In addition, a high percentage of respondents did not respond to all the questions in the survey. Thus, we used data provided and treated blank fields as missing data. Because this study was merely descriptive, no additional methods were used to address missing data.
Despite these limitations, the results of this survey may help guide the field further by providing support and rationale for the form programs should take. This survey provides valuable information for health care professionals, particularly for those who are interested in treating pediatric chronic pain, as it provides important information about the current and ideal features of pediatric chronic pain programs.
However, we trust that the results may also be useful to policymakers, administrators, and others responsible for making decisions about promoting pediatric chronic pain programs in places where they are lacking and underscore the need for improved access to treatment programs around the globe. The lack of progress and knowledge translation in the management of chronic pain, particularly in the development of programs for young people, may be due to various factors.
The highly complex nature of the experience, as in the case of pediatric chronic pain, is probably at the heart of the problem. Nevertheless, the lack of guides for creating and implementing programs based on the knowledge available might also be at least partially responsible. No single formula can be applied to all hospitals, clinics, or countries, as health care systems vary from country to country, but the information contained in this article may be useful for those planning to develop a multidisciplinary pain program for pediatric chronic pain or even for those that are already established and are seeking avenues for change and improvement.
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However, standards are as yet unavailable, and there is no international accrediting body. Thus, one important avenue for knowledge translation and improvement of pediatric chronic pain management would be to develop a set of agreed standards that programs must comply with to be accredited by a national or international body.
Promoting change, and particularly significant and long-lasting change, involves going beyond simply giving guidelines or training initiatives. Organizational and intellectual changes are also needed how things are conceptualized, the attitudes of the personnel involved, etc. The information contained in this study, and in others to be produced in the future, could help those who have started to see the need for change to envisage the possibility of developing and implementing a pediatric chronic pain program in their hospitals.
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The authors wish to express their gratitude to Adam Cummins for his help in developing the web-based survey. Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. National Center for Biotechnology Information , U.
Journal List Pain Rep v. Pain Rep.
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Published online Aug McGrath , c G. Allen Finley , c and Gary A. Walco d. Patrick J. Allen Finley. Gary A. Author information Article notes Copyright and License information Disclaimer. E-mail address: tac. Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4. This article has been cited by other articles in PMC. Abstract Introduction: The treatment of youth with chronic pain has improved in recent years. Objectives: The objectives of this study were to identify the features of programs as they exist at present and to determine what features they should have in an ideal state.
Methods: A web-based international survey was used to collect information. Results: Respondents were pediatric pain experts representing different specialties located in 12 countries. Conclusions: The results of this survey may be useful for health care professionals interested in treating chronic pain in children and adolescents and for policy makers concerned with improving the care given to these children and their families. Keywords: Pediatric chronic pain, Treatment, Chronic pain programs, Survey. Methods 2. Procedure The survey was conducted in the last 3 months of Measurement The survey questionnaire contained 86 questions in English on a wide range of issues related to the areas of roles and processes.
Data analysis The information in the questionnaires was coded and scored by a research assistant, and the results are presented as median and percentage scores. Results 3. Table 1 Characteristics of participants. Open in a separate window. Figure 1. Country of program being reported.
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Main features of existing pediatric chronic pain programs Most programs were specialized units. Figure 4. Table 2 Characteristics of pediatric chronic pain programs. Figure 2. Figure 3. Delivery of services. Data are in percentages. Discussion The objectives of this study were to identify current features of programs treating children and adolescents with chronic pain, as well as to solicit international expert opinion on ideal features of these programs. Disclosures The authors have no conflict of interest to declare. Acknowledgments The authors wish to express their gratitude to Adam Cummins for his help in developing the web-based survey.
Footnotes Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. References  American Pain Society. Assessment and management of children with chronic pain.
A position statement from the American Pain Society. Accessed July 25, Multidisiciplinary programs for management of acute and chronic pain in children. Pain in infants, children, and adolescents. Philadelphia: Lippincot, Pediatric pain clinics: recommendations for their development. Can you think of a reason why the great majority of people having had one of their breasts partly removed do not experience persisting phantom breast pain?
Unfortunately those nerves are too small to reconstruct surgically. Any other idea? This is exactly what we need to get at. Not only the nerve damage will determine the pain you will or will not experience, many factors contribute to the pain. Remember that last time during the intake you mentioned several factors that aggravate your pain, and you also mentioned things that can relief your pain. For instance, you mentioned that you experience less pain when you are having fun with your friends. How can you explain that?
The aggravating factors can then be explained as the ones pushing on the accelerator Fig. Pain neuroscience education slide illustrating how the brain controls two top-down systems that can either inhibit the brake or facilitate the accelerator pain.. Pain neuroscience education slide illustrating nociceptive pathways and using the spam filter metaphor to illustrate descending nociceptive inhibition..
It has a powerful spam filter in the back gate of the spinal cord Fig. What part of your body is in control of your spam filter? During the treatment program, we will teach you how you can control the spam filter in your spinal cord.
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And so does the brain! The brain is a fantastic computer, but it simply has not enough capacity to process all input it constantly receives. Therefore, it has the spam filter in the spinal cord, but it will also be highly selective to the messages passing the spam filter and entering the brain.
So even when a message arising from your painful fingers or toes will enter your brain, processing of those messages will not per se imply that you will feel pain.
In case older patients are unfamiliar with using email, one need to use an alternative metaphor to explain the descending nociceptive inhibition, like a volume nod from a radio than one can turn up or down. After the patient understands the idea of descending inhibition and facilitation, modifiable psychological and behavioral factors can be slowly introduced and related to the patient's situation and experiences, with emphasis on how they will be addressed during subsequent phases of the comprehensive treatment program e. Yet the patient sitting in front of you has experienced a lot of pain over the past couple of months, implying that many more pain memories were added, new books were written and the patient ended up with an entire pain library in the brain.
Nearly everything the patient does on a regular day has been previously connected with a pain experience, and all those memories are written down somewhere in that library.
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This makes it very easy for the brain to connect everyday situations with previous pain experiences, even when the situation is not threatening at all. The brain is trying to warn the patient of being in suspected danger, even though there is currently nothing to be afraid of. This is similar to anticipatory nausea and vomiting in the setting of chemotherapy induced nausea and vomiting. Further questions to be asked during the PNE session can be related to the patient's understanding and opinion regarding the PNE content e.
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The therapist and patient discuss these answers by relating them to the PNE content.. The PNE will typically address past or current cancer treatments, including radiotherapy, surgery or chemotherapy and its long-term consequences. For instance, many patients who survived cancer use adjuvant endocrine therapy like aromatase inhibitors. The reason for this common side effect of aromatase inhibitors is still an active area of research, and advances have been made. Animal work suggests that aromatase inhibitors selectively target the transient receptor potential ankyrin 1 TRPA1 channel, a major pathway in pain transmission and neurogenic inflammation.