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Spain, pediatric pain: 2019. Things are moving on.



Spain, pediatric pain: 2019. Things are moving on.

Newsletter September  2019 Tania Garcia  Pain (IASP)

Just only last year was denounced that we needed at least 8 pediatric pain Units in a country of 47 million of persons, where more than 300000 children are known to suffer from chronic pain. We have had up till now just only a couple well recognized pain units in Madrid and Barcelona (one of them belong to the Public Health System, and a Private one with a nonprofit working perspective as it belongs to a religious order, and this same February Dr. Jordi Miro at the 3rd National Children Pain meeting announced that none of the pediatric pain units have the right dotation and characteristics required specially talking about multidisciplinary treatment.

In Spain, most children are cared in the public health care system. Most insurance companies do not recognize the pain care for adults away from hospitals installations either for public and private hospitals. There are not exclusively private pediatric pain units.

Due to the hard work done by Jordi Miro (actual counselor of The International Association of the Study of Pain) and colleagues there have surged two different reactions to the fact that any government investment had been done for the treatment of children pain in the recent years.

In Valladolid (North East of Spain ) using the adult installations (with a history of adult pain clinic of more than 15 years) in a National Health Service Hospital they have developed a multidisciplinary team for the treatment of children. This team have got physicians (anesthesiologist, pediatricians: a palliative specialist and a neurology one, a rehabilitator, and a
psychiatrist) and a psychology and several nurses. They are already treating some patients that have access to high level of care with minimal or no direct cost to them or their parents.

Their main objects are to promote health education of the population related to pain treatment, develop epidemiological investigation, and create relationship with primary care providers to improve the treatment of children in the primary care settings

350 miles from there in Valencia, on the eastern coast of Spain, a group of 8 women have started to work together as already we were doing it on separate bases, so we can imply strength to our hard work:
I lead a group of 8 women in Valencia Spain.

• Psychologist, she already works for Catholic university teaching medical and psychology students and developing psychological support for rheumatology children ward at one of the mayor hospitals in Valencia)
• Educational psychologist, she has created new “apps” for teaching mothers to help their children
deep breathing. That was done in our language. We are going to translate it to Portuguese as well.

• Pharmacist that adequate the medication to the children for easy application and comfort)
• Nurse (specialist in non-pharmacological treatment)
• Pediatrician
• Physiotherapist that gives teaching also at university and works with children introducing classical dance to the physiotherapy exercise: mainly patients with cerebral palsy.
• Occupational therapist that works with different methods and gives conferences at Harvard university
• Pediatric anesthetist recently spent a month in Boston at Boston Children Hospital learning from Dr. Neil Schechter,Dr Charles Berde. Dr Navil Sethna ,Rachel Coakley).Recently published update national guidelines for acute pain.

Our main objectives are:
1. Improve knowledge of general population and professionals related to children’s pain treatment.
Improve the knowledge of the insurance companies to reduce the cost generated of the under- treatment of children.
2. Create University courses for health providers: postgraduate formation in acute and chronic pain
in children.
3. Collaborate with our out-of-hospital providers to improve the use of the resources they already have to provide a first line treatment of children. Creation of the Group of Study of Children’s
Pain including extra-hospitalary primary care providers.
4. Create parents and caregiver’s workshops to show them about their child’s pain so that they can better understand it and provide different methods that could be used by them at home. We have
already developed “Tales and Apps.”
5. Be more sensitize about the need to take into account the complaints about pain in children (something not related to our idiosyncrasy). We have completed an Itinerary Photographical exposition.
6. Reduce the emotional consequences of the chronic pain and help people involved with it.
7. Search for institutional commitments to create better conditions for the management of children’s pain from an interdisciplinary view at school and in sports activities.
8. Initiate school talks with parents and professionals.
9. Create projects similar to Children´s Comfort Promise (Minnesota, USA hospital) on National basis.
10. Create a multidisciplinary team inpatient intensive treatment for children that do not improve
with treatment as usual.

With these diverse objectives, we can learn from each other in order to improve the care and education of our children and professionals. We believe we can bridge the huge distance we currently have from other countries in the world.

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