The physician assesses pain only at admission and discharge.A typical day includes three hours of occupational therapy, three hours of physical therapy, and one hour of aquatic therapy. While in the program, all medications for pain and aids used, such as wheelchairs or crutches, are withdrawn. During therapy, it is understood that pain is present, but the focus is to reach the agreed upon goals, improve a previous record in various exercises, and, increase overall function. Each session builds upon the activities from the previous session. An exercise program is given to the patient to complete at night in order to continue working on increasing function and self-desensitization.

Daily therapy is accomplished by the patient without parental involvement. Parents and caregivers may participate in evening visits and stay at the hospital with their child overnight.

Our comprehensive program includes psychological services. The psychologist helps educate the child or teen about the condition, discusses any stressful areas in the child or teen’s life and assists  the patient to develop coping mechanisms for any future stressors. Additionally, meetings with the family help determine if family or marital therapy is required. The work of the psychologist is supported by the Child Life Specialist, who works on coping and increased expression through modalities such as art and music.

Upon completion of the program, we guide the family and patient through their preparation for return to their community. At discharge, a Home Exercise Program is provided for the child or teen to continue to improve function and decrease pain. The goal upon discharge is for the child or teen to return to all normal activities, including school and extracurricular involvement, without any physical modifications. Together with the primary physician, the team teaches children and teens that they are able to cure themselves of the RND, use the necessary tools to handle any stressors that may precipitate a reoccurrence, and performexercises to reduce pain if the RND does flare up again.

We also work with children and teens who have other forms of chronic pain and partner with families to develop an appropriate treatment program.

Patient Outcomes
With a mission to help every child reach his or her full potential, the Children’s Specialized team is highly motivated by a strong record of positive patient outcomes and success. The Pain Management Program is founded in evidence-based practices, and statistics for this intensive physical therapy model show:

• Pain level decreases from 76 to 1 for those in full remission (Sherry et al., 1999)
• 92% of patients had complete resolution of pain and full function.
• After 5 years, 88% of patients had no pain.

These statistics are compared to other types of treatment, such as sympathetic blocks, local injections, surgeries, medications, and immobilizations, not part of the Pain Management Program at Children’s Specialized, where statistics show success rates to be much lower, with 54% of patients reporting residual pain (Wilder et al., 1992).