Opioid therapy is the cornerstone of treatment for acute procedural and postoperative pain and is regularly prescribed for severe and debilitating chronic pain conditions. Although beneficial for many patients, opioid therapy may have side effects, limited efficacy, and potential negative outcomes. Multidisciplinary pain management treatments incorporating pharmacological and integrative non-pharmacological therapies have been shown to be effective in acute and chronic pain management for pediatric populations. A multidisciplinary approach can also benefit psychological functioning and quality of life, and may have the potential to reduce reliance on opioids. The aims of this paper are to: (1) provide a brief overview of a multidisciplinary pain management approach for pediatric patients with acute and chronic pain, (2) highlight the mechanisms of action and evidence base of commonly utilized integrative non-pharmacological therapies in pediatric multidisciplinary pain management, and (3) explore the opioid sparing effects of multidisciplinary treatment for pediatric pain.

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.

Findings revealed ratings of anxiety in youth with and without autism spectrum disorder facing surgery varied by reporter and setting, highlighting the importance of using multiple reporters in research of youth with autism spectrum disorder in the perioperative period. Furthermore, while results showed group differences in premedication patterns and induction compliance, groups did not differ in level of negative behavior change after surgery. Future research can examine how individual differences in youth with autism impact anxiety in the perioperative setting and degree of behavior change postprocedure.

Objective: To equip clinicians with recommendations specific to concerns related to the novel coronavirus disease 2019 (COVID-19), which impact the physical, emotional, and social health of youth with headache disorders. Background: COVID-19 has affected societies on a global scale including children and youth with chronic headache disorders. Many concerns are predicted to arise in the 2020-2021 school year, whether classes are conducted in-person or virtually. Methods: Clinical impressions were combined with a review of the literature, although limited due to the recent nature of this issue. Results: We describe recommendations to support caregivers and youth as they face changes expected with the return to school in the fall of 2020. Conclusion: Although there are significant concerns for caregivers and youth with migraine given the context of changes related to the pandemic, there are many recommendations that can help minimize exacerbations of the physical, emotional, and social health of youth with chronic migraine.

ObjectiveTo review the contemporary issues of healthcare disparities in Headache Medicine with regard to race/ethnicity, socioeconomic status and geography and propose solutions for addressing these disparities.MethodsAn internet and PubMed search was performed and literature was reviewed for key concepts underpinning disparities in Headache Medicine. Content was refined to areas most salient to our goal of informing the provision of equitable care in headache treatment through discussions with this group of 16 experts from a range of headache subspecialties.ResultsTaken together, a multitude of factors including racism, socioeconomic status and insurance status and geographical disparities contribute to the inequities that exist within the healthcare system when treating headache disorders. Interventions such as improving public education, advocacy, optimizing telemedicine, engaging in community outreach to educate primary care providers, training providers in cultural sensitivity and competence and implicit bias, addressing health literacy and developing recruitment strategies to increase representation of underserved groups within headache research are proposed as solutions to ameliorate disparities.ConclusionNeurologists have a responsibility to provide and deliver equitable care to all. It is important that disparities in the management of headache disorders are identified and addressed.

Objective To determine what dose of melatonin is most effective for treating migraine acutely in children and adolescents. Background Acute migraine medications may not work for all patients and may cause side effects. Melatonin is effective for migraine prevention in adults and has been used acutely for procedural pain in children. Our goal was to determine whether a “high” or “low” dose of melatonin is more effective for treating migraine acutely in youth. Methods In this pilot, randomized, open‐label, single‐center, dose‐finding trial, children and adolescents aged 4‐17 years with episodic migraine were randomized to “high‐dose” or “low‐dose” dose melatonin (<40 kg: 4 mg vs. 1 mg; ≥40 kg: 8 mg vs. 2 mg). The primary outcome measure was change in mean pain score between time 0 and 2 hours. Secondary outcomes included 2‐hour pain‐relief and pain‐freedom rates. Results Eighty‐four participants (n = 42 per group) were enrolled in this study. Mean (SD) participant age was 11.8 (3.5) years and 55% (46/84) were female. Mean (SD) headache days/month was 5.6 (3.8). Sixty‐six (79%) participants provided outcome data and were included in the analyses, n = 24 in the high‐dose group and n = 22 in the low‐dose group. The drop‐out rate was 43% (18/42) in the high‐dose group vs. 48% (20/42) in the low‐dose group. Mean (SD) change in pain intensity at 2 hours was −2.7 (2.1) cm in the high‐dose group vs. −2.3 (2.1) cm in the low‐dose group (p = .581), a difference of 0.4 cm (95% CI: −1.17 to 1.92). Two‐hour pain‐freedom rate was 41% (7/17) vs. 27% (4/15) in the high‐dose vs. low‐dose groups (p = .415), and 2‐hour pain‐relief rate was 94% (16/17) vs. 80% (12/15), (p = .482). There were no serious adverse events. Napping occurred in the majority (67% (14/21) high dose vs. 47% (9/19) low dose). Higher mg/kg dose of melatonin and napping were each independently associated with greater headache benefit. Conclusions As an acute treatment for pediatric migraine, both low and high doses of melatonin were associated with pain reduction; however, study drop‐out was high. Higher dose and napping after treatment predicted greater benefit.

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.

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