Clinical Sections

Pediatric Anesthesia

Pediatric Pain

The Pediatric Pain Resource Nurse Program (PPRN) is a venue for developing a solid knowledge base in pediatric pain management philosophy. [PDF Application]

Download our Pediatric Pain Coloring and Activity Book and meet Peter and Patty Pain-Free.

The Yale Pediatric Pain Management Service has pioneered new techniques in neonatal pain management, expanded the Pediatric Acute Pain Service, and developed pain management pathways that are in step with national trends and the new JCAHO mandates on pain management.

Open Forum Pain Service Rounds are offered where house staff are invited to present and to make inquiries about pain management as it pertains to their interests. The Chronic Pain Service has been expanded to include interventional diagnostic and therapeutic blockade techniques, acupuncture with moxibustion, and the Service serves as an information source for naturopathic medicine. The pharmaceutical armamentarium has been expanded in search of improved pain relief. The use of adjuvant agents has reduced the incidence of unwanted side effects as well as the amount of required narcotics, making pain relief, safer and more efficacious.

The Yale Pediatric Pain Management Service is involved in the three arms of academic medicine: Patient care, staff and lay education, and research. Current research activities include efficacy and safety studies on the use of oral tramadol and the use of transdermal fentanyl in children with chronic pain. The success of the Pediatric Pain Service is evidenced by its increasing number of referrals. Since January 1998, more than 2,100 infants, children and adolescents have been care for by Pediatric Pain Management Services. In comparing annual growth, there has been a 30% increase in the number of patients on-service. The outpatient data for chronic pain services shows similar increase and attests to the value of formal pain management consultation.

The resident staff are primarily from the department of anesthesiology who are rotating in Pediatric Anesthesiology. A three-week elective is available for second and third year pediatrics residents interested in pediatric anesthesiology, pain management and sedation practices. The resident staff take in-house call to assure 24-hour availability of physician based care. This is a new practice that was started this academic year. In the past, night time coverage was shared with the adult services. Therefore, pediatric pain management is through house staff dedicated to the care of children.

The four Pain Service physicians are pediatric anesthesiologists with expertise in perioperative pain management, acupuncture, and/or chronic pain. The director holds credentials in pain management via written examinations by the American Board of Anesthesiology and the American Board of Pain Medicine and is a member of the Examination Council of the American Board of Pain Medicine.

The types of services offered by the Yale Pediatric Pain Management Services includes 1) Acute Pain Service for management of perioperative and medical pain states via PCA, major conduction neuraxial blockade and peripheral nerve blockade techniques. 2) a Consultative Service for in -patients with complex pain management issues such as high dose opioid taper, multiple drug management and pain due to disease such as cystic fibrosis and sickle cell disease, 3) the Chronic Pain Clinic for in patient and out patient services. The types of chronic pain disorders managed include, low back pain, fibromyalgia, reflex sympathetic dystrophy and cancer pain. We believe that this service must be used to enhance primary care. Therefore, every effort is made to have the primary physician not only kept abreast but closely involved in all cases.

Future planned activities include the advancement of integrative medicine, incorporation of clinical pathways in individual pain entities and syndromes and an interactive educational venue. Pediatric Pain Management Services have been awarded monies from the Yale Auxiliary to develop pediatric pain education. Plans include a puppet show on pain management, an activities and coloring book on pain management, and various brochures for education of the medical and lay communities.