Undertreated pain in childhood can create risk for lifelong suffering, disability, loss of work productivity, emergency room visits, and hospitalizations.
Persistent pain is a disabling illness that seriously impacts and often disables 15-30% of our nation’s children! Ongoing pain can arise from cancer, arthritis, injuries, or other diseases, but more commonly it is caused by intractable headaches, abdominal pain, fibromyalgia, neuropathic pain like CRPS, muscle conditions, and many common disabling conditions that can be treated effectively before they become chronic lifelong struggles. A recent study found that by age 20 years, more than 26% of Americans or about 76.5 million people have problems with persistent pain.
For example, over 45 million Americans get chronic, recurring headaches, a number which far exceeds the sufferers of asthma, diabetes and coronary heart disease combined. Persistent pain is becoming a costly epidemic. Ten years ago, the annual cost of pain from all causes was about $100 billion, while recent studies have found that annual costs associated with low back pain alone are about $85.9 billion. The total cost of arthritis, the nation’s leading cause of disability, is about $128 billion. Compared with the expense of other chronic conditions, the annual costs associated with chronic pain far exceed those related to heart disease, hypertension, and respiratory disease combined.
There are several reasons why there is so little prevention of adult chronic pain:
• Insufficient pediatric programs to treat pain in childhood. Few centers in the country have the expertise to treat persistent pain in children. Fewer yet have implemented an interdisciplinary approach to treating chronic pain that integrates a mind-body, family approach with specialists practicing complementary medicine.
• Insufficient training in pain management for pediatricians and family medicine practitioners. Primary Care Clinicians (PCPs) receive little training in how to diagnose and treat common pain conditions in children. The typical child with persistent pain who finally reaches a specialty pediatric pain clinic will have first seen an average of eight different subspecialists and undergone numerous tests. Despite that, they still hurt, are missing school, and their life has been put on hold while they suffer.
• Mind-body, family-centered, pediatric pain clinics are not sufficiently revenue-generating businesses. Because overhead for hospitals and university medical centers is high, they have to generate revenues by focusing more on providing surgical procedures and less on allowing doctors to spend time simply speaking with patients.
• Inadequate efforts being made by the medical profession towards preventing pain and promoting wellness/healthy living in children. Most pediatric pain clinics barely have time to treat patients with the most severe pain problems and often have long waiting lists just for initial consultations or appointments. Also, PCPs have so little time to see patients that the time they have is primarily focused on treating the current problem/symptom rather than addressing the root of the condition. Helping children and families learn about stress management, healthy eating, exercise, and other health-promoting behaviors can reduce the risk of childhood pain becoming chronic pain into adulthood.
1. Provide expert, integrative diagosis and treatment to children and young adults with pain who have NOT had relief from their primary care providers and other specialists.
2. Reduce healthcare disparities by establishing a proven integrative, mind-body, family-centered model in the community to treat pain in infants, children, adolescents, and young adults by:
• Working in partnership with the UCLA Pediatric Pain Research team to implement the latest state-of-the-
art tools and methodologies into practice as well as carry on outcome-based studies.
3. Provide training in treatment of common pain problems presented by children to physicians and other clinicians (e.g. PCPs, 4th year medical students, complementary clinicians like acupuncturists).
4. Serve the community and impact healthcare policy related to the national problem of pain by:
• Serving as a model program that can be replicated in high-poverty urban as well as rural communities.
• Using telemedicine to provide support for developing new programs, PCPs, families at great geographic
distance, and children too sick to attend the onsite clinic.
• Holding workshops for parents and teachers in the community on topics such as stress management,
In 1991, Dr. Zeltzer created the UCLA Pediatric Pain Clinic to treat children and adolescents who had chronic pain. Given her longtime interest in mind-body medicine, she began the clinic with a psychologist, physical therapist, and acupuncturist. Gradually the clinic’s interdisciplinary program grew to its current team (see WCLA clinical team). While the clinic gained a reputation over time with patients coming from all parts of the country as well as throughout California, the clinic was limited in having a site where all the team could see patients in one place and where a day treatment program could be established. Clinic space at UCLA was tight and only patients whose insurance included a contract with UCLA could be seen. It was necessary to limit the clinic to one day per week because the costs of running the clinic at UCLA were significantly higher than the income produced by the pain clinic. While the Department of Pediatrics and the medical school in general were very supportive of the Pain Clinic, it was not possible to continue in a very limited way (one day per week with one physician, Dr Zeltzer, whose salary was derived from research and other sources rather than from clinic revenues). However, for 10 years Dr. Zeltzer worked with various community individuals to try to relocate the pain clinic into the community as Whole Child LA and link it with a non-profit that she formed with community leader Eva Ho, a business executive who created the business plan and business leadership for the non-profit, originally called Whole Child Foundation, to support the creation of Whole Child LA.
The year 2009 was an important one for launching of Whole Child LA. First, the Pediatric Pain Program at UCLA was awarded the American Pain Society’s Clinical Centers of Excellence in Pain Management award, the only pediatric pain program of the five national awardees. Also this is the year that the medical corporation, Whole Child LA, became official with the California Secretary of State and the Medical Board. In 2009, the name change became official for the 501c3 non-profit that Dr. Zeltzer began in 2005 as the National Children’s Pain Center to the Whole Child Foundation. Then, in 2019, Whole Child Foundation was relaunched under the name Creative Healing for Youth in Pain (chyp).
As Dr. Zeltzer is the Distinguished Professor of Pediatrics, Anesthesiology, Psychiatry and Biobehavioral Sciences and the Director of the Pediatric Pain Program at UCLA and has continued in this academic role, she wanted her program at UCLA to link closely with Whole Child LA. Dr Zeltzer’s pediatric pain research program has been studying why some children have more problems with pain than do others, the relationship between parents’ and children’s pain, sex difference and the role of puberty in pain, genetics and pain, and various treatments for children’s pain. The close link with her pediatric pain clinic at UCLA allowed her patients to benefit from this array of research studies that were ongoing. It seemed only logical to move her entire pediatric pain research team and studies to the same off-campus site as the Whole Child LA so that patients could not only see pain clinicians in one site but also take part in research as they wished in the same site. While the research program is still part of UCLA, it links with the independent Whole Child LA and chyp through Dr. Zeltzer’s role in both.
Her entire interdisciplinary clinical pain team moved to Whole Child LA and team meetings take place at this site now, and her entire research team likewise moved to the same off-campus site so that the two programs could be linked in this way. Many of the pain clinicians are also involved in Dr. Zeltzer’s UCLA pediatric pain research studies, such as a previous one on acupuncture with Mike Waterhouse and Dr. Samantha Levy. Current research involves the study of Iyengar yoga with Beth Sternlieb. Many others likewise involve the Whole Child LA pain care clinicians. This teaming of Whole Child LA with the UCLA Pediatric Pain Research Program creates more than each alone and also allows medical students, pediatric residents, and even community physicians, psychologists, physical therapy students, and others to learn our mind-body integrative model of pediatric pain care.
In 2010 Dr. Paul Zeltzer, a Hematology-Oncology and Immunology specialist joined the WCLA clinic and he and Dr. Lonnie usually see the patients together.
Whole Child LA offers state-of-the-art medicine in combination with the regenerative power of complementary therapies to treat children suffering from chronic pain. Patients choose from a variety of healing modalities ranging from acupuncture to art therapy. The staff works as a team to develop an individualized approach for each child that involves active participation of the child and family. Collective wisdom and coordinated care greatly enhance the effectiveness of treatment of chronic pain.
Our goal is to manage pain and disease symptoms in children, adolescents, and young adults through creative use of the arts, biomedical sciences, and complementary healing practices, with a focus on the family. Our CAM (complementary and alternative medicine) clinicians work together as a team to discuss a holistic approach to the management of chronic pain for the patients.
“Our clinical team donates time to our weekly meetings because we share a common passion for working with kids in chronic pain who have not been
well served by the traditional medical model. It is rewarding to see these young people develop the skills and insight that transform their suffering
into an opportunity for growth. We feel privileged to hold a spot on a medical team that is creating something greater than what each of us can do
individually. We see our medical model as a valuable contribution to the future direction of medical care.”
- Beth Sternlieb, Certified Iyengar Yoga Teacher
Through our approach, we wish to create new models of health care that integrate a broad spectrum of healing arts and sciences, and to train professionals in using this approach. Scientific knowledge stemming from research on pediatric pain management is then translated into practical tools for the treatment of pain and other distressing symptoms.
The knowledge acquired at the clinic will be incorporated into experiential learning-based programs for families, teachers, community outreach workers, health care professionals, and the general public, to increase learning opportunities for pediatric pain through the creative use of media.
“I benefit from the synergy of the clinicians involved in the Pediatric Pain Program - the open exchange of ideas and information is a catalyst for me to
grow and expand in my treatment of health-challenged individuals.”
- Christopher Slate, L.M.T., C.S.T., Craniosacral Therapist
“Working with practitioners from all disciplines provides me with a unique opportunity to look at a patient’s needs from many different angles, enabling solutions to be found through the symbiosis of clinical skills. These kinds of patients frequently have needs that go beyond the scope of one modality.”
- Michael Waterhouse, M.A., L.Ac., Acupuncturist and Chinese Herbal Specialist
“Through the generosity of our staff, we have been able to accommodate children who cannot afford our care; however, we are striving to expand our capacity to meet their needs because of our commitment to the under-served.”
- Lonnie Zeltzer, M.D., Director
Dr. Zeltzer among top 1% of doctors in US
US News & World Report has named Dr. Lonnie Zeltzer among the Top 1% of Doctors in the US. This prestigious recognition comes from a peer nomination process in conjunction with Castle Connolly Medical Limited. The directory is compiled to help consumers find excellent medical care and to reinforce collaboration and support among medical professionals.
Congratulations to Dr. Zeltzer!
Integrative pediatric pain program at UCLA is the recipient of the American Pain Society’s Clinical Centers of Excellence in Pain Management Award for 2009.
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PARTH R BHATT