SPPM Global Virtual Conference: A Continuum of Acute and Chronic Pain, Part 1
Rita Agarwal MD, FAAP, FASA and Galxy Li MD
I’m going to try something a bit different and review a meeting for the PAAD readership. Today and tomorrow, I’ve asked Dr. Rita Agarwal of Stanford University, the PAAD’s primary pain article reviewer and Dr. Galxy Li of Nemours Children’s Specialty Clinics of Jacksonville and Wolfson Children’s Hospital, Jacksonville, FL to summarize the primary lectures that were presented virtually at the Scoiety for Pediatric Pain Medicine’s (SPPM): A Continuum of Acute and Chronic Pain held on November 5, 2022. If you think this is a good or bad idea send me your thoughts and I will post. Myron Yaster MD
THIS! This is what all virtual conferences should aspire to be: a forum of international experts from multiple countries discussing research and clinical perspectives in pediatric acute pain, chronic pain, anesthesia, and sustainability.
Pain impacts everyone at some point in their lives, and is the most common reason one seeks medical care for themselves or their loved ones. Yet, it can often be problematic to successfully treat, without confounding side effects. Connecting together all those who are interested in understanding, treating and improving pain outcomes can ultimately help reduce the pain burden children suffer. Conference Chair Galaxy Li MD of Nemours Children’s Health, Jacksonville, FL; SPPM Education Committee Chair Yuan Chi Lin MD of Boston Children’s Hospital; Program Shadow Jamie Kitzman MD of Children’s Healthcare of Atlanta; and the Society for Pediatric Pain Medicine launched SPPM Global on 5 Nov 2022, a fantastic meeting that was recorded, and is now available for on-demand viewing for registrants. Each of the speakers delivered profound lectures that were applicable to pediatric anesthesiologists. SPPM members Shreela Palit PhD of Nemours Children’s Health Jacksonville and Sophie Pestieau MD of Children’s National Memorial served as moderators for the first four speakers.
The conference opened with the incomparable Suellen Walker MD, Professor of Pediatric Anesthesiology and Pain at University College London, consultant in pain management, and transitional researcher in developmental neurobiology and pediatric neuropathic pain. Dr Walker discussed neuropathic pain in children, including definition, causes and treatment in her lecture “When Pain Nerves Misfire: Recognizing and Assessing Neuropathic Pain in Children.” She outlined that neuropathic pain is caused by a lesion or disease of the somatosensory nervous system from insults, including trauma, surgery, chemotherapy, erythromelalgia, and Fabry’s disease. Dr Walker explained that it is most commonly identified by history, physical, screening tools, and increasingly, testing such as quantitative sensory testing; and can have long-lasting biopsychosocial effects. She asserted that 20% of cancer survivors go on to have persistent pain, and many have reduced Quality of Life (QOL) measures. In a study from Great Ormand Street Hospital for Children (GOSH) that compared adolescents with CRPS to those with peripheral neuropathic pain (PNP), many similarities were found (mean pain score was 6, ~60% were girls), but the most significant difference was the duration of pain. Twenty-five percent of children with PNP still had pain at 5 years, compared to 0 for the children with CRPS.
Allison Fernandez MD, a pediatric anesthesiologist with a passion for Big Data and the inaugural president of the Society for Pediatric Anesthesia Improvement Network (SPAIN) from Johns Hopkins All Children’s Hospital in St Petersburg, Florida, shared her lecture, “ACL Reconstruction and Post Op Pain Management.” She reviewed the perioperative pain management techniques commonly used for these surgeries in teenagers, before sharing the preliminary results of the latest SPAIN research on regional anesthesia and patient outcomes at 6 months undergoing ACL reconstruction. There were initially nine sites involved in data gathering, with preliminary data available for 305 patients. She pointed out that the most common regional technique used was a single shot femoral adductor canal nerve block, followed by single shot popliteal nerve block. Ninety six percent of children received intraoperative opioids and the majority, except for those at one site, received opioids in the recovery room. By six months, nearly all patients had pain scores of £ 1, and most were no longer using opioids.
Next up was Fiona Campbell MD, Professor of Anesthesiology from the University of Toronto, Director of the Chronic Pain Program and Co-Director of SickKids Pain Centre, another giant in the pediatric pain world. She discussed “Risk Factors for the Transition from Acute to Chronic Post-Surgical Pain (CPSP): A Complicated Journey.” She estimated at least 20% of the annual 4 million pediatric surgeries in the USA will be complicated by CPSP, with some studies reporting rates as high as ~50%, depending on the type of surgery, such as spine fusions. This has a tremendous impact on disability, sleep, function, education, quality of life, and cost of care. She pointed out that research in this area is currently focused on identifying patient, surgical, and treatment factors that contribute to CPSP. Several studies have targeted preexisting pain, pain catastrophizing in patient and parent, and parental anxiety as preoperative factors that contribute to the development of[p1] CPSP. Dr Campbell postulated that the duration of surgery may increase the development of CPSP, and in the postoperative period, the experience of moderate to severe pain, high analgesic use and parental pain-catastrophizing also appear to be contributing factors.
Following the identification of risk factors for chronic postsurgical pain, Kathryn Birnie PhD Assistant Professor of Anesthesiology, Perioperative and Pain Medicine, and Community Health Sciences from the University of Calgary presented “Human-Centered Health Service Design to Prevent Pediatric Chronic Postsurgical Pain,” an inspirational, multidisciplinary approach to identifying, and treating perioperative children to prevent chronic postsurgical pain. Collaborating with Canadian patients with lived experience, their families, and other healthcare providers, she led a campaign of streamlining over 500 pediatric pain concerns from national surveys into 25 and then ten critical priorities at an in-person workshop. The #1 priority Dr Birnie identified was to investigate strategies to prevent acute pain from becoming chronic pain. In partnership with the University of Calgary, youth with CPSP, their families, preop and postop health care professionals, administrators, and with support for the Canadian Pain Society and the Canadian Institute of Health Research, the team developed a Surgical Integrated Pain Service for patients with various needs in providing resources to deliver optimal pain interventions. Their success and commitment to empowering children and their families with pain towards prevention of pediatric CPSP is inspiring other childrens hospitals.
An interactive, live, question-and-answer session with the SPPM Global speakers followed with our moderators at hand. Insightful questions from around the world were posed and addressed by our expert panel. Afterwards, a brief intermission ensued, featuring original music of SPPM members Ken Goldschneider MD of Cincinnati Children’s Hospital and Pulsar Li DO of Loyola University Medical Center. Please stay tuned for a review of the second half of SPPM Global!
[p1]I have no idea why there’s a gap here btwn “of “and “cpsp” but I cannot delete it