55.3 PEDIATRIC CHRONIC PAIN: INFRASTRUCTURES AND LEVELS OF CARE

Abstract

Objectives: Successful management of chronic pain requires addressing physical symptoms and comorbid mental health conditions. Pharmacological and nonpharmacological interventions can be successfully provided by a multidisciplinary approach that is both effective and safe. This model can be delivered in different settings, including outpatient, intensive outpatient, and inpatient. In this module, we focus on assessing the patient’s presentation, establishing the appropriate level of care, detecting the need to transition or modify settings, and understanding the prevalent challenges due to the COVID-19 pandemic. Methods: Souraya Torbey, MD, will: 1) highlight the distinction between outpatient clinic program and intensive day treatment, with an emphasis on the advantages and challenges of each model;2) clarify the intensive day treatment programs, their types, and structures;3) discuss medical decisions in the appropriate level of care;4) review the referral processes;and 5) discuss treatment modalities in the setting of COVID-19, including telehealth. Results: Outpatient pain treatment programs allow the child to stay at home in a familiar environment. However, such arrangements may lack the intensity, consistency, and integration necessary to make progress. Intensive day treatment or partial hospitalization programs are a midway between inpatient and outpatient. They provide a smooth transition from inpatient to outpatient through the support of a structured treatment program. The COVID-19 pandemic has resulted in an increase in pediatric chronic pain and mental health issues, concomitant with a decrease in availability of in-person psychiatric and rehabilitation services. The development of telehealth/hybrid models arose to respond to these needs and to increase access for those who might not be close to big centers. We discuss the implementation of these virtual platforms in the outpatient treatment models of chronic pain. Conclusions: This presentation aims to explore the distinction between outpatient clinic and intensive day treatment, highlighting the advantages and challenges of each model respectively, including the effect of the COVID-19 pandemic. Attendees will also be equipped with the necessary tools to implement alternate multimodal approaches in communities where such multidisciplinary programs are scarce. MDM, PAH, TVM