In My Words: Paediatric Pain Management – Brooke Biggs, PT | Physiotherapist

I am a physiotherapist in the Pediatric Chronic Pain Program at McMaster Children’s Hospital, and I’ve been there since 2015. Before that I was with Hamilton Health Sciences. I started in Brain Injury Rehab which was an inpatient program. And then I did some coverage on stroke units, so acute care. And from there I went into the Pediatric Chronic Pain Program.

Spotlighting healthcare practitioners amongst the community of practice in ECHO Paediatrics collaborative, CPD-accredited programs.

The brain injury program was for adults; sometimes we’d even get 16-year-old males, up to about [age] 35. That was kind of the range where you see a lot of traumatic brain injuries mainly due to risky behavior, like motor vehicle accidents, ATV accidents, falls, that kind of thing. So that’s where I got some exposure to working with youth a little more.

I really enjoyed working with that age population so when I heard about the pediatric chronic pain program it was really interesting. I did see a lot of pain [cases] when I was working in private practice. But I was treating solo at that time in the community, and obviously knowing what I know now, I see why it could have been really frustrating working solo and you’re wondering why your patients might not be getting better when we’re doing everything you should be doing that you learned in school.

Since working in paediatric chronic pain, that biopsychosocial approach has been really interesting. And if I could go back in time to when I was working in the community, I think trying to tap a little bit more into the psychology support, social work support for some of those patients would have been really, really helpful. Because a lot of them had chronic pain, it just wasn’t identified as chronic pain. And we were very much treating from an acute model of pain. And I think that happens a lot. We see that a lot in our practice.

My colleagues had attended a session or two and I started attending; it was just a really good review. It’s a great summary of the overall approach that we should be taking from a chronic pain and paediatric perspective. It covers the biopsychosocial approach and it goes through the “3-Ps” approach being the pharmaceutical, the physical and the psychological treatments.  It was great learning, whether you already know the information and it kind of adds on to that or if you’re brand new to chronic pain and you want to learn more.

It’s really helpful to say, “I’m doing this” or “No, I have to adjust my practice and learn more about this technique or this practice” or to even bring it back to our team at McMaster because the evidence is showing this is a best practice in chronic pain.

Being encouraged to present cases has been a good experience for me. You never know who’s attending the sessions. And oftentimes there’s a specialist from across Canada, who work in different areas, who can help you out with tough cases and make some great suggestions.

I’m thinking about one case in particular, and this was at the beginning of the pandemic and virtual care was just sort of starting. We had a patient who lived 3 hours away [from Hamilton], and we hadn’t quite switched to virtual care yet and we weren’t really using Zoom, and ECHO had been using Zoom for quite a while.

This young person was having trouble and there was a big barrier to coming in-person because it was a six hour turnaround for them to get home. I presented their case and there was a lot of expertise [in the ECHO session], other providers suggesting, you know, ‘maybe you do telephone check-ins a couple of times a week to make sure they feel supported’; and ‘maybe you should tap into peer supports in their community because we’ve had a really good success rate of having a buddy, someone who they can look up to and have that relationship in their own community.’

And this young person – because they had chronic pain, and they were super sedentary and their diet had shifted to become really unhealthy – they had some weight management issues and had gained a lot of weight. And in the ECHO session there was someone from the children’s exercise and nutrition clinic at McMaster, and they were listening to the story and they said, “You know what? We should probably be seeing this kid as well, because it sounds like they’re at risk for different obesity related issues. And we could do collaborative care here or a shared care model with this this youth and maybe help you when you’re finished your work with chronic pain; follow them up long term to set some activity goals and to get them a little bit more active and living a healthier life.”

So that was really helpful. And I got emails during that case presentation and contact names, so I think that patient really benefited from those suggestions. And we went on and referred this youth to the Children’s Exercise and Nutrition Clinic at McMaster, to that person who is part of the ECHO community who had attended the [ECHO Zoom session] with me. So those were really helpful recommendations and I think definitely it changed the outcome of the [patient] case.

We have a lot of new staff come on over the years and I always point them to ECHO [Paediatrics] and say you should sign up for these sessions. It’s really helpful and gives you a good overview. And it’s not over a couple of days. It’s weekly sessions or even more spaced out, so they can really digest the information. I think ECHO [Paediatrics] has been a really great resource for them. Even the recorded sessions that ECHO [Paediatrics] has online, I go back to them all the time if I missed one. Motivational Interviewing was a really big interest in mine. There’s a bunch of sessions on motivational interviewing that I really want to learn more about but I couldn’t attend the sessions, so those recordings are really helpful to tap into.

It’s sort of an ongoing education.  You get to know the ECHO [Paediatrics] team and the characters, the presenters, and that kind of consistency is really helpful.  You get to know the people in Toronto, or at SickKids, to reach out to should you have any problems. They’re super open and collaborative and you get that feeling from day one, that they’re there to help you. They want everyone to be providing evidence based, biopsychosocial approach to practice with chronic pain. And, you know, they ultimately want what’s best for patients.

So I really get that feeling of collaboration with the ECHO [Paediatrics] team. They’re very open to discussion. No question is a bad question. From a very beginner who knows nothing about chronic pain, they’re very validating – to someone who’s been in the field for many, many years and is even an expert in their area. They’re really good with all areas of people’s learning.