An initial appointment may be scheduled by contacting Boston Children's Hospital's Pain Treatment Services at 617-355-7040.
The clinical nurse specialist will obtain a brief medical history, and prior to the initial appointment, all pertinent prior medical records should be sent to Pain Treatment Services. This will allow physicians to review a patient's past medical history and accelerate the initial assessment on the day of the initial clinic visit.
All new patient visits are on Tuesday mornings and last approximately five hours. This visit will include assessments by a pediatric anesthesiologist or pediatrician, a clinical nurse specialist, a physical therapist and a clinical psychologist.
The Pain Treatment Services team will then meet from 12 p.m. to 1 p.m. to develop a unified treatment plan. This plan will be presented to you immediately following their meeting.
Follow-up visits are on Thursdays and last approximately 30 minutes.
In addition to follow-up visits with Pain Treatment Services, referrals are often made to a physical therapist, a psychologist and/or other specialists. If a child is referred to a physical therapist, he or she will be evaluated and, where appropriate, exercise programs, ultrasound and other modalities or the use of transcutaneous electrical nerve stimulation (TENS) may be prescribed.
Managing chronic pain
Chronic pain is often frustrating for those struggling with it, and its treatment often requires the expertise of individuals from many different disciplines. With this in mind, the Chronic Pain Clinic at Boston Children's Hospital was designed to evaluate and treat children and young adults with persistent pain using a multidisciplinary approach.
All children referred to our program are seen by a pain physician, psychologist and physical therapist, and the recommendations made are intended to address not only the pain per se, but the disability that may have been created by it. Typical problems evaluated by the Chronic Pain Clinic include:
- complex regional pain syndrome (the new name for reflex sympathetic dystrophy)
- widespread musculoskeletal pain
- back pain
- persistent post surgical pain
- pain associated with sports injury or other orthopedic problems
- abdominal pain
- pain in multiple locations
Headache is typically evaluated and treated by the Headache Program of the Pain Treatment Service, although many pf the children we see have headache as one of their chronic pains. Suggested interventions may include:
- analgesic medications or medications for nerve pain
- cognitive behavioral approaches (biofeedback, relaxation, meditation, guided imagery, reframing)
- physical therapy
- use of TENS (transcutaneous electrical nerve stimulation) units
- nerve blocks
Some of these services may be provided on site, but we often can identify providers closer to home. We also will help with return to, or modification of, school, as well improving sleep, which is often challenging for all people who are in pain.
If further medical evaluation is needed, referrals will be offered, and if the chronic pain is so disabling that it meets criteria for admission to the Mayo Family Pediatric Pain Rehabilitation Center (PPRC), then a referral may be made to that program. All patients admitted to the PPRC require initial screening in the Chronic Pain Clinic.
The referral process
Individuals can be referred to the Chronic Pain Clinic by their primary care provider, by a specialist who is caring for them, or by self-referral.
After the initial phone call is made to our program, your family will receive an email questionnaire, which is intended to provide us with detailed information about your child. This information will help us decide if the Chronic Pain Clinic is an appropriate setting and if so, will reduce the time necessary for history-taking at the evaluation.
Once the information has been reviewed and it is felt that the Chronic Pain Clinic can be of help, your family will receive a phone call from one of our nursing staff and an appointment will be scheduled. The waiting time for an appointment varies significantly, but typically ranges from a few days to a few months.
The evaluation process
When families arrive, they're greeted by our clinic staff and given their schedule for the day. A comprehensive history will be assembled from the information provided on our web-based intake form, as well as from the interview during the visit. Families should expect a comprehensive physical examination, a detailed physical therapy evaluation, and a psychological assessment of the child and family during their visit. Once these are completed and all other records are reviewed, the staff will develop recommendations which will be shared with the family.
Ongoing follow-up by our nursing staff is also a critical part of our care.
Most patients seen in the Chronic Pain Clinic need subsequent follow-up to evaluate their progress and determine the efficacy of the interventions that have been offered. Modifications of the program will be made depending on the child’s response to the initial recommendations.
Education and research
The Chronic Pain Clinic at Boston Children's is one of the oldest and largest pediatric pain centers in the world. Since we are a major training site for doctors in this field, there may be Fellows in pain medicine who will participate in the evaluation of your child. Your child's care, however, will always be closely supervised by one of our highly experienced attending physicians, who will be present throughout the evaluation.
The Chronic Pain Clinic is actively involved in research to advance this field and provide new information to help children in pain. We take this responsibility very seriously, and you may be asked to participate in some of the research that we are doing. If you are asked and are comfortable with the research that is proposed, we welcome your participation. If not, this in no way impacts on the care that you will receive, which we believe is of the highest possible quality.