Novel Interventions in Children's Healthcare (NICH): a promising treatment for intractable pediatric pain

Abstract

A subset of youth with recurrent and chronic pain face complex psychosocial challenges. Some of these youth do not respond to multidisciplinary outpatient care, are at increased risk for repeated hospitalizations, and utilize a disproportionate amount of healthcare resources. Intensive behavioral health interventions for youth with complex medical conditions have proven effective in improving psychosocial functioning and reducing avoidable hospitalizations. Based on this research, we adapted an intensive behavioral health program to treat youth with chronic pain who have not responded to multidisciplinary care and have been repeatedly hospitalized. The intervention, NICH, involves family-based problem solving, care coordination, and case management. Treatment is implemented across settings (home, hospital, and tele-health). We present a case series of youth (n=4) with chronic intractable pain (Cases A-D: 7yrs female with leg pain; 10yrs male with neuropathic pain; 15yrs female with chest pain; 15yrs male with back pain). We documented emergency department (ED) visits and admissions pre-, during, and post-treatment. During the 5 months pre-treatment, participants had 1-16 (M=6.25, SD=6.70) hospitalizations and ED visits. None were regularly attending school. Case A had 3 ED visits, Case B was hospitalized once for a 6-day period, Case C had 3 ED visits and 2 hospitalizations, and Case D had 16 ED visits. Since beginning treatment, all participants have had zero hospital or ED visits, and have returned to school or completing online classes. Initial findings suggest substantial reductions in hospital/ED visits and healthcare costs for each patient. These four cases accumulated an estimated $93,000 in hospital/ED costs, averaging $23,250 each. Since involvement in NICH, all had no costs associated with hospital/ED visits. NICH involves delivering intensive behavioral healthcare in real world settings and holds promise for improving health and psychosocial functioning, reducing unnecessary healthcare spending, and preventing long-term pain rehabilitation hospitalizations for youth with chronic pain. A subset of youth with recurrent and chronic pain face complex psychosocial challenges. Some of these youth do not respond to multidisciplinary outpatient care, are at increased risk for repeated hospitalizations, and utilize a disproportionate amount of healthcare resources. Intensive behavioral health interventions for youth with complex medical conditions have proven effective in improving psychosocial functioning and reducing avoidable hospitalizations. Based on this research, we adapted an intensive behavioral health program to treat youth with chronic pain who have not responded to multidisciplinary care and have been repeatedly hospitalized. The intervention, NICH, involves family-based problem solving, care coordination, and case management. Treatment is implemented across settings (home, hospital, and tele-health). We present a case series of youth (n=4) with chronic intractable pain (Cases A-D: 7yrs female with leg pain; 10yrs male with neuropathic pain; 15yrs female with chest pain; 15yrs male with back pain). We documented emergency department (ED) visits and admissions pre-, during, and post-treatment. During the 5 months pre-treatment, participants had 1-16 (M=6.25, SD=6.70) hospitalizations and ED visits. None were regularly attending school. Case A had 3 ED visits, Case B was hospitalized once for a 6-day period, Case C had 3 ED visits and 2 hospitalizations, and Case D had 16 ED visits. Since beginning treatment, all participants have had zero hospital or ED visits, and have returned to school or completing online classes. Initial findings suggest substantial reductions in hospital/ED visits and healthcare costs for each patient. These four cases accumulated an estimated $93,000 in hospital/ED costs, averaging $23,250 each. Since involvement in NICH, all had no costs associated with hospital/ED visits. NICH involves delivering intensive behavioral healthcare in real world settings and holds promise for improving health and psychosocial functioning, reducing unnecessary healthcare spending, and preventing long-term pain rehabilitation hospitalizations for youth with chronic pain.