Research

The Pediatric Pain Management Clinic (PPMC) at Stanford Medicine Children’s Health offers multiple research projects outlined below. Investigations aim to understand pediatric functioning over time as youth, caregivers, and families participate in medical and behavioral health treatment(s) offered through the PPMC, and/or intensive outpatient services offered in the Pediatric Pain Rehabilitation Program (PReP).

CARES for Kids

Principal Investigator: Jennifer Rabbitts, MD
Funding: PCORI
Acute pain is one of the most common issues confronting adolescents and young adults recovering at home after surgery. Analgesic regimens to treat this pain have often relied on prescription opioids. In light of the opioid epidemic, concerns about opioid prescribing have grown, prompting new consideration to use non-opioid medications like non-steroidal anti-inflammatory drugs (NSAIDs) plus acetaminophen as first-line therapy. Our pragmatic, randomized trial compares two clinically relevant analgesic regimens prescribed to pediatric patients at discharge after low-risk surgeries outpatient surgeries (e.g., tonsillectomy, adenoidectomy, cholecystectomy, knee arthroscopy): (1) non- steroidal anti-inflammatory drugs plus acetaminophen (referred to as the “NSAID” regimen) or (2) low-dose opioid medications plus NSAID and acetaminophen (the “opioid” regimen).

iGET Living

Principal Investigator: Lauren E. Harrison, PhD
Funding: NIH (NIAMS)
iGET Living is a digital adaptation of a graded exposure treatment for youth with chronic pain and their caregivers. iGET Living targets pain-related fear and avoidance by gradually increasing engagement in activities that are challenging to do in the context of chronic pain. Phase one of this study (NCT 05079984) focused on an iterative, user centered development of the youth and caregiver interventions, followed by a small pilot trial to examine feasibility and preliminary efficacy. The second phase is focused on utilizing service design methodologies to identify barriers and facilitators to implementation and adoption of iGET Living in several clinical contexts at Stanford Medicine, Children’s Health.

Pediatric Pain Rehabilitation Program (PReP) Outcomes

Principal Investigator: Sara Williams, PhD

The Pediatric Rehabilitation Program (PReP) is an intensive interdisciplinary pain treatment program offering children and adolescents physical therapy, occupational therapy, pain psychology (including individual, parent/caregiver, and family support), medical follow-up, and group therapies. Participants and their parents/caregivers are tracked weekly to monitor progress while in the program and following discharge utilizing the Pediatric Collaborative Health Outcomes Information Registry (Peds-CHOIR). Collecting such information may facilitate understanding of how youth with pain and their families progress during and after participation in an intensive rehabilitation model of treatment. Factors that predict functional gains and improvements in pain over time are explored.

PEDS-BACK

Principal Investigators: Amber Borucki, PhD and Lauren Harrison, PhD
Funding: Pediatric Anesthesia and Pain Pilot Award
The PEDS-BACK study is a study that is investigating pediatric chronic back pain.  This study aims to address major gaps in the literature regarding our understanding of the etiology and co-morbid conditions associated with chronic back pain in the pediatric and adolescent population and represents a critical first step in hopefully a larger multi-faceted approach to identifying and categorizing key factors that are correlated with pediatric chronic back pain.

Sleep and opioid use/misuse in adolescents following surgery (TOPS)

Principal Investigator: Cornelius Groenewald, MD
Funding: NIH (NHLBI)
The opioid crisis remains a significant public health concern affecting adolescents in the United States. Medical use of prescription opioids following surgery is considered a pathway by which many adolescents transition to opioid misuse. Sleep deficiency following surgery may increase opioid use/misuse, directly or indirectly via increased pain or worsening mood, however has not been explored in previous studies. To fill this gap in knowledge, the primary aim of this study is to investigate how sleep deficiency influences opioid use and opioid misuse following outpatient knee, elbow, and shoulder surgery in adolescents. We hypothesized that sleep deficiency drives increased opioid use and also problematic opioid use following surgery.

Studying Intersecting Identities in Pain (SIIP)

Principal Investigator: Lauren E. Harrison, PhD
This program of work aims to understand the experiences and intersectionality of minoritized youth with chronic pain to inform equitable, affirming pain care. Several unfunded projects have been completed, including expanding the assessment of sexual orientation and gender identity of youth who are seen in the Pediatric Pain Management Clinic and a qualitative semi-structured interview study with LGBQTIA+ youth with chronic pain. Both of these studies serve to better understand the experiences of LGBTQIA+ youth with chronic pain. Upcoming work in this area will focus on the physiological impacts of cumulative stress (e.g., minority stress), and the differential impact that stress can have on the development and maintenance of chronic pain for minoritized youth.

Studying Melatonin and Recovery in Teens Following Surgery (SurgerySMART)

Principal Investigator: Jennifer Rabbitts, MD
Funding: NIH (NIAMS)
The goal of the study is to learn if melatonin can help teens having major musculoskeletal surgery by promoting healthy sleep. Melatonin is a hormone that is produced by the brain to help with a person’s sleep cycle and can be taken as a dietary supplement that may be effective in promoting longer, higher quality sleep. This study will assess the feasibility and acceptability of melatonin for teens undergoing major musculoskeletal surgery (e.g., spinal fusion, Nuss repair), as well as determine optimal measured outcomes (sleep, pain, health-related quality of life) at short- and long-term follow-up. Please email surgerysmart@stanford.edu for more information.

Targeted Realtime Assessment of Chronic Pain in Youth (TRAC-Pain)

Principal Investigator: Laura Simons, PhD
Funding: NIH (NINDS)
The TRAC-Pain Study is a pioneering research effort aimed at leveraging wearable digital health technology to monitor and understand the pain experience in adolescents with chronic musculoskeletal (MSK) pain. Participants will wear a smartwatch to passively collect physiological and activity data over 12 weeks while also completing brief daily surveys on pain, mood, fatigue, and stress. This study seeks to develop a digital biosignature of pain, enhancing diagnosis, treatment, and overall pain management.