Today and for the rest of the weekend I am attending the Alberta Pain Conference. How wonderful that over 4000 people from all over the world joined in to learn and help fight the battle of chronic pain. Even more so that the conference includes people who suffer from chronic pain – our best teachers. I have made some notes of the meeting so far. Apologies to the presenters if I misrepresented you in any way. Please call me on it so I can correct it if I do.
Thank you Katie for sharing your journey. Reminding us how important it is to listen to the patient’s experience of pain. Reminding us of how chronic pain comes with grief – the loss of your function; the loss of the vision you have of yourself; sometimes the loss of the future you imagined for yourself.
Thank you for reminding us that small daily goals work, that you need to choose your own activities – pursue your own interests, and find things that you feel you can do. Be kind to yourself if you can’t do everything you want. Find a community of other youth who suffer from chronic pain. Thank you for sharing your courage and hope.
Dr. Katie Birnie reminded us of the importance of the patient and the family in the partnership of care. Invest in research that is important to Patients! Mutual respect and inclusiveness in the most important part of care. She also spoke about her research – a multidisciplinary team approach to research.
The gaps identified include attention to sleep, physical interventions, patient satisfaction, and adverse events. Some shockers – 2/3 of children continue to have procedures without adequate or any analgesia. Vets gets 75% more pain education than medical professionals. It takes 17 years before research reaches the people who should see the results. I think it takes even longer to introduce the changes needed. She introduced SKIP and invited us to visit Kidsinpain.ca.
Dr. Melanie Noel tells us 1 in 4 children suffer from chronic pain, pain like migraines and stomach aches. Even if the pain resolves, these children are at risk for lifelong consequences, including PTSD, anxiety, and depression. Distressing memories can affect us for life.
She studied chronic pain and the link to trauma. How does your mother, or your father’s trauma affect you, as a child? Can trauma be carried through your genes? Her research backs the rational truth that past traumas, like high ACEs, affect the development of chronic pain and how you respond to treatment for pain.
She speaks about the importance of sleep and how sleep deprivation can affect mood and pain – even 30 minutes less sleep than necessary is a risk factor, especially in adolescents. Poor sleep drives pain and pain causes poor sleep. A vicious cycle. Children can benefit from cognitive behavioural therapy.
Go to bed when you are really tired. Don’t lie in bed if you can’t fall asleep. If you wake up and not sleeping after 15 minutes, get up, break the association of the bed with not sleeping. DO NOT GO ON YOUR PHONE. Do something calming or boring (ha ha – read a dictionary).
The tragedy is that most children often don’t access any, or adequate, medical assessment. Most children with chronic pain have parents who have experienced chronic pain. Treatment of parents, acceptance of the needs of parents too, is vital when we treat children with chronic pain.
She did give us hope – positive message – positive childhood experiences can buffer the effects of abuse in childhood. Children are resilient and can be protected. Protections: The ability to talk to your family about your feelings, enjoying community experiences, support by friends or another family member, and a feeling of safety.
Dr. Samina Ali. children who have procedures who have poorly managed pain have longer healing periods, they stay in hospital longer, they can have enduring fear and anxiety over future health care, like needlestick anxiety, and they can even avoid going to a health care professional when they are older.
It was horrifying to listen to her research – how children had major surgeries – heart and abdominal surgery, children with severe pain – how they never received pain medications. White children were twice as likely to receive necessary opioids than black children. We have work to do on ALL fronts.
Managing pain in children, physical measures matter, even something as simple as a warm blanket, a warm hug,; psychological – nowadays we can even use virtual distractions, or a book, or an iPad, or something as simple as bubbles; pharmacologic tools should be used, included opioids when needed. Mild to moderate can be treated with Ibuprofen (10mg/kg) and Acetaminophen (15 – 20mg/kg) and both these drugs decrease the need for opioids and will decrease the dose needed. DO NOT USE CODEINE. DO NOT START CODEINE. (Might consider continuing use in an adolescent who has already found relief).
If you use opioids, sent patient home with modest amounts of opioids. Short-term treatment is most important – usually 3 days of treatment. Give the patient a back-up plan in case they struggle with their pain.
CAPHC online resource available to anyone in the world.
On average, a child admitted to hospital has to suffer 6 painful procedures. Only 28% have adequate pain care. Up to 80% of emergency care visits are pain related. More than half of all procedures were done with no analgesia. No intravenous procedures without analgesia.
We need to use topical anesthetic. Comfort positioning. Distraction. Analgesia.
We can do better! Dr. Nivez Rasic: All chronic pain was at one time acute.
Dr. Rob Tanguay says you can’t treat chronic pain without looking at trauma.
Thank you for a wonderful talk by experienced, knowledgeable, caring people.