of Fine Arts, United States
Workshop speakers: Lori Gooding, Olivia Yinger, University of Kentucky, Ellyn Hamm, Florida State University, United States
This workshop will provide an overview of pediatric procedural support music therapy. Presenters will present a review of recent research in this area and describe the development of model programs in the United States which have helped reduce pediatric pain, distress, and the need for sedation during medical procedures. In addition, this workshop will describe evidence-based clinical applications of music therapy to reduce pediatric pain and distress. Video examples will be shown to illustrate effective procedural support music therapy practices, and recommendations will be given on ways to incorporate music applications for procedural support when a music therapist is not present.
Learning Objectives After attending this workshop, participants will be able to describe: 1.) results from previous research on pediatric procedural support music therapy, and 2.) pediatric procedural support music therapy programs in inpatient and outpatient settings, 3.) music therapy applications used to decrease pain and distress for young children.
Programme no: 216
OPIOID-INDUCED HYPERALGESIA AND RISK ASSESSMENT FOR OPIOID THERAPY
Workshop organizer: Lucy Chen, MGH/Harvard Medical School, Anesthesia, Critical Care and Pain Medic, United States
Workshop speakers: Lucy Chen, MGH/Harvard Medical School, Robert Jamison, B & W Hospital, Harvard Medical School, Jianren Mao, MGH, Harvard Medical School, United States
Opioids have been successfully used for adult and pediatric acute postoperative pain and chronic or cancer-related pain. More recently, preclinical and clinical studies have revealed that chronic exposure to opioid analgesics may alter the central nervous system processing of pain, leading to an increase in pain sensitivity, which commonly described as opioid-induced hyperalgesia. This concept complicates the rationale of chronic opioid use and challenges clinical management of chronic pain patients. This symposium will provide a clinic-oriented summary on the mechanisms, diagnosis and management of opioid-induced hyperalgesia. In addition, the up-to-date information on risk assessment and management for opioid-related clinical issues including addiction will be discussed. Education Objectives 1. To review the current clinical data regarding opioid-induced hyperalgesia; 2. To discuss the neurobiological mechanism of opioid-induced hyperalgesia and its clinical implication and management; 3. To update opioid risk assessment and management strategies in the context of opioid-induced hyperalgesia and abuse-like behaviors.
Programme no: 301
INNOVATIVE METHODS FOR ASSESSMENT AND INTERVENTION WITH THE FAMILY IN PEDIATRIC PAIN
Workshop organizer: Christine Chambers, Dalhousie University, Departments of Pediatrics and Psychology, Canada
Workshop speakers: Christine Chambers, Dalhousie University, Canada, Line Caes, Ghent University, Belgium, Tonya Palermo, Univ of Washington and Seattle Children’s, United States
The family has long been acknowledged as an important social context where children learn about and receive support for their pain. This workshop will provide an overview of innovative methods for assessment and intervention with the family in pediatric pain, using different methodologies and in diverse settings, including the lab, the clinic, and the internet. Results from recent illustrative studies will be presented. The importance of this work in helping to better understand the complexity of family relationships as they relate to pain, and future directions for research in this area, will be discussed.
Learning Objectives: 1) To identify different methods of studying the role of the family in pediatric pain 2) To showcase the results of various recent research studies investigating assessment and intervention with the family in pediatric pain 3) To consider the relative merits and challenges associated with use of these methods and directions for future research.
Programme no: 302
PERSISTENT PAIN IN CONTROLLED ORGANIC DISEASE
Workshop organizer: Neil Schechter, Children’s Hospital Boston, Department of Anesthesia, United States
Workshop speakers: Samuel Nurko, Children’s Hospital Boston, Laura Schanberg, Duke University, William Zempsky, Connecticut Children’s Medical Center, United States
Persistent pain in patients with systemic disease which has been successfully treated or is in remission has often been interpreted as psychological in origin or representative of disease flare. Recent evidence suggests that neither of these etiologies may be correct and the pain may stem from a different mechanism such as peripheral or central sensitization and require an entirely different treatment approach. For some entities, this may be considered “functional pain”. In this workshop, experts in three different diseases (inflammatory bowel disease, juvenile idiopathic arthritis, and sickle cell disease) will review what is known about the epidemiology, mechanism, and treatment of persistent pain in each disease state. Learning Objectives: 1) Review the basic principles of “functional disorders” and central sensitization 2) Demonstrate how this concept may manifest itself in different disease states 3) Review the similarities and differences in treatment approaches to persistent pain in these three disease states
Programme no: 303
PAIN: THERE IS AN APP FOR THAT
Workshop organizer: Mark Connelly, University of Missouri-Kansas City, United States
Workshop speakers: Anna Huguet, IWK Health Centre, Jennifer Stinson, The Hospital for Sick Children, Canada, Mark Connelly, University of Missouri-Kansas City, United States
Information technology increasingly has become a mainstay for healthcare delivery due to its potential for improving health outcomes while reducing treatment costs. In the field of pediatric pain, mobile technology increasingly has been implemented to facilitate self-monitoring of pain and to equip children with the self-management strategies and support necessary to optimize their care. Three examples of apps developed to improve the assessment, management and/or support of young people with several recurrent and chronic pain conditions will be presented. The educational objectives are to: 1. Describe the process of developing an app; 2. Identify key features of apps that lend to their success in terms of improved health outcomes; and 3. Discuss opportunities and challenges of pain apps.
Programme no: 304
PAIN RELIEF FOR NEONATES IN INTENSIVE CARE THROUGH PARENTAL COMFORT
Workshop organizer: Ananda FERNANDES, Coimbra School of Nursing, Child and Adolescent Health, Portugal
Workshop speakers: Celeste JOHNSTON, McGill University, Canada, Eva CIGNACCO, University of Basel, Switzerland, Marsha CAMPBELL-YEO, Dalhousie University, Canada
Preterm birth represents a challenge for the baby, the parents and the staff that care for them. In the last decade neonatal care has emphasized the need to protect infants from noxious environmental stimuli, namely pain, and to promote parental involvement through family centered care. Within this framework, a number of non-pharmacological interventions have been studied to relieve pain during the multiple procedures that neonates endure during their hospitalization. This workshop has been designed to summarize the current questions around the endogenous mechanisms behind the efficacy of non-pharmacological pain management interventions and offer directions for future research; to present the evidence about facilitated tucking and skin to skin care, two interventions for pain relief that involve parental participation; and to discuss the barriers and strategies to facilitate knowledge translation in clinical settings.
Programme no: 305
BRAIN IMAGING IN PEDIATRIC PAIN
Workshop organizer: Lorenzo Fabrizi, University College London, Neuroscience Physiology and Pharmacology, United Kingdom
Workshop speakers: Lino Becerra, Harvard Medical School, United States, Lorenzo Fabrizi, University College London, United Kingdom, Ruth Grunau, University of British Columbia, Canada
Infants and children are exposed to numerous noxious medical procedures but little is known about nociceptive processing at the level of the infant brain, how this changes with brain maturation and affects cortical development. Knowledge of brain processing in this young population is fundamental to improve understanding of pain perception and potential effects of pain. In this workshop we aim to explore the use of techniques such as functional magnetic resonance imaging and electroencephalography to study: (i) the development of pain perception in early maturation; (ii) the influence that early noxious procedure have on brain development and (iii) the potential clinical applications of brain imaging in paediatric pain. The audience will learn about: 1) Brain imaging techniques currently employed in paediatric pain assessment in clinical practice and research 2) Development of brain structure and functions involved in pain perception 3) Influence of early pain experiences on brain development
Programme no: 306
ACUTE PAIN IN HOSPITALIZED CHILDREN: PREVALENCE, PERCEPTIONS, AND PRACTICE CHANGE
Workshop organizer: Kathryn A Birnie, Dalhousie University/IWK Health Centre, Canada
Workshop speakers: Kathryn A Birnie, Dalhousie University / IWK Health Centre, Canada, Alison Twycross, Kingston Uni and SGUL, United Kingdom, Bonnie Stevens, University of Toronto / Sick Kids, Canada
Pain is a significant issue for hospitalized children with detrimental consequences if inadequately addressed. Effective pain management is critical. Research advances in pediatric pain assessment and management have not always translated to improved care, and practices remain sub-optimal. This interactive workshop updates attendees on recent research and key issues regarding the prevalence, stakeholder perceptions, and knowledge translation (KT) strategies to improve pain practices and outcomes for hospitalized children. Knowledge of pain prevalence and management lay the groundwork for designing, implementing, and evaluating KT initiatives.
1) Consider the purpose of pain prevalence studies and how differing use of the term “clinical significance” influences our interpretation of prevalence rates. 2) Reflect on implications for practice and research from studies exploring children’s and parents’ perceptions of the quality of acute pain management in hospital. 3) Learn about multidimensional KT strategies integrating evidence and quality improvement to influence clinical, education, research, and policy outcomes.
Programme no: 311
BOYS IN PAIN: WHO, WHAT, WHY?
Workshop organizer: Sabine Kost-Byerly, Johns Hopkins University, Anesthesiology/Critical Care Medicine, United States
Workshop speakers: Sabine Kost-Byerly, Johns Hopkins University, Lonnie Zeltzer, David Geffen School of Medicine at UCLA, United States, George Chalkiadis, University of Melbourne, Australia
Male patients are a minority in pediatric pain centers, particularly after puberty. Research suggests that they approach and experience experimental pain differently than females. Do boys in pain centers present with the same complaints, coping mechanisms, and co-morbidities as girls? Are therapeutic interventions as successful for boys or should they be adjusted to improve outcomes? In this workshop we will review and show data concerning boys from experimental pain studies, clinical presentations and therapeutic outcomes in pediatric pain centers. In discussion with the audience we will define recommendations for future research. After this workshop the learner will: ? Comprehend sexual differences in the response of children to experimental pain. ? Appreciate the presentation of male pediatric patients with chronic pain ? Understand the efficacy of therapeutic interventions in male children with chronic pain ? Realize future research objectives in pain assessment and management for male patients.
Programme no: 312
CHANGING INSTITUTIONAL CULTURE ABOUT PAIN TREATMENT
Workshop organizer: Neil Schechter, Children’s Hospital Boston, Department of Anesthesia, United States
Workshop speakers: Neil Schechter, Children’s Hospital Boston, United States, G. Allen Finley, IWK Health Centre, Paula Forgeron, University of Ottawa, Canada
Numerous studies suggest that 20% of children experience unnecessary pain in healthcare facilities. The reasons for this are variable but it is clear that uniform application of the basic principles of pain management would reduce the burden of suffering. Strategies to address this lack of uniformity are often attempted but unless there is an institutional commitment to reducing pain, improvement is typically unsustainable. This workshop will review strategies to change provider behavior regarding pain management. Specific focus will be placed on ChildKind, a global initiative to reduce pain in healthcare facilities. Objectives: 1) Review the evidence on strategies aimed at changing clinician behavior. 2) Discuss how to promote an institutional commitment to pain reduction and identify barriers to it, as well as the specific roles of different health professional disciplines. 3) Review the basic principles of ChildKind and its potential to promote institutional culture change.
Programme no: 313
NEONATAL PHARMACOLOGY – RECENT KNOWLEDGE AND FUTURE ASPECTS
Workshop organizer: Vineta Fellman, Lund University, Dep of Clinical Sciences, Pediatrics, Sweden
Workshop speakers: Dick Tibboel, Sophia Children’s Hospital, Rotterdam, Netherlands, Vineta Fellman, Dep of Clinical Sciences, Lund Universit, Stefan Lundeberg, Karolinska Institute, Stockholm, Sweden
Pharmacological treatment of pain in newborn infants differs due to a lack of evidence based guidelines. This leads to use of traditional drugs that are not optimal, and implementation of drugs used in other patient populations but not tested and proven suitable in the neonatal population.
Newborn infants, especially preterm infants, are very vulnerable as they are undergoing NICU-care during a period of rapid CNS-development. The need for analgesics and sedative drugs aiming at less pain and stress is evident, but there are evidence of both side effects of the treatments and neurotoxicity on the vulnerable brain. A “balanced approach” is recommended ? enough drugs to prevent pain, but not more than needed. More pharmacokinetic, pharmacodynamic and pharmacogenetic studies are needed. In this workshop recent research data will be presented and different aspects on clinical treatment strategies, as well as aims and approach of future studies will be discussed.
Programme no: 314
SELF-REPORT OF PAIN INTENSITY IN CHILDREN: HOW YOUNG IS TOO YOUNG?
Workshop organizer: Carl L von Baeyer, University of Saskatchewan, Psychology & Pediatrics, Canada
Workshop speakers: Carl L von Baeyer, University of Saskatchewan, Canada, Henry Vo, Sydney Children’s Hospital, Australia, Martin Schiavenato, University of Miami, United States
Methods to obtain self-reports of pain intensity are highly developed for children aged 5 years and older, but research focusing on self-report in 3- and 4-year-olds is sparse. The usual scales using numbers, tokens, and pictures of faces might not be the best way to ask about pain in children under 5. Measures must be adapted to patients’ developmental level, e.g., their developing skills in reasoning and magnitude estimation. The presenters are from three countries and three disciplines.
Objectives: (1) Recognize and understand the development of cognitive and social skills required for a preschool-aged child to provide self-reports of pain intensity. (2) Be aware of the limitations and assumptions of existing research on self-report of pain in preschool-age children. (3) Learn about pilot studies on improving these measures, including comparisons of scales using faces, number of tokens, and different-sized objects to obtain graded self-reports of pain intensity.
Programme no: 315
FEAR OF PAIN IN CHILDREN: THEORY, EXPERIMENTAL ASSESSMENT, AND EXPOSURE TREATMENT
Workshop organizer: Tanja Hechler, Witten/Herdecke University, German Paediatric Pain Centre, Germany
Workshop speakers: Laura Simons, Boston Children’s Hospital & Harvard Med, United States, Tanja Hechler, German Paediatric Pain Centre, Children’, Germany, Jeanine A Verbunt, Maastricht University, Netherlands
The Fear Avoidance Model of Chronic Pain (FA) provides a biopsychosocial framework to explain how individuals transit from an acute pain experience to being trapped in a vicious cycle of chronic pain. The FA model is conceptually sound and highly relevant to clinical practice. As researchers in adult chronic pain seek to move the FA model forward (i.e., Crombez et al., 2012; Vlaeyen & Linton, 2012), we must not only examine these same tenets in children, but keep pace with our evolving understanding of the model. This workshop will provide an overview of the current state of research and clinical treatment applying the FA model in children.
Objectives 1. Present the FA model in pediatric chronic pain, development considerations and the role of parents. 2. Describe the role of maladaptive interoception and innovative experimental assessment paradigms. 3. Present first results of graded in-vivo exposure treatment of fear avoidance in youth
Programme no: 316
PERSISTENT POSTSURGICAL PAIN IN CHILDREN: PREDICTORS, TRAJECTORIES AND IMPACT
Workshop organizer: Christine Sieberg, Boston Children’s Hospital/Harvard Med, Anesthesia/Psychiatry, United States
Workshop speakers: Christine Sieberg, Boston Children’s Hospital/Harvard Med, Jennifer Rabbitts, Seattle Children’s Hospital, Michael Costigan, Boston Children’s Hospital/Harvard Med, United States
Close to 25% of patients referred to chronic pain clinics identify surgery as the antecedent; however, mechanisms determining which patients develop persistent postsurgical pain are poorly understood and research has largely focused on adults. Identifying predictors of poorer long-term outcomes in children with postsurgical pain may prevent development of chronic pain and persistence into adulthood. In this workshop, Drs. Sieberg and Rabbitts will present longitudinal findings from two studies examining pain trajectories in children who have undergone major surgery. Additionally, Drs. Rabbitts and Sieberg will present data on quality of life, physical functioning, and psychological distress in youth after major surgery and their role in chronic pain maintenance. Dr. Costigan will discuss genetic contributions to the transition from acute to chronic pain. Attendees will understand prevalence rates and trajectories of postsurgical pain as well as the interplay of innate and extrinsic factors which contribute to persistent postsurgical pain in children.
Programme no: 321
HOW TO PLAN, DEVELOP, RUN AND EVALUATE AN INTERDISCIPLINARY PAEDIATRIC PAIN CLINIC?
Workshop organizer: John Collins, Children’s Hospital at Westmead, Pain Medicine & Palliative Care, Australia
Workshop speakers: Boris Zernikow, German Paediatric Pain Centre, Germany, John Collins, Children’s Hospital at Westmead, Sydney, Australia, Charles Berde, Boston Children’s Hospital, United States, Susie Lord, Kaleidoscope Hunter Children’s Health Network, Division of Anaesthesia, Intensive Care, Natasha Haynes, Children’s Hospital at Westmead, Sydney, Australia
An interdisciplinary approach is the gold standard in the treatment of children with severe and long lasting chronic pain. Different health care systems and treatment settings require different actions in planning, developing and running a clinic meeting these standards and in shaping the evaluation of the work. Examples of well-established clinics from three continents (America, Australia, Europe) will be presented. Learning objectives: By the presentation of best practice examples the participants will gain knowledge on how to build a new paediatric pain clinic or how to improve and evaluate an established one.
Programme no: 322
WORKING TOGETHER TO PREDICT AND EXPLAIN CHRONIC PEDIATRIC PAIN AND RELATED DISABILITY
Workshop organizer: Anna Huguet, IWK Health Centre, Canada
Workshop speakers: Anna Huguet, IWK Health Centre, Canada, Ruben Nieto, PSINET Research group-IN3, Spain, Gabrielle Page, York University, Canada
Chronic and recurrent pain is prevalent in children population and can be associated with moderate-severe disability. Understanding the process of chronification of pain and its course is essential to prevent further pain and unnecessary suffering. Consequently, our educational objectives are the following ones: 1. Present several research methods (i.e., systematic reviews and confirmatory and exploratory research approaches) aimed at gaining knowledge about the etiology and course of chronic pediatric pain and disability. 2. Identify potential biopsychosocial predictive and prognostic factors of chronic pain and pain-related disability in children; as well as potential psychological mechanisms underlying these processes. 3. Consider whether there exist differences across various types of chronic pain. 4. Discuss gaps in the literature and implications for clinical practice.
Programme no: 323
PROMOTING PSYCHOLOGICAL FLEXIBILITY IN PARENTS OF ADOLESCENTS WITH CHRONIC PAIN
Workshop organizer: Dustin Wallace, Children’s Mercy Hospital, Integrative Pain Management, United States
Workshop speakers: Laura Simons, Pain Treatment Srvc, Boston Children’s, Dustin Wallace, Children’s Mercy Hospital, Kansas City, United States, Rikard Wicksell, Karolinska University Hospital, Sweden
Parent psychological flexibility is defined as the capacity to accept distress and discomfort, including when one’s child has pain, while remaining present-focused and persisting or changing behavior based on overarching values. This stance may lead to improved child outcomes through several mechanisms: (1) direct modeling, as adolescent pain acceptance is associated with better functioning; (2) reduced parent distress, as parental worry and catastrophizing are known contributors to child disability; and (3) flexible behavioral responses that allow parents to respond in ways that encourage functioning rather than disability in their children. Learning objectives: 1) Workshop attendees will learn methods of assessing psychological flexibility in the context of parenting a child with chronic pain and how it relates to multiple dimensions of child functioning. 2) Workshop attendees will hear early outcomes from cutting-edge treatment intervention trials designed to increase parent psychological flexibility in the context of child pain.
Programme no: 324
WHO NEEDS WHAT AND WHEN: MATCHING CHRONIC PAIN INTERVENTION TO CASE COMPLEXITY.
Workshop organizer: Bruce Dick, University of Alberta, Anesthesiology and Pain Medicine, Canada
Workshop speakers: Rachael Coakely, Harvard Medical School, United States, Jill Chorney, Dalhousie University, Canada, Hannah Connell, Bath Centre for Pain Services, United Kingdom
Chronic pediatric pain often creates complex and pervasive difficulties in a young person’s life and negatively affects their family, school functioning, and social relationships. Several innovative treatment programs will be discussed that integrate empirically supported practice using different care pathways, tiered according to the level of complexity of patient presentation and health care resource availability. Outcome data from each program will be presented along with directions for future clinical programming and research.
1) To increase understanding of available and effective models for care delivery for young people with chronic pain across a spectrum of complexity within diverse international health care settings (UK, USA, Canada). 2) To learn optimal “doses” of intervention for particular patients, best practice components, and pros and cons of various delivery methods. 3) To increase attendees’ ability to develop, administer, and evaluate flexible, cost-effective, and efficacious pain management programming for youth with chronic pain.
Programme no: 325
TRANSLATIONAL RESEARCH ON DEVELOPMENT OF VISCERAL PAIN IN CHILDREN
Workshop organizer: Zeltzer Lonnie, UCLA Pediatric Pain Program, Pediatrics, United States
Workshop speakers: Gosta Alfven, Karolinska Institute, Sweden, Jennie Tsao, University of California, Los Angeles, Elie Al-Chaer, University of Arkansas, United States
This workshop will examine the early precursors of functional abdominal pain and later outcomes from animal model, human experimental pain, and clinical perspectives. The focus will be on understanding the developmental trajectory of functional visceral pain in children and adolescents with implications for adult chronic pain. Objectives:
1. To understand the clinical syndromes of functional abdominal pain. 2. To understand experimental pain responses including conditioned pain modulation in children and adolescents. 3. To understand in an animal model how early pain impacts later chronic visceral pain.
Programme no: 326
AMERICAN PAIN SOCIETY’S GUIDELINES FOR MANAGING PEDIATRIC POST-OPERATIVE PAIN
Workshop organizer: Renee Manworren, Connecticut Children’s Medical Center, Pain and Palliative Care Medicine, United States
Workshop speakers: Steven Weisman, Children’s Hospital of Wisconsin, Gary Walco, Seattle Children’s Hospital, United States
Many pre-operative, intra-operative, and post-operative interventions and management strategies are available for reducing and managing postoperative pain in adults and children. The American Pain Society, in partnership with the American Society of Anesthesiologists and the U.S. Veterans Health Administration Health System and Department of Defense Health System, commissioned a systematic review to inform and update clinical practice guidelines on management of postoperative pain. This workshop will explain the methods used to develop these guidelines, review the evidence supporting guideline recommendations, and identify the potential for future research to address gaps in the evidence.
Objectives: 1. Explain the guideline development process used by the American Pain Society 2. Analyze the post-operative guideline recommendations and supporting evidence. 3. Explore potential gaps in the evidence for pediatric research opportunities