I am the Director of Psychology Services for the Pediatric Pain Clinic, Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University Medical Center. I am a committed clinician, educator, and researcher with a focus on assessment and development of treatment interventions to improve the lives of youth with chronic pain. I am faced with the day-to-day challenges of treating children with very complex chronic pain conditions. The successful and cost-effective long-term management of chronic pain depends on integrated medical, mental health, and physical rehabilitation treatments. Decisions about the appropriate treatments, however, are dependent on accurate and useful data—data that have been lacking for adults and children who experience chronic pain. This lack of information inspired the creation of a Health Registry/LHS called CHOIR. I helped lead the pediatric adoption of CHOIR, called Peds-CHOIR, which is a novel, open-source outcome-dual tracking vehicle for youth with chronic pain and their caregivers.
In recent years, I have researched evidenced-based treatments of pediatric chronic pain and identification of important patient characteristics that may inform treatment outcomes. Integral to this research was the utilization of Peds-CHOIR, which was designed to track outcomes for children and adolescents with chronic pain and their caregivers. My publications in peer reviewed journals documents the development and implementation of this registry platform as well as the potential for deep phenotyping of treatment responsive and non-responsive patients.
In addition to practicing behavioral pain medicine for 12 years, I am the director of the pediatric pain psychology fellowship for the past 7 years. The education curriculum created for the pain psychology fellowship is now the leading standard in the field in educating future pediatric psychologists who want to specialize in pain medicine.
- Pediatric Pain Psychology
- Pediatric Pain Rehabilitation
Clinical Associate Professor, Anesthesiology, Perioperative and Pain Medicine
Director of Pediatric Pain Psychology Services, Pediatric Pain Clinic at Stanford Children's Health (2016 - Present)
Director of Pediatric Psychology Training, Department of Anesthesia, (2011 - Present)
Professional Education, American Society of Clinical Hypnosis, Clinical Hypnosis (2015)
Professional Education, Stens Corporation, 5-Day Professional Biofeedback Certificate Program (2012)
Professional Education:Yapko 100 Training in HypnosisCA
Professional Education:National Pediatric Hypnosis Training InstituteMN
Professional Education:Wayne State University School of Medicine (2002) MI
Fellowship:Wayne State University School of Medicine (2003) MI
Internship:Wayne State University School of Medicine (2002) MI
Current Research and Scholarly Interests
Clinical interventions, treatments, and outcomes in pediatric pain management
Graduate and Fellowship Programs
Pain Management (Fellowship Program)
Pediatric pain psychology: Guidelines for advanced subspecialty training.
Clinical Practice in Pediatric Psychology
2017; 5 (1): 17-35
View details for DOI 10.1037/cpp0000174
Pediatric-Collaborative Health Outcomes Information Registry (Peds-CHOIR): a learning health system to guide pediatric pain research and treatment.
2016; 157 (9): 2033-2044
The pediatric adaptation of the Collaborative Health Outcomes Information Registry (Peds-CHOIR) is a free, open-source, flexible learning health care system (LHS) that meets the call by the Institute of Medicine for the development of national registries to guide research and precision pain medicine. This report is a technical account of the first application of Peds-CHOIR with 3 aims: (1) to describe the design and implementation process of the LHS; (2) to highlight how the clinical system concurrently cultivates a research platform rich in breadth (eg, clinic characteristics) and depth (eg, unique patient- and caregiver-reporting patterns); and (3) to demonstrate the utility of capturing patient-caregiver dyad data in real time, with dynamic outcomes tracking that informs clinical decisions and delivery of treatments. Technical, financial, and systems-based considerations of Peds-CHOIR are discussed. Cross-sectional retrospective data from patients with chronic pain (N = 352; range, 8-17 years; mean, 13.9 years) and their caregivers are reported, including National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) domains (mobility, pain interference, fatigue, peer relations, anxiety, and depression) and the Pain Catastrophizing Scale. Consistent with the literature, analyses of initial visits revealed impairments across physical, psychological, and social domains. Patients and caregivers evidenced agreement in observable variables (mobility); however, caregivers consistently endorsed greater impairment regarding internal experiences (pain interference, fatigue, peer relations, anxiety, and depression) than patients' self-report. A platform like Peds-CHOIR highlights predictors of chronic pain outcomes on a group level and facilitates individually tailored treatment(s). Challenges of implementation and future directions are discussed.
View details for DOI 10.1097/j.pain.0000000000000609
View details for PubMedID 27280328
The Effect of Pain Catastrophizing on Outcomes: A Developmental Perspective Across Children, Adolescents, and Young Adults With Chronic Pain.
journal of pain
2017; 18 (2): 144-154
Pain catastrophizing is one of the most powerful predictors of poor outcomes in youth and adults with pain; however, little is known about differential effects of pain catastrophizing on outcomes as a function of age. The current study examined the predictive value of pain catastrophizing on pain interference and pain intensity across children, adolescents, and 2 age groups of young adults with chronic pain. Cross-sectional data are presented from the adult and pediatric Collaborative Health Outcomes Information Registry (CHOIR), including measures of pain catastrophizing, pain intensity, pain interference, and emotional distress from 1,028 individuals with chronic pain. Results revealed that age moderated the relation between pain catastrophizing and pain interference, with the strength of these effects declining with age. The effect of pain catastrophizing on pain interference was strongest in adolescents and relatively weak in all 3 other groups. Emotional distress was the strongest predictor of pain interference for children, whereas pain intensity was the strongest predictor for both adult groups. Pain catastrophizing was found to predict pain intensity and, although age was a significant moderator, statistical findings were weak. Developmental considerations and clinical implications regarding the utility of the construct of pain catastrophizing across age groups are discussed.This article explores differences in pain catastrophizing as predictors of pain interference and pain intensity across cohorts of children, adolescents, and 2 age groups of young adults. This work may stimulate further research on chronic pain from a developmental perceptive and inform developmentally tailored treatment interventions that target catastrophizing, emotional distress, and pain intensity.
View details for DOI 10.1016/j.jpain.2016.10.009
View details for PubMedID 27825857
- A Pilot Study of Mindfulness for Pediatric Chronic Pain Children 2017; in press
- Spotlight on the Pediatric Pain Psychology Special Interest Group Clinical Practice in Pediatric Psychology 2017; 5 (1): 15-16
- Traumatic stress and pediatric pain: A neurobiological stress-health perspective Journal of Child and Adolescent Trauma 2017; in press
Restrictive parenting buffers head start students from stress
INFANTS AND YOUNG CHILDREN
2007; 20 (1): 55-63
View details for Web of Science ID 000243050000005