Dedicated procedure suite expands options for treating pediatric chronic pain

Children with chronic pain often face delays in treatment that can worsen disability and disrupt normal development. Jamie Fleming, MD, says providing timely, individualized care is essential to helping children return to school, physical activity, and other aspects of daily life.

Fleming, section chief of Pain Management and director of Interventional Pain Management at Phoenix Children's, said the hospital's dedicated pediatric interventional pain procedural suite has expanded the team's ability to match treatment to each child while reducing delays in care. Opened in 2025, the suite complements the hospital's multidisciplinary pain program, which integrates pain medicine, psychology, physical therapy, occupational therapy, integrative medicine, and interventional pain management to restore function while minimizing opioid use.

How does a dedicated pediatric pain procedure suite improve care?

Fleming said one of the greatest advantages of the dedicated procedure suite is its flexibility.

"The procedure suite does have a lot of big advantages, and we're lucky to have one," she said. "It lets us essentially match the setting to the child and to the procedure, and this has a lot of advantages because each child is so different."

Rather than relying exclusively on the operating room, clinicians can perform select lower-risk procedures in a setting that may be more appropriate for some children.

"Some patients really require anesthesia, and some really do not, and that can depend on age and anxiety around the procedure and a bunch of different things," Fleming said. "When there are patients that really don't require anesthesia and are getting a relatively low-risk procedure, we are able to move them into the procedure suite."

She noted that avoiding the operating room when appropriate may reduce anxiety for some patients while improving scheduling flexibility.

"For some patients, the thought of having a procedure in the operating room makes them associate it more like a surgery, and it can ramp up anxiety," Fleming said. "So this allows for a calmer, less intimidating type of environment for some of these patients, and it really does improve access because we can avoid some of the scheduling constraints that we have in the OR."

Why does timely treatment matter for children with chronic pain?

According to Fleming, reducing delays allows children to begin rehabilitation sooner.

"When you're looking at treating chronic pain, time does matter. You want to treat patients quickly and start to improve their function quickly for best outcomes," she said.

She explained that interventional procedures are not intended to replace rehabilitation but can help children participate more fully in physical therapy and other components of multidisciplinary care.

"Sometimes these injections can get patients over the hump, where they go from not moving to being able to participate in physical therapy and other activities, and the sooner we can get that going, the better," Fleming said.

What should pediatricians do when children present with chronic pain?

Fleming said the most important step pediatricians can take is acknowledging the child's experience.

"The single most important thing is to validate their pain and tell them that you believe them and that their pain is real," she said. "You would be surprised at how often patients hear that it's all in their head or that you know their pain isn't real because they didn't see something on diagnostic studies."

She encouraged pediatricians to recognize when pain is affecting a child's ability to participate in normal activities and to intervene before functional decline worsens.

"The 5 things really to focus on are validate their pain, explain in simple terms the way that their nervous system functions and how it generates pain signals and how it's influenced by different things going on in their life. Encourage gradual return to function, and also screen for things like poor sleep, mood problems, stressors going on at home or at school, and then refer early, especially when function is declining."

Why is family coaching an important part of treatment?

Fleming said supporting families is as important as treating the child because parents influence how pain is managed at home.

"The family will be a big key in what this patient's doing at home and how their pain is overall managed in their regular environment," she said. "And the family coaching is really critical."

She described a common scenario in which a child with persistent abdominal pain or headaches has a normal diagnostic evaluation but continues to miss school and avoid activities.

"If we say something like, ‘Your imaging and workup are normal, you are fine.’ That's very invalidating, and the patient, the family will feel very dismissed," Fleming said.

Instead, she recommends acknowledging the child's pain while explaining the path forward.

"But if you say something like, 'I believe your pain is real, and now we need to help your nervous system recover and help your body recover,' we can really change the trajectory that that patient and family experience," Fleming said.

What defines success in pediatric chronic pain treatment?

Fleming emphasized that successful treatment is measured by improvements in function rather than complete elimination of pain.

"The goal isn't zero pain. The goal is to restore function," she said. "If the child gets back to school and movement and doing the things they love to do, that's really a clinical success. But on a bigger scale, it's also prevention of disability and preserving their developmental trajectory."