Pediatric Pain Rehabilitation Program

Kennedy Krieger Institute • 707 North Broadway • Baltimore, MD 21205

Directors:

Dr. Sabine Kost-Byerly
Frank S. Pidcock, MD
Keith J. Slifer, PhD

Inpatient Pain Services Coordinator:

Cynthia M. Ward, PsyD

About Our Program:

The Pediatric Pain Rehabilitation Program provides inpatient evaluation, treatment and follow-up services for children and adolescents with chronic pain due to known illnesses or of unclear etiology that has resulted in functional disability. Oftentimes, patients have undergone numerous medical tests, consulted with many medical specialists and have declined in social and school functioning. Many patients may be enrolled in home and hospital school due to difficulties getting to and being at school.

Our patients typically range in age from 6 to 18 years, with an average age of 13. Patients who are older than 18 years and younger than 6 years will be considered for inpatient admission on a case-by-case basis. Our patients often have pain-related secondary mental health conditions or symptoms such as depression or anxiety. Patients are often taking various medications without much effect on pain symptoms or daily functioning. Patients who require intensive psychiatric services may not be appropriate for inpatient rehabilitation treatment.

The inpatient pediatric pain rehabilitation team consists of: pediatric rehabilitation physicians, physical therapists, occupational therapists, pediatric psychologists, pediatric anesthesiologist, social workers, nurses, neuropsychologists, educators and therapeutic recreation and child life specialists. Additional consultative services are provided as needed in areas, including psychiatry, nutrition, complementary and alternative therapies (massage, energy, acupuncture, etc.) and other medical diagnostic consultation (i.e., neurology, anesthesiology, etc.).

Primary Program Goals:

The goals of the program are to help patients participate more fully in daily activities and to develop pain coping skills that help them to successfully return to school, home and community life. The focus is on restoring functioning and pain management, rather on ongoing medical and diagnostic assessments.

While patients are inpatient, treatment goals are set shortly after admission, with the patient and family as an integral part of the treatment team. While on the unit, patients receive intensive coordinated rehabilitation therapy and cognitive behavioral therapy tailored to their medical condition and psychological needs. They learn behavioral pain coping techniques to better help them manage their pain and increase their function. Parents and caregivers are also involved in treatment. Family therapy is a component of the program to ensure that parents are provided with appropriate education and can effectively support their child at time of discharge. Parents are taught different interventions to help their child's coping, functional gains and overall quality of life. The therapy goals are discussed on a daily basis. In addition to specific individual therapies, children spend time in the therapy center which reinforces therapy goals during leisure and recreational activities.

Educational and neuropsychological assessments are provided during the inpatient stay, with a focus toward assuring smooth school and community reintegration upon discharge. Discharge planning begins immediately upon admission and is coordinated with the referring physician, insurance case managers, family, school and other community agencies. The majority of patients treated in our program are discharged to home and return to school either full-time or part-time with the hope of full-time after a gradual transition. After discharge, many patients continue outpatient treatment with physical and/or occupational therapies, behavioral psychology services and psychiatry.

Most children and adolescents who come to our inpatient pain program have pain that causes them to:

  • Miss school, enroll in home-schooling or drop out from school all together
  • Withdraw from extracurricular activities and lose social contact with family and friends
  • Present with sleep difficulties and emotional distress secondary to pain or other clinical symptoms

Parents and caregivers of these children and adolescents may have:

  • Sought/visited numerous medical specialists without beneficial pain relief
  • Lost work days to manage their children's medical condition
  • Experience family stress related to the child's pain condition
  • Experience their own emotional difficulties related to their child's illness
  • Acquired significant treatment expenses or financial stress

Arrangements for community referrals will be provided for patients who live far away. At time of discharge from our inpatient and day treatment care, all patients will be scheduled for a follow-up appointment in the outpatient multidisciplinary pediatric pain clinic. Follow-up appointments usually occur one to three months after discharge from the inpatient unit.

Our Success:

When patients come to our program, they have really tried everything. From trying numerous medications, seeing multiple specialists, and also trying outpatient services. Most of these interventions have not been effective and patients are in need of a multidisciplinary team that will assess and provide recommendations accordingly.

The patients who get admitted to our inpatient pain rehabilitation program are those individuals who have tried several things and continue to experience pain and are non-functional. Through our integrative treatment approach, we not only treat the pain, but teach patients and their caregivers the tools they need to cope. We help patients successfully return to school and their social activities, and help them increase their overall quality of life. Our program has a proven record of treatment success and patient satisfaction:

  • 100 percent of family members reported overall satisfaction with our care
  • 98 percent of children met or exceeded the goals set at their admission
  • 100 percent of patients would recommend our programs to others in need of rehabilitation

In most cases, patients are discharged from our inpatient pain program with less pain-related impairment; they have achieved better coping, physical conditioning and tolerance, and have returned to participation in developmentally-appropriate activities at home and in the community.

Contacts:

If you would like to know more about our inpatient rehabilitation pain program or make an appointment to determine eligibility, please contact our Care Management Office at (443) 923-9400 or (800) 554-2080.

Diagnoses Served:

  • Musculoskeletal Pain
  • Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy)
  • Functional Gait Disorders
  • Hypermobility
  • Ehlers-Danlos Syndrome
  • Fibromyalgia
  • Post-surgery or injury
  • Abdominal Pain
  • Chronic Fatigue Syndrome
  • Postural Orthostatic Tachycardia Syndrome (POTS)
  • Neutrally Mediated Hypotension

Informational Resources:

Kost-Byerly S: Management of chronic pain in children. In: McInerny TK, Adam HM, Campbell DE, Kamat DM, Kelleher KJ, eds. American Academy of Pediatrics Textbook of Pediatric Care 1st Ed. Elk Grove Village, IL: American Academy of Pediatrics, 2008

Lauder, G.R. & Massey R. (2010). Complex Regional Pain Syndrome (CRPS) Explained: For Teenagers, By Teenagers.

Maynard, C., Amari, A., Wieczorek, B., Christensen, J., & Slifer. K. (2010). Interdisciplinary Behavioral Rehabilitation of Pediatric Pain-Associated Disability: Retrospective Review of an Inpatient Treatment Protocol. Journal of Pediatric Psychology, 35 (2), 128-137

Zeltzer, L. (2005). Conquering Your Child's Chronic Pain: A Pediatrician's Guide for Reclaiming a Normal Childhood.

Related Materials and Information