Chronic Pediatric Pain in Low- and Middle-Income Countries

Walters, Camila B; Kynes, J. Matthew; Sobey, Jenna H.; Chimhundu-Sithole, Tsitsi; McQueen, Kelly

doi:10.3390/children5090113

Cited by 16 publications

(6 citation statements)

References 50 publications

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“…The low prioritization itself may be due to underrecognition of the pain problem 15 because systematic information about the extent and impact of pain has not been available. 10,22 For example, up to now, there are still no reliable data of national cost and economic impact of chronic pain in Thailand.…”

Section: Introductionmentioning

confidence: 99%

Comparing the ICD-11 chronic pain classification with ICD-10: how can the new coding system make chronic pain visible? A study in a tertiary care pain clinic setting

Zinboonyahgoon¹,

Luansritisakul

Eiamtanasate

et al. 2021

Pain

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Pain is a frequent reason for patients to ask for medical services. However, systematic information about the extent and impact of pain, especially in developing countries, has not been available up to now. We evaluated whether the 11th edition of the International Statistical Classification of Diseases and Related Health Problems (ICD) can fill this gap by coding all electronic out-patient medical records of the pain clinic at Siriraj Hospital in Thailand in 2019 (8714 visits), using the ICD-10 and ICD-11 browsers referenced on the WHO websites. The 3 most frequent pain-related codes in ICD-10 were R52.2 “other chronic pain” (29%), M54.5 “low back pain” (18%), and M79.6 “pain in limb” (13%). In ICD-11, the 3 most frequent codes were MG30.31 “chronic secondary musculoskeletal pain associated with structural changes” (28%), MG30.51 “chronic peripheral neuropathic pain” (26%), and MG30.10 “chronic cancer pain” (23%). Thus, using the currently valid ICD-10 system, roughly one-third of patient encounters were coded as “other chronic pain,” and the next 2 were specifying the pain region rather than any underlying cause. By contrast, ICD-11 coding of the same patients identified underlying causes (bones and joints, somatosensory nervous system, cancer, or surgery), which provide guidance towards differential patient management. In our pain clinic, most patients suffered from chronic cancer pain, chronic neuropathic pain, and chronic secondary musculoskeletal pain, which were poorly defined or nonexistent in the current ICD-10 coding system. Compared with the ICD-10, the ICD-11 provides more detailed diagnostic categories and is more informative for clinical use, research, and resource allocation for pain-related conditions.

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Section: Introductionmentioning

confidence: 99%

Comparing the ICD-11 chronic pain classification with ICD-10: how can the new coding system make chronic pain visible? A study in a tertiary care pain clinic setting

Zinboonyahgoon¹,

Luansritisakul

Eiamtanasate

et al. 2021

Pain

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show abstract

“…In LMICs, pain in pediatric pain services are often inadequate or unavailable, staff capacity is low, and training that is conducted is often done at a poor level by a person of a different culture or language (Albertyn, Rode, Millar, & Thomas, 2009). For example, Walters, Kynes, Sobey, Chimhundu-Sithole, and McQueen (2018) described a 15-month observation period in Malawi where the assessment and management of pediatric pain were not observed at all. Among other findings, this led to the conclusion that most of the world’s pediatric population with chronic pain is left untreated (Walters et al, 2018).…”

Section: What Is Pediatric Psychology?mentioning

confidence: 99%

“…For example, Walters, Kynes, Sobey, Chimhundu-Sithole, and McQueen (2018) described a 15-month observation period in Malawi where the assessment and management of pediatric pain were not observed at all. Among other findings, this led to the conclusion that most of the world’s pediatric population with chronic pain is left untreated (Walters et al, 2018). Pediatric psychologists’ acute awareness of the need for advocacy in this area means they are the perfect allies for promotion and training, to ensure reduced levels of chronic pain and the associated mental health and functional disability that goes alongside this experience.…”

Section: What Is Pediatric Psychology?mentioning

confidence: 99%

Contributing to global mental health: Can pediatric psychology extend our reach?

Morgan

2019

Clinical Practice in Pediatric Psychology

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Objective: Global mental health is a burgeoning field of psychology that seeks to create equity in access to services across the globe, regardless of the environment or circumstances. To date, pediatric psychology is rarely included within the scope of health care offered in conflict or postdisaster environments or when addressing health needs in low- and middle-income countries (LMICs). This article identifies previous areas that pediatric psychology and global mental health have intersected and outlines the possibilities for additional contribution to each field, including advocacy, capacity building, consultancy and research. Method: A literature search was conducted regarding the areas of global mental health and pediatric psychology to form the basis for this opinion piece. Results: Pediatric psychology is ideally placed to advocate for the needs of children with medical conditions in LMICs, not only within areas where a pediatric psychology presence is already established, such as HIV, tuberculosis, and noncommunicative disease. For example, within epidemics, pediatric psychologists can advocate for the needs of patients and process adjustment during recovery, and postconflict pediatric psychologists can play a role in the ongoing treatment needs of children suffering war injuries, malnutrition, and/or disease. Last, pediatric psychologists will be able to utilize skills in teaching and training of medical staff and lay counselors in LMIC communities to build capacity for managing mental health in the context of physical health conditions, including within primary health care networks and humanitarian aid efforts. Conclusions: Despite adolescent health being one of the Key Development Goals for the World Health Organization, the mental health care of children and adolescents appears to be largely neglected in LMICs outside of the trauma context. Pediatric psychology has unique expertise in mental health care in the context of medical problems, thus being ideally placed to work alongside humanitarian medical teams, within primary health care networks, and with local ministries of health to promote the holistic support of children with health needs.

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“…This pain education gap does not only impact Canadian HCPs. Indeed, this issue impacts specialty medical education for HCPs across North America and globally with the World Health Organization recommending that all countries prioritize pain management through education to build global capacity to improve management worldwide [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Pediatric Project ECHO® for Pain: implementation and mixed methods evaluation of a virtual medical education program to support interprofessional pain management in children and youth

et al. 2023

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Background Pediatric pain is a complex health challenge requiring a multi-modal management approach. It is critical that healthcare providers (HCPs) have access to ongoing, flexible education and mentorship specific to pediatric pain. However, there are significant gaps in available pain education and a need for more opportunities to support interprofessional training. Project Extension for Community Healthcare Outcomes (Project ECHO®) is a model for delivering online HCP education and cultivating a virtual community of practice. Within the pediatric pain setting, ECHO® has potential to improve local access to specialized pain knowledge, particularly among the physicians, nurses, and allied health providers who primarily manage these cases in community and hospital settings across rural and urban environments. The purpose of this study was three-fold. First, to evaluate the feasibility (participation levels, acceptability) of implementing Project ECHO® in the context of pediatric pain. Second, to measure preliminary program impacts on HCP knowledge, self-efficacy, and clinical practice. Third, to characterize HCP program engagement levels before and after onset of the COVID-19 pandemic. Methods A needs assessment was conducted to identify interprofessional education gaps and inform the program curriculum. The no-cost Pediatric ECHO® for Pain program offered TeleECHO sessions (didactic and case-based learning) as well as foundational education. Surveys were distributed at baseline and 6 months to assess outcomes using 7-point Likert scales. Participant engagement was assessed for periods prior to and during the COVID-19 pandemic. Descriptive and inferential statistical analyses were conducted. Results Eighty-five TeleECHO sessions were hosted, with a mean attendance of 34.1 ± 23.4 HCPs. Acceptability scores at 6 months (n = 33) ranged from 5.0 ± 1.4 to 6.5 ± 0.5. Participants reported statistically significant (p < 0.05) improvements in knowledge (7 out of 7 topics) and self-efficacy (8 out of 9 skills). Most participants reported positive practice impacts, including improved satisfaction with managing children with pain. Exploratory analyses showed a trend of greater engagement from ECHO® learners after onset of the COVID-19 pandemic. Conclusions Project ECHO® is a feasible and impactful model for virtual education of interprofessional HCPs in managing pediatric pain.

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Chronic Pediatric Pain in Low- and Middle-Income Countries

Cited by 16 publications

References 50 publications

Comparing the ICD-11 chronic pain classification with ICD-10: how can the new coding system make chronic pain visible? A study in a tertiary care pain clinic setting

Comparing the ICD-11 chronic pain classification with ICD-10: how can the new coding system make chronic pain visible? A study in a tertiary care pain clinic setting

Contributing to global mental health: Can pediatric psychology extend our reach?

Pediatric Project ECHO® for Pain: implementation and mixed methods evaluation of a virtual medical education program to support interprofessional pain management in children and youth

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