Chronic Pain is classified as pain that lasts greater than six months and can interfere with daily life. Kids, adolescents, and teenagers with chronic pain syndromes may look just like you or me, but they are experiencing mild to extreme pain that does not go away as expected following an injury, illness, or trauma.
Children’s Specialized Hospital (CSH) inpatient physical therapist, Kate Vieni works alongside a team to help the pediatric population manage pain and encourage functional activity, so kids can go back to enjoying and having fun doing normal childhood activities.
Kate works within CSH’s Chronic Pain and Functional Neurological Disorders (FND) Center of Excellence, an inpatient program in New Brunswick, New Jersey that supports improvement in functional independence and participation in daily routines, and promotes overall quality of life for children and adolescents affected with Chronic Pain and FND conditions.
The program uses a multidisciplinary rehabilitation model including physicians, nurses, therapists, social workers, and more to deliver a patient-specific rehabilitative plan. The therapy approach utilized within this program is related to a nervous system that is overwhelmed and aims to help patients understand his or her nervous system and develop strategies to calm it down.
It includes a combination of therapeutic interventions, such as aquatic, occupational, physical, and recreational therapy, plus age-appropriate psychoeducation support sessions for both the patient and their support persons.
Kate has been working with the chronic pain population for over ten years and is always looking for ways to enhance her knowledge and understanding to better serve this population. However, she was having trouble finding continuing education that focuses on pediatric chronic pain management.
In 2018, she discovered Evidence in Motion, a healthcare learning solutions company providing certifications and continuing education courses. One certification in particular stood out to Kate: Therapeutic Pain Specialist. This course would help her to gain advanced clinical competency in the evaluation and treatment of chronic pain. In the Fall of 2021, Kate obtained a Therapeutic Pain Specialist certification.
Following this certification, she was offered a Pain Science Fellowship, which began in the summer of 2022 for a 22-month duration along eight others to contribute to an eventual total of 48 other nationwide fellows. Through the Fellowship in Pain Sciences at EIM, Kate gained an exceptional understanding of pain mechanisms and their impact on pain experience, including how to use an enhanced clinical bio-psycho-social approach for advanced assessment and treatment through online and hands-on instruction.
Out of all the fellows in the program, Kate was one of three who work in pediatrics and is the only current fellow practicing on the East Coast.
The Pain Fellowship
The program had a unique component as fellows were tasked with creating a scholarly project around pain. Kate reflected on her day-to-day at CSH and found that she spent time explaining what the Neurophysiology of Pain Questionnaire (NPQ) was asking to patients and families.
The NPQ asks twelve true or false questions, (including an option to mark as unsure) to determine an individual’s thoughts, beliefs, and knowledge about pain from their perspective while receiving care. She recognized that this questionnaire wasn’t an appropriate evaluation of pain knowledge for the pediatric population given the complexity of its medical jargon. Kate utilized this to create her scholarly project.
A lot of research, education, and resources are geared toward adults, and Kate’s project worked to modify this tool specifically for the pediatric population, as nothing of its kind ever existed before.
Her fellowship project was spent on modifying this tool after getting explicit permission from the original creator of it to make these changes.
Kate worked tirelessly to develop a modified NPQ to adapt to the needs of youth and adolescents with chronic pain. The participants in the program clinically piloted this questionnaire over the past six months and Kate recently presented her project at her graduation.
Although the modified NPQ was created for youth, clinicians and patients from a variety of age groups reported that it is preferred because the language is more appropriate for laypeople.
The tool is primarily being utilized with individuals admitted to the Chronic Pain and Functional Neurological Disorders program at CSH.
“The fulfillment came with seeing my work come to life. Being involved in a research opportunity that has the potential to change the way we educate and work with pediatric patients with chronic pain is a dream.”
Kate was also able to network with and grow alongside some fantastic clinicians across the country, which was an incredible experience for her. “The fellowship has advanced my skills and knowledge to provide patients with a greater biopsychosocial approach to pain and symptom management,” she notes.
Kate recently submitted her project for publication, and the next steps will be to validate the tool and patent it for widespread clinical use.
Spreading the Word About a Revised NPQ
Kate, alongside Dr. Katherine Bentley, Section Chief of Pediatric Physiatry and Director of the Chronic Pain Program, and Dr. Kate Hottinger, Pediatric Psychologist at Children’s Specialized Hospital, recently attended the 5th International Conference on Functional Neurological Disorders (FND) in Verona Italy, an educational opportunity that takes place every two years.
The conference allowed the team to hear from the top researchers and practitioners in the field and it granted an opportunity to network and collaborate, especially with pediatricians in FND. It also opened up new ways for the team to continue to enhance their knowledge of FND through the pediatric special interest group (SIG), a small group of professionals, including physical and occupational therapists, neurologists, psychologists, psychiatrists, and others who specialize in treatment of pediatric patients diagnosed with FND.
The special interest group is aimed at being an ongoing educational resource for those involved – some meetings will involve an article review, and others may involve a case study/presentation. The goal is for group members to share new tools/information and maintain an evidence-based approach to treatment.
Kate explains, “Joining the pediatric special interest group will allow us to continue to share knowledge within that sector and be in a position to provide our patients with the best clinical care possible. I think the biopsychosocial approach is a completely different take on how to work through a therapeutic alliance and help patients return to meaningful activities. That is the most rewarding part of it.”