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Fortier receives grants to study pediatric, neonatal pain

November 30, 2010

Michelle Fortier, PhD, of UC Irvine’s Department of Anesthesiology and Perioperative Care, has received grants to fund research into easing pediatric and neonatal pain from the Hoag Foundation and Children’s Miracle Network

A $450,000 Hoag Foundation grant will fund a project titled “Treating Pain in Children with Cancer: A 21st Century Innovative Approach,” which proposes to use smart phone technology to optimize the treatment of children’s pain at home. Approximately 12,000 children are diagnosed with cancer in the U.S. each year and the majority experience significant pain throughout their illness.

Though effective interventions are widely available, World Health Organization data indicates that cancer pain management is seriously inadequate, leading to needless suffering among tens of thousands of children each year. As parents have become more responsible for managing children’s pain at home, they tend to under treat that pain by not providing enough medication or substituting less potent medications than those prescribed. In an effort to improve this group’s quality of life, this study proposes to use technology that permits children to monitor their pain using handheld electronic devices and transmit their data in “real time” to their oncology treatment team. That team would be able to respond with pain management instructions and recommendations.

The study’s goals are to:

1) Provide an understanding of how often children who are being treated for cancer experience pain at home

2) Understand why parents under treat children’s pain and identify parents most in need of additional intervention to help with pain management

3) Develop an innovative electronic intervention using smart phone technology to help treat children’s pain at home

4) Demonstrate that the intervention results in lower pain scores, more medication given, and better quality of life in children

This project has the potential to revolutionize children’s cancer pain management by using innovative technology to improve pain treatment. In addition, it is an intervention that can be used to manage pain from a wide range of illness and not limited to cancer.

A $50,000 Children’s Miracle Network grant will fund a project titled “Managing Neonatal Pain and Distress: The Next Frontier.” Fortier and CHOC pediatric psychologist Dr. Marni Nagel will document daily care received by neonates and seek to optimize the timing of such care to decrease the duration and intensity of pain.

This one-year project will document the frequency of painful procedures and handlings undergone by low birth weight and critically ill infants at CHOC Children’s and UC Irvine’s neonatal intensive care units (NICU). It proposes to implement an intervention to structure infant handlings to allow for periods of rest and recovery. Although advances in neonatal care have led to increased survival of critically ill infants, these advances also subject infants in the NICU to repeated, invasive, and painful medical procedures. Recent research suggests that premature infants not only experience pain, but their biological pain pathways can be permanently and negatively altered through early pain experiences. In addition, not providing premature infants with designed periods of rest and healing may lead to poorer health outcomes and longer hospital stays.

To address these concerns, this project will consist of two phases:

Phase I (9 months): Observe and document the number of procedures/handlings that 50 neonates undergo daily through video recordings of infants’ hospital stays. Both procedures/handlings and periods of rest will be observed and coded. It is hypothesized that neonatal care is not well coordinated among all providers and specialties and thus is provided at the convenience of the healthcare providers rather than tailored to individual infants. This phase will examine optimal times of healthcare delivery for each infant.

Phase II (3 months): Conduct a pilot, randomized controlled efficacy trial in which infants will be randomly assigned to experience coordinated times of handling for care, procedures, and physician rounding designated to specific two-hour time intervals throughout the day (experimental condition) followed by two-hour intervals of rest in which no procedures or invasive handlings, including rounding, would occur. Infants in the control group would continue to experience care and treatment according to current standard practice. It is hypothesized that infants in the experimental condition will evidence decreased duration and intensity of pain and distress during their hospital admission, decreased health status acuity, shorter length of hospitalization, and increased caregiver and healthcare provider satisfaction compared to infants in the control group.