Overview

Overview

Pediatric Pain Rehabilitation Program wins acreditation.

When a Child Hurts the Whole Family Hurts

Chronic pain can be so disabling that it can prevent a child from participating in normal age-appropriate activities, such as school, social events, and sports. It also can lead to isolation and depression as the child withdraws from friends and family.

When a child suffers, the whole family suffers. Not only are you consumed with finding a way to help your child, you may be experiencing added stress due to lost work time and other disruptions to daily living.

The Pediatric Pain Rehabilitation Program at Cleveland Clinic Children’s offers hope to children and families coping with chronic pain and related functional disability, even after standard therapies, surgeries and medications have been exhausted. The Center is designed to help both children and families reclaim their lives.

Programs

Programs

Your child and family will benefit from the expertise of our inter-disciplinary team. We offer a comprehensive range of services.

Outpatient Services

Pediatric Pain Assessment & Continuity Clinic

  • The Pediatric Pain Rehabilitation Assessment Clinic provides interdisciplinary evaluation of children and adolescents with chronic pain and related functional impairment (e.g., missed school days, withdrawal from friends and activities). Our evaluation is designed to help you determine which treatment services will be most effective in helping your child return to normal activity. It is one half-day in length and includes assessments by a physician who specializes in pain/rehabilitation medicine), a psychologist, and either a physical therapist or occupational therapist. The team will then meet with the family to review all findings and recommendations.
  • If referred for inpatient pain rehabilitation, yYou and your child will receive a tour of our facilities and have opportunities to learn more about the services we provide. This will give you an opportunity to meet and observe us in action so that you can decide if we are the right fit for your child and family.
  • If any services are recommended, our team is also available to monitor your treatment progress and provide additional consultation as needed.
  • To schedule an evaluation, please contact Terri Burris at 216.448.6253.

Outpatient Group Treatment for Chronic Pain

  • Evidence-based treatment is provided to children ages 8-18 with varied chronic pain diagnoses. We combine the skills of cognitive-behavioral therapy and physical rehabilitation.
  • Treatment is provided to children, while parents also actively participate in the intervention.
  • 8 sessions will be provided over a 2 month period, covering the following topics:
    • Breathing exercises
    • Relaxation skills (Imagery/PMR/autogenic)
    • Distraction
    • Thinking strategies (cognitive restructuring)
    • Problem-solving
    • The power of acceptance
    • Sleep hygiene
    • Body mechanics
    • The power of Pacing
    • Stretching, strengthening, and endurance training
    • Parent wellness
    • Parent support of child self-management
    • Working with schools
    • Siblings and family coping with chronic pain
    • Personal goal setting and action plans
    • Relapse prevention
  • Treatment is currently provided at the following locations in the region:
  • Contact 216.448.6253 for current and upcoming groups.

Individual/Family Outpatient CBT for Chronic Pain

  • Evidence-based psychological treatment is provided individually to children ages 5-21 with varied chronic pain diagnoses.
  • For children with headache alone, they may also consider Behavioral Treatment for Headache.
  • Treatment is provided to children and parents. Other family members may be involved.
  • You can expect 10-15 sessions provided over a 4 month period, covering the following topics:
    • Personal goal setting and action plans
    • Breathing exercises
    • Relaxation skills (Imagery/PMR/autogenic)
    • Distraction
    • Thinking strategies (cognitive restructuring)
    • Problem-solving
    • The power of acceptance
    • Sleep hygiene
    • The power of Pacing
    • Parent wellness
    • Parent support of child self-management
    • Working with schools
    • Siblings and family coping with chronic pain
    • Relapse prevention
  • Treatment is currently provided at the following locations in the region:
  • Your progress will be monitored through the Pain assessment and Continuity Clinic

Outpatient PT/OT for Chronic Pain

  • Evidence-based physical and occupational therapy is provided individually to children ages 5-21 with varied chronic pain diagnoses.
  • Sessions cover the following topics:
    • Personal goal setting and action plans
    • The power of Pacing
    • Body mechanics
    • Stretching, strengthening, and endurance training
    • Parent support of child self-management
    • Relapse prevention/home exercise programs
  • Treatment is currently provided at the following locations in the region:
  • Your progress will be monitored through the Pain assessment and Continuity Clinic

Biofeedback for Chronic Pain

  • Evidence-based biofeedback treatment is provided individually to children ages 5-21 with varied chronic pain diagnoses
  • You can expect 10-20 sessions provided over a 3 month period. Typical treatment involves:
    • Respiration
    • Heart-rate variability (HRV)
    • Temperature
    • Muscle Contraction (sEMG)
  • Treatment typically lasts 30-45 minutes
  • Treatment is currently provided at the following locations in the region:
  • Your progress will be monitored through the Pain assessment and Continuity Clinic

School Reentry Planning Program

  • Our team works closely with the Center for Pediatric Behavioral Health who can provide additional psychological and/or educational testing as needed.
  • We can then assist the family and school system in appropriate accommodations or services to optimize student performance and support academic growth.

Multidisciplinary Patient Educational Program

  • Open to all families, whether active patients or not.
  • Our staff will provide monthly presentations regarding chronic pain in children and families.
  • Contact 216.448.6253 for a current list of dates, topics and cost.
What We Treat

What We Treat

Pediatric Pain Rehabilitation located at Cleveland Clinic Children's Hospital for Rehabilitation is specifically designed for children and teens whose chronic pain interferes with their normal activities.

We treat children and adolescents with:

Complex regional pain syndrome (CRPS), a complex neurological syndrome that is a major cause of disability. It is characterized by severe, burning pain, extreme sensitivity to touch, tissue swelling and excessive sweating.

Chronic headache, either migraine or tension-type. These headaches may not be caused by serious underlying disease, but they also may not respond to medications, leaving children in pain much of the time.

Chronic abdominal pain, which can be caused by a variety of digestive disorders, such as irritable bowel syndrome (IBS), and include a mixture of disabling symptoms that interfere with daily functioning.

Fibromyalgia, a complex, debilitating disorder characterized by chronic widespread pain, multiple tender points (areas of surface pain near the joints), sleep disturbances and fatigue.

Juvenile Arthritis, which causes joint inflammation and pain episodes lasting weeks to months, creates significant distress and makes it difficult for children to perform daily activities.

Sickle Cell Pain, a genetic abnormality affecting the body’s hemoglobin. Disabling symptoms include severe pain in the chest, back, arms, legs, and abdomen, as well as fever and difficulty breathing.

Postural Orthostatic Tachycardia Syndrome (POTS), is a form of dysautonomia, which means the body’s ability to regulate automatic functions is altered. Many children complain of fatigue, headaches, lightheadedness, heart palpitations, exercise intolerance, nausea, poor concentration, shaky feeling, fainting of feeling faint, coldness or pain in the extremeties, chest pain and shortness of breath.

Other conditions affecting our patients include chronic back pain, various types of arthritis, chronic pelvic pain, chronic leg pain and chronic diffuse pain.

Why Choose Us

Why Choose Us

Our Center blends the expertise of behavioral health, physical medicine and rehabilitation, and rehabilitation therapy services in all our core programs. We work closely with nutrition, nursing, recreational therapy, and integrative medicine in the programs we provide.

Our Pediatric Pain Rehabilitation Program, led by Gerard A. Banez, PhD, is the first and only interdisciplinary pain rehabilitation program dedicated to children and adolescents to be accredited by the Commission on Accreditation for Rehabilitation Facilities (CARF), demonstrating our commitment to providing the highest quality services. The program was recently recognized by the American Pain Society as a Clinical Center of Excellence in Pain Management for its distinguished, comprehensive pain care.

Each year we see over 180 children with chronic pain and their families in our Assessment Clinic. We also provide care to over 100 children per year in our Pediatric Pain Rehabilitation Program and hundreds of children each year in our outpatient programs.

Our staff is dedicated to improving the lives of our patients through innovative clinical activities and treatment-center research.

Outcomes

We are proud of the change that we are able to bring to our patients’ and families’ lives through the Pediatric Pain Rehabilitation Program. Our results consistently show that patients’ pain and functional impairment — typically of two or more years’ duration prior to program entry — are significantly improved. Children who complete the program report substantial improvements in their physical functioning, social activity, and anxiety about pain.

Our long-term assessments have revealed that these gains are maintained over time. Follow-up of 190 adolescents treated in the program revealed these clinically significant and sustained improvements:

  • Upon admission: Patients averaged 3.32 missed school days per week, and parents reported an average of 2.51 missed work days per week. Surveyed parents rated their child’s pain a 6.76 on a 0-to-10 scale.
  • Two years after program discharge: Patients surveyed two years after their child completed the program averaged 0.22 missed school days per week, and parents reported 0.16 missed work days. Surveyed parents rated their child’s pain a 3.79.
  • Three years after discharge: Patients surveyed three years after their child completed the program reported 0.32 missed school days per week, and parents reported zero missed work days. Surveyed parents rated their child’s pain a 3.0.

2016 Outcomes

The Pediatric Pain Rehabilitation Program at Cleveland Clinic Children’s Hospital for Rehabilitation is a unique and innovative program designed for children and adolescents with chronic pain that interferes with normal activities. As a result of their pain, these children do not attend school, interact with peers or participate in normal activities. Our program focuses on helping children manage their pain and on restoring daily activity. It consists of inpatient and day hospital components, and blends pediatric subspecialty care, behavioral health, and rehabilitation therapies in an individualized, but coordinated, manner. The program was a recipient of the 2015 American Pain Society Clinical Centers of Excellence in Pain Management award and is the first pediatric specialty, interdisciplinary pain rehabilitation program accredited by the Commission on the Accreditation of Rehabilitation Facilities (CARF).

  • In 2016, a total of 119 patients were seen. 61% of our patients were from out-of-state. In 2015, 106 patients were seen.
  • In 2016, patients reported an average 89% improvement in Physical Functioning, based on the BAPQ. 2015 data revealed an average 56% improvement.
  • In 2016, patients reported an average 28% improvement in Social Functioning, based on the BAPQ. 2015 data revealed an average 30% improvement.
  • In 2016, patients reported an average 29% improvement in Pain-Specific Anxiety, based on the BAPQ. 2015 data revealed an average 30% decrease.
  • One-month follow up assessment for 2016 revealed an average 5% decrease in pain severity, compared to a 13% decrease in 2015.
  • In 2016, the Pediatric Pain Rehabilitation Program conducted a follow-up of patients five years post-discharge. One-hundred nineteen out of 192 patients were contacted, and 57 patients (47%) completed a telephone follow-up survey.
  • Significant reductions in school and/or work days missed, health care utilization, and medication usage were reported.
  • On a scale of 0 (no pain) to 10 (maximum pain), a significant decline in pain from admission to 5-year follow-up was reported.
What To Expect

What To Expect

Patients and families should plan to arrive at 8:30 a.m. on the day of admission. The first day will primarily be information gathering, assessments and evaluations. Parents typically stay through the morning of the first day as their child adjusts to hospital staff and routines. Therapists may evaluate your child while you are waiting or speaking with other staff members.

Inpatient/day Hospital Program

  • Pediatric Pain Rehabilitation Program
    • Our unique program, staffed by an interprofessional team of experts in rehabilitation services, behavioral health, and medical care, blends two weeks of intensive inpatient treatment with one week of outpatient therapies specifically tailored to meet the needs of each child’s pain condition and functional impairment. We work closely with parents and caregivers how to support their child to achieve enduring long-term results.

Program/Hospital Information

The following resources will help you better understand our program, and what next steps you and your child can take toward finding relief.

Pediatric Pain Rehabilitation Program Sample Schedules

First Two Weeks

Patients are admitted to the Children's Hospital for Rehabilitation Campus to be treated on an inpatient basis. They will be evaluated by:

  • Pediatric physician
  • Physiatrist
  • Psychologist
  • Occupational therapist
  • Physical therapist
  • Recreational therapist

After we evaluate each patient’s needs, we form a specific, individualized treatment plan to provide pain management.

First Weekend

On Saturday, please plan some activities that your child enjoys, i.e. books, movies, games, as they will have free time but may not leave the hospital.

On Sunday, as long as patients are medically stable and have no technology prohibiting it, families and patients may go out for a 6-8 hour day pass that is active and will support your child’s program goals.

End of Week 2: Discharge from Inpatient Program

Your child will be discharged on Friday of the second week to begin the Day Therapy Program for the third week. Parents should plan to report to the unit at the end of the day Friday to complete discharge paperwork.

Third Week

Children are treated on an outpatient basis during the third week. They come to the Day Therapy Program and continue the work of the first two weeks, but return to their families each evening.

Each day begins at 8 a.m. Parents should walk children into the hospital. On the first day there will be paperwork that needs to be completed and you should plan to stay briefly.

Pick up times vary throughout the week but are between 4 p.m. and 6:30 p.m.

Parent/Family Meetings

Parent Group is held every Tuesday at 3 p.m. and every Thursday at 10 a.m. Family Meetings are held on the second Thursday of the program during the 1 p.m. hour. In addition, parents may also be asked to participate in meetings, family education, and counseling throughout their child’s stay.

Staff

Staff

Program staff include pediatric physical medicine and rehabilitation specialists, psychiatrists, hospitalists, nurses, psychologists and counselors, a social worker, physical therapists, occupational therapists, recreation therapists and a teacher.

Program Directors

Medical Director

Program Coordinator

  • Kristen Buchannan, LISW

Patient Care Management

  • Dorothy Kasper, RN, BSN, CCM, CPN

Administrative Assistant

  • Terri Burris

Anesthesiology/Pain Management

Behavioral Health

Rehabilitation Medicine

Child and Adolescent Psychiatry

Neurology

Additional Specialties

Contact Us

Contact Us

Additional Information & Referrals

You shouldn’t feel helpless. Your child is not alone, and neither are you. Explore our site further to learn more about specific pain conditions that can be effectively treated through our program, hear from patients who have found relief, and find additional resources that will guide you through the appointment process.

For more information or to refer a patient, call 216.448.6253.

Resources

Resources

General Information

We have provided the following resources to help guide you in learning more about pediatric chronic pain, in general, and/or specific pediatric pain conditions.

Publications from our Center

Selected publications:

2017

Benore, E., & Monnin, K. Behavioral Treatment for Headaches in Children: A Practical Guide for the Child Psychologist. Clin Pediatr (Phila). 2017; 56(1), 71-76.

Kempert, H., Benore, E., & Heines, R. Easily Administered Patient-Reported Outcome Measures: Adolescents' Perceived Functional Changes After Completing an Intensive Chronic Pain Rehabilitation Program. Arch Phys Med Rehabil, 2017; 98(1), 58-63.

Kempert H., Benore E., & Heines R. Physical and Occupational Therapy Outcomes: Adolescents’ Change in Functional Abilities Using Objective Measures and Self-Report Scandinavian Journal of Pain. Jan 2017; Volume 14; 60–66

2016

Culbert TP, Banez GA. Pediatric applications other than headache. In Schwartz MS, Andrasik F, ed. Biofeedback (4th edition). New York, NY: Guilford. 2016; 629-650.

Kempert, H. Adolescent Return to Ambulation: A Flow Chart for Multidisciplinary Staff Education. Phys Med Rehabil Int.2016; 3(1): 1079.

Kempert H., Benore E., & Heines, R. Easily Administered Patient Reported Outcome Measures: Adolescents’ Perceived Functional Changes after Completing an Intensive Chronic Pain Rehabilitation Program. Archives of Physical Medicine and Rehabilitation. Sept 2016; (online:http://dx.doi.org/10.1016/j.apmr.2016.08.471).

Suder, R. (2016). The lived experience of adolescents with chronic pain: A phenomenological study (Doctoral Dissertation). Publication in process from ProQuest® Dissertation Publishing.

2015

Benore E, D’Auria A, Banez, G, Worley S, Tang A. The influence of anxiety reduction on clinical response to pediatric pain rehabilitation. Clin J Pain. 2015; 5:375-383.

Evans JR, Benore E, & Banez G. Conversion disorder and pediatric chronic pain – talking through the challenges. Pediatr Pain Letter. 2015;17(2);16-20.

Evans, J., Benore, E.B., & Banez, G. The Cost-Effective of Intensive Interdisciplinary Rehabilitation for Pediatric Chronic Pain. Journal of Pediatric Psychology, 2015; 40(10) 1-8.

Kempert, H. Dealing with Challenging Patients’ and Families in Treatment of Complex Regional Pain Syndrome (CRPS) – When to Adopt a Multidisciplinary Approach? ADVANCE for Physical Therapy & Rehab Medicine. Oct 19. 2015 Pg 22-24, 38.

Kempert, H., Pearson, R., Daghstani, S. Adolescents’ Perceived Change in Functional Abilities after Completion of an Intensive Chronic Pain Rehabilitation Program. ADVANCE for Physical Therapy & Rehab Medicine. Feb 7. 2015 pg 6-7.

Wojtowicz, A. A., & Banez, G. A. Adolescents with chronic pain and associated functional disability: A descriptive analysis. J Child Health Care, 2015; 19(4), 478-484.

2014

Ahuja, VT. Chronic Pain and Associated Depression/Anxiety in Children: A Treatment Strategy. Psychiatric Insights. Cleveland Clinic, 2014.

Banez, G. A., Frazier, T. W., Wojtowicz, A. A., Buchannan, K., Henry, D. E., & Benore, E. Chronic pain in children and adolescents: 24-42 month outcomes of an inpatient/day hospital interdisciplinary pain rehabilitation program. J Pediatr Rehabil Med, 2014; 7(3), 197-206.

Katholi B, Daghstani SS, Banez GA, Brady KK. Non-invasive treatments for pediatric complex regional pain syndrome - a focused review. PM & R. 2014; 14: S1934-1482.