Summer 2011

Integrated Pain and Palliative Care for Children

As awareness has grown of the roles pain and symptom management play in healing and quality of life, hospitals have sought to more effectively address these concerns.

One of the unique challenges children pose in this regard is that their symptoms are particularly vulnerable to the psychological stresses of hospitalization. Working with children often means working with an entire family. Younger children can't articulate what they're feeling.

In response, UCSF Benioff Children's Hospital is instituting an Integrative Pediatric Pain and Palliative Care Program that brings together existing expertise across the spectrum of pediatric pain and symptom management. Known as IP3, the program includes these three elements:

  • Pediatric anesthesia
  • A hospitalist-based pain resource team that focuses on non-anesthesia pain management techniques
  • Compass Care, the hospital's highly regarded palliative care program that applies symptom management techniques to chronic and end-of-life care

"The idea is to have a broad-based program functioning at the highest level, especially as we look toward becoming a freestanding facility when we move to Mission Bay in 2014," says Audrey Foster-Barber, M.D., Ph.D., who co-leads the program with hospitalist Karen Sun, M.D., anesthesiologist Atsuko Baba, M.D., and nurse practitioner Robin Kramer, who created the Compass Care program.

The Right Technique at the Right Time

Foster-BarberFoster-Barber said, "By taking a more holistic look, we help the inpatient physician focus on the cure while we try to improve the treatment experience for the child and his or her family."

At least one member of the IP3 team is available 24/7 to consult with the inpatient care team, and to initiate a pain and symptom management plan that applies the right management technique for the right child at the right time. IP3 also will train clinical care teams in areas such as recognizing unspoken signs that a child is in pain or distress.

"We focus on both the unique physiology of children and the behavioral aspects of how they respond to our care," Foster-Barber said.

Such a mindset is as applicable to children with complex conditions as it to those with a broken leg or appendicitis. "There's a lot of nuance to assessing when anesthesia techniques are appropriate, as opposed to or in combination with complementary techniques and behavioral management," she said.

What It Looks Like

Typically, postsurgical pain management begins with medication. But perhaps after a day or two, a member of the care team notices that the child's pain increases when her mother leaves the room. The IP3 team can then draw on options that include medication, biofeedback, visualization and behavioral techniques.

Doctor with child

For example, at UCSF Benioff Children's Hospital, clinicians use something called "the magic glove," an imaginary protection that they "place" on a child before an IV. By helping children draw on their imagination and their strengths for coping, this simple technique is very effective in that most children clearly experience less distress.

Foster-Barber said, "By applying this type of expertise and working with other caregivers to increase awareness of these state-of-the-art symptom management techniques, we believe we can speed healing and ease the stay for both patient and family.

For more information, contact Dr. Foster-Barber at (415) 353-4149.

Summer 2011 Table of Contents

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