Abstract
Who for? Chronic pain (CP) affects up to 30% of children. Of these, a smaller proportion (approx. 3-5%) shall experience significant, disabling CP, impacting on education, peer and family relations, physical health and emotional wellbeing. Uni-disciplinary treatment modalities are not supported by evidence. Untreated, there is a significant association with the development of lifelong CP.
In 2020, funding was secured by Children’s Health Ireland to develop a service to manage children living with CP. Working with key multi-disciplinary stakeholders and supported by a parental advocacy group, a model of care was established. This allowed for recruitment of staff and the merger of existing services to develop the first funded national multidisciplinary service for children with CP.
What did you do? A model of care was developed. This model reflected the current evidence base and best international practice in the management of CP in children. It incorporated the initial triage, assessment and management pathways of such children and families. Central to this was the use of outcome measures to determine baseline function and the success of interventions utilised. Given the specialist nature of the service and the limited staffing resource, emphasis was placed on collective upskilling of team members, regardless of professional background. This facilitated the development of integrative interdisciplinary therapeutic practice. Satisfaction with service engagement was undertaken with all service users. Therapeutic pathways were developed with an emphasis on a biopsychosocial model, utilising group rehabilitative programmes, to develop self-management strategies with emphasis on functional restoration and quality of life in the absence or presence of CP.
Results: An evidence based service pathway was implemented. Therapeutic content was developed to include audio-visual and educational resource. Patient and family feedback revealed high levels of satisfaction with initial MDT assessment to include being understood and heard, receiving information, and understanding the therapeutic plan. There was a significant improvement in reported ‘hope’ with regard to future outcome when assessed prior to and after meeting with the team. Following attendance at a 2 day 'STEPS' programme, statistical end of treatment improvements in self efficacy and pain related anxiety were recorded.
What is the learning? CP is common in children and adolescents. It is associated with significant cost and impact. It can be associated with high levels of disability and psychosocial morbidity. Best practice guidelines advocate the use of a biopsychosocial rehabilitative model of care delivered by a specialist dedicated service. The development of such a service should utilise resource to maximise therapeutic outcome. This includes delivery of evidence based interventions, in group settings, and implementing an integrated interdisciplinary model of care.
Next steps: The service hopes to accommodate all children on the island of Ireland so that all may access timely evidence based integrated pain management. The service also hopes to work with local services to develop a national integrated paediatric pain network. The service has received a funding award to develop an intensive interdisciplinary paediatric pain programme. This will be the first programme of its type to exist on the island of Ireland.