Bio

Bio


Dr. Rashmi Bhandari joined the Pediatric Pain Management Clinic and Stanford faculty in 2005 and has since been working with children who have complex chronic pain conditions and their families. She is the Director of Psychology Services for the Pediatric Pain Clinic and overseas all aspects of clinical pain psychology services. In addition to practicing behavioral pain medicine for 12 years, Dr. Bhandari is the director of the pediatric pain psychology fellowship training. The education curriculum created for the pain psychology fellowship is now the leading standard in the field, educating future pediatric psychologists who want to specialize in pain medicine. Dr. Bhandari has extensive training in bio behavioral interventions for chronic pain such as biofeedback and is certified by the American Society of Clinical Hypnosis.

Dr. Bhandari is a committed clinician, educator, and researcher with a focus on assessment and development of treatment interventions to improve the lives of youth with chronic pain. Decisions about the appropriate treatments, however, are dependent on accurate and useful data—data that have been lacking for adults and children who experience chronic pain. This lack of information inspired the creation of a Health Registry/LHS called CHOIR. Dr. Bhandari helped lead the pediatric adoption of CHOIR, called Peds-CHOIR, which is a novel, open-source outcome-dual tracking vehicle for youth with chronic pain and their caregivers.

In recent years, Dr. Bhandari has researched evidenced-based treatments of pediatric chronic pain and identification of important patient characteristics that may inform treatment outcomes. Integral to this research was the utilization of Peds-CHOIR, which was designed to track outcomes for children and adolescents with chronic pain and their caregivers. Her publications in peer reviewed journals documents the development and implementation of this registry platform as well as the potential for deep phenotyping of treatment responsive and non-responsive patients.

Clinical Focus


  • Psychology
  • Pediatric Pain Psychology
  • Pediatric Pain Rehabilitation

Academic Appointments


Administrative Appointments


  • Director of Pediatric Pain Psychology Services, Pediatric Pain Clinic at Stanford Children's Health (2016 - Present)
  • Director of Pediatric Psychology Training, Department of Anesthesia, (2011 - Present)

Professional Education


  • PhD Training:Wayne State University School of Medicine (2002) MI
  • Professional Education:Yapko 100 Training in Hypnosis (2016) CA
  • Professional Education:National Pediatric Hypnosis Training Institute (2014) MN
  • Professional Education, American Society of Clinical Hypnosis, Clinical Hypnosis (2015)
  • Professional Education, Stens Corporation, 5-Day Professional Biofeedback Certificate Program (2012)
  • Fellowship:Wayne State University School of Medicine (2003) MI
  • Internship:Wayne State University School of Medicine (2002) MI

Research & Scholarship

Current Research and Scholarly Interests


Clinical interventions, treatments, and outcomes in pediatric pain management

Teaching

2019-20 Courses


Stanford Advisees


Graduate and Fellowship Programs


Publications

All Publications


  • Pediatric pain psychology: Guidelines for advanced subspecialty training. Clinical Practice in Pediatric Psychology Benore, E., Bhandari, R., Harbeck-Weber, C., Logan, D. E., Banez, G. 2017; 5 (1): 17-35

    View details for DOI 10.1037/cpp0000174

  • Pediatric-Collaborative Health Outcomes Information Registry (Peds-CHOIR): a learning health system to guide pediatric pain research and treatment. Pain Bhandari, R. P., Feinstein, A. B., Huestis, S. E., Krane, E. J., Dunn, A. L., Cohen, L. L., Kao, M. C., Darnall, B. D., Mackey, S. C. 2016; 157 (9): 2033-2044

    Abstract

    The pediatric adaptation of the Collaborative Health Outcomes Information Registry (Peds-CHOIR) is a free, open-source, flexible learning health care system (LHS) that meets the call by the Institute of Medicine for the development of national registries to guide research and precision pain medicine. This report is a technical account of the first application of Peds-CHOIR with 3 aims: (1) to describe the design and implementation process of the LHS; (2) to highlight how the clinical system concurrently cultivates a research platform rich in breadth (eg, clinic characteristics) and depth (eg, unique patient- and caregiver-reporting patterns); and (3) to demonstrate the utility of capturing patient-caregiver dyad data in real time, with dynamic outcomes tracking that informs clinical decisions and delivery of treatments. Technical, financial, and systems-based considerations of Peds-CHOIR are discussed. Cross-sectional retrospective data from patients with chronic pain (N = 352; range, 8-17 years; mean, 13.9 years) and their caregivers are reported, including National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) domains (mobility, pain interference, fatigue, peer relations, anxiety, and depression) and the Pain Catastrophizing Scale. Consistent with the literature, analyses of initial visits revealed impairments across physical, psychological, and social domains. Patients and caregivers evidenced agreement in observable variables (mobility); however, caregivers consistently endorsed greater impairment regarding internal experiences (pain interference, fatigue, peer relations, anxiety, and depression) than patients' self-report. A platform like Peds-CHOIR highlights predictors of chronic pain outcomes on a group level and facilitates individually tailored treatment(s). Challenges of implementation and future directions are discussed.

    View details for DOI 10.1097/j.pain.0000000000000609

    View details for PubMedID 27280328

  • Rapid identification and clinical indices of fear-avoidance in youth with chronic pain. Pain Heathcote, L. C., Bhandari, R. P., Timmers, I., Harrison, L. E., Simons, L. E. 2019

    Abstract

    Pain-related fear and avoidance are increasingly demonstrated to play an important role in adult and childhood chronic pain. The Fear of Pain Questionnaire for Children (FOPQC) is a 24-item measure of pain-related fear-avoidance in youth that has demonstrated good indices of reliability and validity, treatment responsiveness, and associations with brain circuitry alterations. This study describes the development and psychometric examination of the FOPQC-SF, a short form of the original measure. We selected 10 items for the short form that best represented the content and two-factor (Fear and Avoidance) structure of the original measure from a cohort of 613 youth (Mage = 14.7 years) with chronic pain. Next, confirmatory factor analyses from a second sample of 526 youth (Mage = 14.7 years) with chronic pain who completed the FOPQC-SF supported the original two-factor model but indicated that one item should be moved to the avoidance subscale. The FOPQC-SF demonstrates strong internal consistency and moderate-to-strong construct and criterion validity. Three-month test-retest reliability estimates (N=94) were strong and there was preliminary evidence of responsivity to change. To aid integration into intervention trials and clinical practice, we provide clinical reference points and a criterion to assess reliable change. The short form could be used for rapid identification of pain-related fear and avoidance in youth during clinic evaluations, and is optimized for clinical registries.

    View details for DOI 10.1097/j.pain.0000000000001742

    View details for PubMedID 31688496

  • Profiling Modifiable Psychosocial Factors among Children with Chronic Pain: A Person-Centered Methodology. The journal of pain : official journal of the American Pain Society Richardson, P. A., Birnie, K. A., Harrison, L. E., Rajagopalan, A., Bhandari, R. P. 2019

    Abstract

    Targeting individually based psychosocial profiles when treating children with chronic pain and their families is key to effective behavioral health intervention and in line with tenants of precision medicine. Extant research is primarily driven by variable-centered models that focus on broad, group-level differences. The current study adopts a person-centered approach, latent profile analysis (LPA), to identify patient subgroups. Cross-sectional data are presented from 366 children (8-17 years; M=14.48; SD=2.36) with chronic pain and a primary caregiver (94% mothers). LPA indicator variables were, self-reported: fatigue, internalizing symptoms, pain catastrophizing, and pain acceptance; parent-reported: pain catastrophizing and responses to child pain. One-way ANOVAs examined the effect of profiles on child age, pain, and function. LPA identified a four-profile solution. Class 1 (12%) demonstrated the lowest scores (conveying least risk) across 5 of 6 factors. Class 4 (37%) had the highest scores (conveying greatest risk) across all factors. Classes 2 (12%) and 3 (39%) demonstrated more variability across domains. Results revealed significant effects of profile based on child age, pain, and function. This study highlights differential presentation of treatment-modifiable domains within a large sample. LPA methodology is showcased to potentially facilitate clinical conceptualizations and tailored approaches to intervention in pediatric chronic pain. Perspective: This article presents a methodological and statistical approach that may be beneficial to better assess individual profiles of pediatric pain functioning. Tools that allow providers to better match patient presentation and intervention are in line with the tenants of precision medicine and may ultimately serve to improve child outcomes.

    View details for DOI 10.1016/j.jpain.2019.08.015

    View details for PubMedID 31521795

  • Interpersonal Dyadic Influences of Pain Catastrophizing Between Caregivers and Children with Chronic Pain. The Clinical journal of pain Parker, D. M., Birnie, K. A., Yoon, I. A., Bhandari, R. P. 2019

    Abstract

    Pain catastrophizing is an important predictor of pain-related outcomes. Caregiver and child levels of catastrophizing about child chronic pain are associated cross-sectionally, yet predictive associations testing interpersonal influences within caregiver-child dyads are lacking. The present study tested caregiver and child influences on partner catastrophizing about child pain over 1 month following initiation of interdisciplinary pain treatment and examined whether change in pain catastrophizing was associated with child pain interference.113 caregiver-child dyads (Mage=14.41) completed measures at the time of initiating care at a pediatric tertiary outpatient pain management clinic (baseline) and approximately 1 month later. Caregivers and children independently reported on catastrophizing about child pain and child pain interference at baseline and 1 month follow up.Caregiver and child pain catastrophizing decreased over 1 month following initial interdisciplinary pain evaluation, with average scores remaining in the moderate to high range. Change in caregiver, but not child, catastrophizing about child pain was predicted by partner baseline pain catastrophizing. Decreases in catastrophizing about child pain were associated with within person improvement in ratings of child pain interference.In the short period following initial pain evaluation, caregivers and children evidenced reductions in pain catastrophizing, which were associated with increased child function. Findings highlight the important role of child cognitive-affective responses to pain in influencing caregiver catastrophizing about child pain. Understanding the individual contributions children and caregivers make to interpersonal pain processes will inform future family-level clinical interventions.

    View details for DOI 10.1097/AJP.0000000000000773

    View details for PubMedID 31613833

  • The role of fatigue in functional outcomes for youth with chronic pain. European journal of pain (London, England) Yoon, I. A., Sturgeon, J. A., Feinstein, A. B., Bhandari, R. P. 2019

    Abstract

    As a complex multidimensional construct, fatigue may play an important role in the physical and psychosocial functioning of youth with chronic pain. Based on a model previously tested in adults, the current study similarly utilized patient-reported outcomes measurement system (PROMIS) to examine how fatigue contributes to functional outcomes for youth with chronic pain. The model tested self-reported ratings of pain intensity, depressive symptoms and sleep disturbance as predictors of outcomes (mobility, pain-related interference and school functioning) as mediated by ratings of fatigue.Two hundred and eighty-five youth with chronic pain ages 8-17 years and their caregivers, completed surveys as part of their initial clinical evaluation at a tertiary paediatric pain clinic. Study measures included: paediatric PROMIS domains (mobility, pain interference, sleep disturbance, fatigue and depressive symptoms), Paediatric Quality of Life school functioning and pain intensity. All mediated effects were calculated via a 1,000-draw bootstrap estimation method in Mplus.Fatigue was found to be a statistically significant mediator of the effects of pain intensity, sleep disturbance and depressive symptoms on outcomes of pain interference, mobility and school functioning. While pain intensity was found to independently contribute to mobility and pain interference, depressive symptoms did not show significant effects on any outcome beyond its association with fatigue. Sleep disturbance predicted pain interference while fatigue predicted school functioning.Findings suggest that fatigue is an important intervening factor for functional outcomes among youth with chronic pain. Targeting fatigue may be effective in optimizing school functioning and reducing the deleterious effects of depressive symptoms.This cross-sectional study highlights fatigue as a potential clinical target by applying a path analytic model to understand its possible significance and distinction from overlapping constructs such as pain intensity, depression and sleep disturbance. Further study of fatigue may be important in understanding its importance in treatment of paediatric chronic pain.

    View details for DOI 10.1002/ejp.1431

    View details for PubMedID 31131940

  • Risk and Resilience in Pediatric Pain: The Roles of Parent and Adolescent Catastrophizing and Acceptance CLINICAL JOURNAL OF PAIN Feinstein, A. B., Sturgeon, J. A., Bhandari, R. P., Yoon, I. A., Ross, A. C., Huestis, S. E., Griffin, A. T., Simons, L. E. 2018; 34 (12): 1096–1105
  • Risk and Resilience in Pediatric Pain: The Roles of Parent and Adolescent Catastrophizing and Acceptance. The Clinical journal of pain Feinstein, A. B., Sturgeon, J. A., Bhandari, R. P., Yoon, I. A., Ross, A., Huestis, S., Griffin, A., Simons, L. 2018

    Abstract

    OBJECTIVES: Both pediatric and parent pain catastrophizing and pain acceptance are key factors associated with pediatric pain outcomes; however, the interactive effects of these factors within the parent-child dyad have yet to be tested. The aims of this study were to examine: (1) the mediating role of child catastrophizing between parent catastrophizing and child outcomes (pain interference and mobility), (2) the mediating role of child acceptance between parent acceptance and child outcomes, and (3) whether child acceptance buffers the relation between parent catastrophizing and child catastrophizing, which in turn impacts child outcomes.METHODS: Cross-sectional data from 324 youth with chronic pain ages 10 to 17 years (M age=14.72, (SD=2.12); 73.1% female; 59% Caucasian) and their parents were collected. Participants completed measures assessing pediatric PROMIS domains (mobility and pain interference), pain catastrophizing, pain acceptance, and child pain intensity. Mediation was conducted via 1000-draw bootstrap-adjusted analyses in Mplus.RESULTS: Parent pain catastrophizing was indirectly associated with child pain interference via child catastrophizing but was not associated with mobility difficulties in the mediation model. Parent pain acceptance was indirectly associated with both child pain interference and mobility via child acceptance. We did not find evidence of child acceptance buffering parent and child pain catastrophizing.DISCUSSION: The findings of this study highlight the need for caregiver involvement in multidisciplinary treatments to mitigate risk and enhance resilience in youth with chronic pain.

    View details for PubMedID 30028367

  • A Pilot Study of Mindfulness Meditation for Pediatric Chronic Pain. Children (Basel, Switzerland) Waelde, L. C., Feinstein, A. B., Bhandari, R., Griffin, A., Yoon, I. A., Golianu, B. 2017; 4 (5)

    Abstract

    Despite advances in psychological interventions for pediatric chronic pain, there has been little research examining mindfulness meditation for these conditions. This study presents data from a pilot clinical trial of a six-week manualized mindfulness meditation intervention offered to 20 adolescents aged 13-17 years. Measures of pain intensity, functional disability, depression and parent worry about their child's pain were obtained at baseline and post-treatment. Results indicated no significant changes in pain or depression, however functional disability and frequency of pain functioning complaints improved with small effect sizes. Parents' worry about child's pain significantly decreased with a large effect size. Participants rated intervention components positively and most teens suggested that the number of sessions be increased. Three case examples illustrate mindfulness meditation effects and precautions. Mindfulness meditation shows promise as a feasible and acceptable intervention for youth with chronic pain. Future research should optimize intervention components and determine treatment efficacy.

    View details for DOI 10.3390/children4050032

    View details for PubMedID 28445406

  • The Effect of Pain Catastrophizing on Outcomes: A Developmental Perspective Across Children, Adolescents, and Young Adults With Chronic Pain. journal of pain Feinstein, A. B., Sturgeon, J. A., Darnall, B. D., Dunn, A. L., Rico, T., Kao, M. C., Bhandari, R. P. 2017; 18 (2): 144-154

    Abstract

    Pain catastrophizing is one of the most powerful predictors of poor outcomes in youth and adults with pain; however, little is known about differential effects of pain catastrophizing on outcomes as a function of age. The current study examined the predictive value of pain catastrophizing on pain interference and pain intensity across children, adolescents, and 2 age groups of young adults with chronic pain. Cross-sectional data are presented from the adult and pediatric Collaborative Health Outcomes Information Registry (CHOIR), including measures of pain catastrophizing, pain intensity, pain interference, and emotional distress from 1,028 individuals with chronic pain. Results revealed that age moderated the relation between pain catastrophizing and pain interference, with the strength of these effects declining with age. The effect of pain catastrophizing on pain interference was strongest in adolescents and relatively weak in all 3 other groups. Emotional distress was the strongest predictor of pain interference for children, whereas pain intensity was the strongest predictor for both adult groups. Pain catastrophizing was found to predict pain intensity and, although age was a significant moderator, statistical findings were weak. Developmental considerations and clinical implications regarding the utility of the construct of pain catastrophizing across age groups are discussed.This article explores differences in pain catastrophizing as predictors of pain interference and pain intensity across cohorts of children, adolescents, and 2 age groups of young adults. This work may stimulate further research on chronic pain from a developmental perceptive and inform developmentally tailored treatment interventions that target catastrophizing, emotional distress, and pain intensity.

    View details for DOI 10.1016/j.jpain.2016.10.009

    View details for PubMedID 27825857

  • A Pilot Study of Mindfulness for Pediatric Chronic Pain Children Waelde, L. C., Feinstein, A., Rashmi, B., Griffin, A., Yoon, I. A., Golianu, B. 2017; in press
  • Multi-Family Pediatric Pain Group Therapy: Capturing Acceptance and Cultivating Change. Children (Basel, Switzerland) Huestis, S. E., Kao, G., Dunn, A., Hilliard, A. T., Yoon, I. A., Golianu, B., Bhandari, R. P. 2017; 4 (12)

    Abstract

    Behavioral health interventions for pediatric chronic pain include cognitive-behavioral (CBT), acceptance and commitment (ACT), and family-based therapies, though literature regarding multi-family therapy (MFT) is sparse. This investigation examined the utility and outcomes of the Courage to Act with Pain: Teens Identifying Values, Acceptance, and Treatment Effects (CAPTIVATE) program, which included all three modalities (CBT, ACT, MFT) for youth with chronic pain and their parents. Program utility, engagement, and satisfaction were evaluated via quantitative and qualitative feedback. Pain-specific psychological, behavioral, and interpersonal processes were examined along with outcomes related to disability, quality of life, pain interference, fatigue, anxiety, and depressive symptoms. Participants indicated that CAPTIVATE was constructive, engaging, and helpful for social and family systems. Clinical and statistical improvements with large effect sizes were captured for pain catastrophizing, acceptance, and protective parenting but not family functioning. Similar effects were found for functional disability, pain interference, fatigue, anxiety, and depression. Given the importance of targeting multiple systems in the management of pediatric chronic pain, preliminary findings suggest a potential new group-based treatment option for youth and families. Next steps involve evaluating the differential effect of the program over treatment as usual, as well as specific CBT, ACT, and MFT components and processes that may affect outcomes.

    View details for PubMedID 29215566

  • Social Risk and Resilience Factors in Adolescent Chronic Pain: Examining the Role of Parents and Peers. Journal of pediatric psychology Ross, A. C., Simons, L. E., Feinstein, A. B., Yoon, I. A., Bhandari, R. P. 2017

    Abstract

    The current study focuses on social risk and resilience in an adolescent population with chronic pain. Prior research identifies parental cognitions and behaviors as influential in youths' experiences of chronic pain and pain-related disability. Adolescent development is characterized by greater autonomy from parents and an increased emphasis on peer relationships. Study aims explore the potential protective effect of high-quality adolescent peer relationships on associations between parent and adolescent cognitive and behavioral responses to pain.238 adolescents with mixed-etiology chronic pain and their parents completed Pediatric Collaborative Health Outcomes Information Registry (Peds-CHOIR) electronic questionnaires prior to their initial visit to a tertiary pediatric pain clinic. Variables in this study include parent catastrophizing, parent protective behavior, adolescent peer relationship quality, adolescent catastrophizing, adolescent functional impairment, and demographic and pain characteristics.As expected, associations between parent and adolescent cognitive and behavioral pain responses were moderated by peer relationship quality. Contrary to expectations, for adolescents endorsing low-quality peer relationships, maladaptive adolescent outcomes were elevated across levels of parental cognitions and behaviors. For adolescents endorsing high-quality peer relationships, adolescent and parent pain responses were linearly related.This study highlights the salience of both family and peer processes in functional outcomes among adolescents with chronic pain. Results suggest that adolescents' adaptive responses to chronic pain may be best supported by the simultaneous presence of adaptive parenting and high-quality peer relationships. Understanding the larger social context in which an adolescent exists is informative in specifying models that predict adaptive outcomes or magnify risks.

    View details for PubMedID 29048554

  • Multi-family pediatric pain group therapy: Capturing acceptance and cultivating change Children Huestis, S. E., Kao, G., Dunn, A., Hilliard, A. T., Yoon, I. A., Golianu, B., Bhandari, R. P. 2017; 4 (12)

    View details for DOI 10.3390/children4120106

  • Spotlight on the Pediatric Pain Psychology Special Interest Group Clinical Practice in Pediatric Psychology Harbeck-Weber, C., Benore, E., Bhandari, R., Logan, D. E., Banez, G. 2017; 5 (1): 15-16
  • Traumatic stress and pediatric pain: A neurobiological stress-health perspective Journal of Child and Adolescent Trauma Kao, G. S., Bhandari, R., Huestis, S., Golianu, B. 2017; in press
  • The Impact of Pain Catastrophizing on Outcomes: A Developmental Perspective across Children, Adolescents and Young Adults with Chronic Pain Journal of Pain Feinstein, A. B., Sturgeon, J. A., Bhandari, R. P., Dunn, A., Rico, T., Kao, M. C., Darnall, B. D. 2016

    Abstract

    Pain catastrophizing is one of the most powerful predictors of poor outcomes in youth and adults with pain; however, little is known about differential effects of pain catastrophizing on outcomes as a function of age. The current study examined the predictive value of pain catastrophizing on pain interference and pain intensity across children, adolescents, and 2 age groups of young adults with chronic pain. Cross-sectional data are presented from the adult and pediatric Collaborative Health Outcomes Information Registry (CHOIR), including measures of pain catastrophizing, pain intensity, pain interference, and emotional distress from 1,028 individuals with chronic pain. Results revealed that age moderated the relation between pain catastrophizing and pain interference, with the strength of these effects declining with age. The effect of pain catastrophizing on pain interference was strongest in adolescents and relatively weak in all 3 other groups. Emotional distress was the strongest predictor of pain interference for children, whereas pain intensity was the strongest predictor for both adult groups. Pain catastrophizing was found to predict pain intensity and, although age was a significant moderator, statistical findings were weak. Developmental considerations and clinical implications regarding the utility of the construct of pain catastrophizing across age groups are discussed.This article explores differences in pain catastrophizing as predictors of pain interference and pain intensity across cohorts of children, adolescents, and 2 age groups of young adults. This work may stimulate further research on chronic pain from a developmental perceptive and inform developmentally tailored treatment interventions that target catastrophizing, emotional distress, and pain intensity.

    View details for DOI 10.1016/j.jpain.2016.10.009

  • Restrictive parenting buffers head start students from stress INFANTS AND YOUNG CHILDREN Bhandari, R. P., Barnett, D. 2007; 20 (1): 55-63