The following is an edited transcript of an MDAdvantage podcast with Steve Adubato, PhD, and Katherine Bentley, MD, recorded on April 1, 2021. In this interview, Dr. Bentley, a pediatric doctor of physiatry at the Children’s Specialized Hospital, an RWJBarnabas health facility located in New Brunswick, New Jersey, discusses the hospital’s nationally recognized, multidisciplinary chronic pain management program for young children.
ADUBATO: To start, remind us about the role of a physiatrist.
BENTLEY: Physiatrists are physical medicine doctors, so we are all about function, and we care for a broad range of patients. We might, for example, be taking care of patients who are in horrible accidents and have spinal cord or brain injuries. In my case, I’m a pediatric physiatrist, so I take care of a lot of young babies who may have been born with complications or disorders. We help them regain their function or develop their function to the best of their ability. I often say we’re somewhere between neurologists and orthopedists. Essentially, we focus on function through rehabilitation.
ADUBATO: As the Director of the Chronic Pain Management Program at Children’s Specialized Hospital, you’ve worked with a team to develop a nationally recognized chronic pain management program. What is that program, and why is it needed?
“We’re looking at more functional pain disorders, such as youngsters with complex regional pain syndrome or amplified musculoskeletal pain syndrome.”
BENTLEY: We have a multidisciplinary program for children, adolescents and young adults with pediatric chronic pain. Chronic pain is really pain that lasts about three to six months. In this case, we’re looking at functional pain disorders, such as youngsters with complex regional pain syndrome or amplified musculoskeletal pain syndrome. This pain management program is really needed because, unfortunately, these disorders can be very debilitating. A patient may change from a high-functioning youngster who’s playing sports and going to school to one who is in so much pain that they can hardly walk.
ADUBATO: How prevalent is the problem of chronic pain in children?
BENTLEY: The statistics that we have on chronic pediatric pain, depending on which reports you read, show that between 20 and 30 percent of children experience some form of chronic pain. Of course, that doesn’t mean that every child would be appropriate for a program like ours.
ADUBATO: The issue of opioids comes up, obviously, when you talk about pain. Can chronic pain be effectively managed in children without the use of opioids?
BENTLEY: Yes, and, in some ways, that’s the essence of our program. We know that, for a variety of reasons, opioids and long-term opioid use are not good for anyone really, except in certain circumstances. Unfortunately, many of the patients we treat in our program have been placed on opioid medications while looking for a diagnosis. In fact, opioids don’t really help with this kind of pain, so in our program we help them come off the opioids while increasing other therapies, such as physical therapy, occupational therapy, aqua therapy and psychological counseling. We also have child-life recreational therapy to help them through this time.
ADUBATO: Can you explain what is involved for children and adolescents who participate in the chronic pain management program at Children’s Specialized Hospital?
BENTLEY: We evaluate all patients through what we call an enhanced evaluation. Because of the pandemic, we do telemedicine and in-person evaluations, depending on the situation. One benefit of telemedicine is that we are able to see patients from across the nation. We can evaluate patients who are further away where, previously, it might have been logistically challenging. A physiatrist and a psychologist together evaluate the patient for about an hour and a half. We are looking at complex regional pain syndrome and amplified musculoskeletal pain syndrome, and we also treat children with chronic headaches or functional abdominal pain. They are diagnoses of exclusion, so many of these youngsters have been to many physicians and have had many tests to find out this is what they have. We want to confirm the diagnosis and then let them know about our program. When they come into the program, they stay with us for about two to four weeks, where they receive an interdisciplinary and multidisciplinary approach to their pain. For most of the patients, the pain improves while they are with us, but the goal is to help improve function. For example, we may be working with a youngster who can’t even sit for school, so we work on those functional things. Five days a week, they have aqua therapy in the morning for an hour, they have two hours of physical therapy, two to three hours of occupational therapy and at least two hours of individual psychological counseling per week. They also have group counseling, so it’s a very busy time when they’re with us.
ADUBATO: You talked about what it’s like for the patients and what these children are dealing with. What about the parents? What support is there for them?
BENTLEY: That’s a very good point. This disease really affects the whole family, because the family is kind of turned upside down. When the children are in therapy with us, their parents aren’t with them, so we meet with them weekly about their child’s progress. We also have a parent education and support group that occurs while their child is in the hospital with us. We help teach parents about what’s going on with their youngster and help them understand the physiology of the pain disorder so they can help their child when they go home.
ADUBATO: What are the red flags that primary care physicians should be looking for when it comes to pain management and the potential use of opioids with children?
BENTLEY: There are some guidelines for use with acute pain, because for some acute pain or accidents or surgeries, opioids are very appropriate. However, opioids should not be prescribed for long periods of time. There are many other medications that can help adjuvant the pain treatment. We want to see really where the pain is coming from because we need a correct diagnosis to be able to treat it properly.
ADUBATO: How available are chronic pain programs like yours around the country, and how effective have they been?
BENTLEY: There are somewhere around 13 to 15 programs throughout the country, and patients can find the program they need on websites and in resource rooms. Sometimes, patients and families travel for these types of programs. Children’s Specialized Hospital also has partnered with Rady Children’s Hospital in San Diego, CA, in a program, so we’re kind of located on both coasts. When we help these children to improve, they really get their lives back. My favorite thing to hear from a parent is, “I got my son or daughter back.” That’s the whole point of this.