Pain Medicine

The inpatient team of the Pain Management Service consists of pain management physicians, an advanced practice nurse, a massage therapist and, when appropriate, a licensed child psychologist or psychiatrist.

The inpatient pain management team provides pain and symptom management 24/7 with expert consultation for hospitalized patients experiencing pain associated with a variety of illnesses or treatments including:

• Pain due to injury
• Pain following surgery
• Pain associated with illness or treatment for an illness (cancer, sickle cell anemia, etc.)
• Nausea, itching or other unpleasant symptoms or side effects of diseases and their treatments
• Anxiety and stress due to hospitalization
• Weaning management from long-term use of pain killers and sedatives
• Prescription of outpatient pain management programs

The Pain Management Clinic also provides evaluation and treatment to children who are not hospitalized, but who are experiencing chronic or recurrent pain.

The initial clinic evaluation is conducted by a team that includes a physician, a nurse practitioner, a child psychologist and a physical therapist, with additional evaluation by our pain management child psychiatry consultant as appropriate. The clinic provides a full spectrum of nonpharmacologic methods, such as acupuncture, acupressure, biofeedback, relaxation training and medical hypnosis in addition to conventional medical management of pain and related symptoms including medication management and interventional pain procedures.

Examples of problems treated at the Outpatient Pain Management Clinic include:

• Chronic, daily, or recurrent headaches
• Chronic or recurrent abdominal pain
• Complex regional pain syndromes (also known as reflex sympathetic dystrophy) and other forms of neuropathic pain
• Fibromyalgia
• Myofascial pain
• Back pain
• Pain secondary to acute or chronic illness (arthritis, cancer, etc.)

The Pediatric Rehabilitation Program (PReP) at Stanford Children’s Health is an intensive day treatment program dedicated to treating children and adolescents suffering from debilitating chronic pain conditions.  The main goal of PReP is to improve your child’s quality of life by increasing their function and pain management.   We treat children and adolescents with chronic pain problems that will benefit from a rehabilitation approach.

We begin with a team evaluation of your child’s pain condition to develop the best treatment plan.  This pain management clinic evaluation will identify if your child’s condition may improve through a functional rehabilitation treatment plan.   Children admitted into PReP are usually unable to attend school, social outings, and no longer participate in enjoyable activities.  The program is designed to treat both the medical and psychological issues associated with these chronic pain conditions.  The PReP providers are an interdisciplinary team of physicians, nurse practitioners, psychologists, psychiatrists, physical therapists, occupational therapists, and teachers who have expertise in treating children and adolescents diagnosed with chronic pain conditions. 

Your child will spend about 8 hours per day for 5 days per week within our program (Monday through Friday).  The day begins with group aquatic therapy with our PReP providers, followed by two hours at the Lucile Packard Children’s Hospital school program, which is staffed by Palo Alto Unified School District teachers.  After a lunch break, your child will participate in individual and group physical therapy, occupational therapy, and psychology sessions.  Pain management psychological services will help your child learn to cope better through the use of relaxation and other appropriate techniques to improve their daily functioning and pain.  Parent education is also provided weekly to help your child succeed at home with pain management behavioral interventions.  Your child will also participate in group therapy sessions and a weekly family therapy session with our psychologist.  Your child will be evaluated by our psychiatrist and will have regular follow up as needed.  At the end of each week, your child will have a medical exam, develop a home exercise plan, and participate in a care conference with the PReP team.  All PReP sessions are mandatory and parent participation is a requirement.  Treatment may also include medication management for pain, sleep, anxiety, and other mood disorders.  Therapeutic nerve blocks may also be utilized if medically indicated.  Acupuncture services are also available, when recommended by our team.

We begin working on a discharge plan to transition home soon after your child begins PReP.  Typically, children return to school and most of their usual activities and are better at managing pain or may even report having no pain.  Many of our patients continue to require some outpatient treatment with psychical therapy, occupational therapy, psychology, or medical follow up for pain management. We work to coordinate care with your home providers. 

A sample schedule is available below.  Treatment length is determined by your child’s PReP team, but typically lasts from 4-8 weeks and no longer than 12 weeks.  Your child’s treatment plan is individualized to their needs based on their pain condition and the progress they make in the program. The PReP team works closely together to create the best outcome for your child.

Families traveling from out of town may qualify to stay at the Ronald McDonald House or the J.W. House, when space is available, for a nominal fee.  Discounted rates may be arranged through the Lucile Packard Children's Hospital Stanford Housing Office for families preferring a nearby motel or hotel, or when other resources are unavailable.

To find out if your child is eligible for PReP treatment, your child should be referred to the Outpatient Pain Management Clinic by their physician who can call the referral center at (800)-995-5724.  Once referred, your child will undergo a multi-disciplinary evaluation to determine eligibility for the program.  If PReP treatment is recommended and appropriate, your child will then be placed on our wait list for the program and insurance authorization will be obtained.  At times, the wait list may take several months, but we encourage families to continue with outpatient therapies until they begin PReP.  Our team may also require that your child achieve certain goals before they start PReP, in order to get the most out of their time in the program.  Our goal is to provide children and their families with at least 2 weeks notice of their start date.  However, sometimes a slot may open sooner than anticipated.

Thank you for your interest in our program.

The Day Rehabilitation Program (DRP) at Stanford Children's Health is a treatment program designed to provide access to pain rehabilitation expertise in a day-long format for patients that are not local to our pain clinic.  The program occurs once per week (approximately for 5 hours), usually between 10 AM to 4 PM.  This allows patients to travel in the morning and evenings on the day of service.  The program may include physical therapy, occupational therapy, medical checkups, psychological sessions, psychiatric sessions, caregiver support sessions, and acupuncture.  Patients are typically in the program for about 6 weeks.  The program begins expert treatment for patients and allows our providers to transition care to local providers at the end of the program as necessary.  If interested, please have your physician submit a referral to our pediatric pain clinic for further evaluation.