When the Pediatric Comprehensive Pain Clinic at University of Iowa Stead Family Children’s Hospital opened three years ago, the goal of Medical Director Anureet Walia, MBBS, was to provide the same kind of evidence-based, multimodal treatments that adult patients find at the Pain Management Clinic.

“We try, if we can, to avoid multiple medications and surgeries to treat chronic pain in children,” Walia says. “But to do that, you have to have a multimodal plan. It’s like a car with four flat tires; if you only work on one tire, you won’t be able to go anywhere. You have to work on all four.”

The clinic – which has a nurse practitioner, a physical therapist, and a psychologist in addition to pain management physicians – is aligned with recently released guidelines from the World Health Organization (WHO) that recommend a combination of physical therapy, psychological management of chronic pain through cognitive-behavioral therapy and other interventions, and pharmacologic management, ranging from drugs like acetaminophen, topical anesthetics, and anti-inflammatory agents to more powerful drugs like morphine for end-of-life care.

 Anureet Walia, MBBS

WHO released its guidelines while noting the dearth of research about chronic pain in children.

“The management of chronic pain in children is complex and challenging, and there is a paucity of high-quality research studies on treatment interventions and management approaches,” the guidelines’ executive summary states. “Pain management requires an approach that is tailored to each individual and context, and is multimodal and interdisciplinary, requiring trained healthcare providers and a coordinated, comprehensive, integrated response.”

“We do know that some things about chronic pain in children are different than chronic pain in adults,” Walia says. “Children don’t have the same pathologies – arthritis, for example – that adults present. Much of what affects children suffering from chronic pain is psychosocial. It’s the fact that they can’t participate in sports or can’t do things with their friends, so they feel isolated and alone. Then their grades might suffer, and maybe the pain is affecting their sleep, so they’re fighting fatigue as well. We need the whole biopsychosocial profile to be able to educate them about the pain they’re dealing with and how the mind and body are connected.

“Then we can look at functional goals – I want to be able to play soccer, or I want to go to school every day – and develop a plan to work toward achieving those goals,” she says.

How such pain management interventions in childhood affect patients later in life is one of the many unanswered questions. “We don’t have long-term studies that show whether these interventions early in life translate into better pain management skills into adulthood,” Walia says. “But we do know that we can equip them with coping modalities that can help them now and give them tools to cope as they grow.”

The Pediatric Comprehensive Pain Clinic is open 7:45 a.m. to 4:30 p.m. Mondays and Thursdays in the Pediatric Specialty Clinic.