Multidisciplinary care helps restore function in children with chronic pain

Chronic pain affects approximately one in five children, yet pediatric pain management remains underrecognized and underserved in many communities. Jamie Fleming, MD, believes improving outcomes begins with recognizing that children require a different approach than adults—one that prioritizes development, family involvement, and restoration of daily function.

Fleming, section chief of Pain Management and director of Interventional Pain Management at Phoenix Children's, said the health system's comprehensive pediatric pain program was designed specifically for children rather than adapted from adult care. The multidisciplinary program brings together pain medicine, psychology, physical therapy, occupational therapy, integrative medicine, and interventional pain specialists to deliver coordinated treatment. In 2025, Phoenix Children's expanded these services with a dedicated pediatric interventional pain procedural suite to support children whose pain persists despite foundational therapies.

Why does pediatric chronic pain require a different approach?

According to Fleming, one of the biggest misconceptions is that children can be treated using the same framework as adults.

"The teams-based approach is so critical to treating pediatric chronic pain," Fleming said. "Really, the thing is, pediatric patients are not just small adults, and so that in itself is very different."

She explained that developmental stage, family dynamics, activity level, emotional coping, and differences in pain physiology all influence how children experience and recover from chronic pain.

"They depend a lot on their family and environment. Their activity levels can be different. How they cope emotionally is very different. Even the reasons why they have pain and their physiology are different," Fleming said.

These differences, she said, require care models designed specifically for pediatric patients rather than adaptations of adult pain programs.

Why is family involvement essential in pediatric pain care?

Fleming said families are central to successful treatment because chronic pain often affects the entire household.

"I think the family is such a huge and critical part of their care and treatment plan," she said. "Understandably, when families come in, they're really frightened. Oftentimes, they have this child with severe pain, and they feel helpless."

Over time, families may unintentionally reorganize their daily lives around the child's pain.

"Sometimes we see families where their entire life reorganizes around the child's pain. They're trying to help their child, but really it ends up reinforcing the whole pain cycle," Fleming said.

For that reason, she said education extends beyond the patient to include coaching parents on how to respond to pain in ways that support recovery rather than reinforce disability.

How does a multidisciplinary pediatric pain program improve care?

Fleming said one of the greatest strengths of Phoenix Children's program is that specialists work together to deliver a consistent treatment plan.

"Our approach at Phoenix Children's is multidisciplinary care, and what that means is we have a lot of different specialists involved, and we all work together to deliver one unified message to the patient," she said.

The team includes pain medicine, psychology, physical therapy, occupational therapy, advanced practice providers, nurses, integrative medicine specialists, and interventional pain physicians.

"We don't want patients going to all these specialists, getting different things from different people, and getting confused and not getting a really uniform and comprehensive plan," Fleming said.

She summarized the program's philosophy with a simple message delivered consistently across disciplines.

"Really, our message to them is: your pain is real. Movement can be safe, and we can restore your function," Fleming said.

How are children with complex regional pain syndrome treated?

Fleming highlighted complex regional pain syndrome (CRPS) as an example of a condition that benefits from coordinated multidisciplinary care.

"This is something that comes into our clinic fairly often, and really these patients, it's a very difficult diagnosis. It's very hard on the child functionally," she said.

By the time many children reach a specialty pain clinic, she said, families are often frustrated after prolonged diagnostic evaluations and declining function.

Treatment begins with physical therapy and pain psychology, with additional therapies added according to individual patient needs.

"Really, we explain the foundation as physical therapy, pain psychology, and then we add on layers depending on the need of the patient," Fleming said. "So, oftentimes, that's different types of non-opioid medications. Sometimes, we even do things like injections to help them participate in their therapies."

What is the primary goal of pediatric pain management?

Fleming said successful treatment should be measured by improvements in function rather than reductions in pain scores alone.

"I think one big thing to know is our goal is not lowering a pain number, and that sometimes sounds different to adult medicine as well," she said. "And our goal is really to restore that child's function, and that functional outcome is really what matters."

She said helping children return to school, sports, family activities, and normal development remains the central objective of comprehensive pediatric pain care.