Attending physician Connecticut Children's Medical Center Hartford, Connecticut, United States
Background: Neuroirritability is defined as persistent or recurrent episodes of pain behaviors which, after assessment and management of potential nociceptive sources, can most likely be attributed to abnormal signaling of the central nervous system. It is a common presentation among pediatric pain and palliative care patients of all ages yet literature to assist in the recognition and treatment of symptoms is limited. We sought to fill this gap by developing a subspecialty clinic and referral guideline to increase awareness and address the needs of this unique group of patients and their families. Objective: Improve recognition of patients experiencing neuroirritability and provide a foundation to develop multimodal care plans for patients and their caregivers on an individual and institutional level. Design/Methods: We have created a subspecialty clinic to address unique presentations of complex patients experiencing neuroirritability and guide families toward an optimal management plan. This can include pharmacologic therapy (gabapentin, clonidine, medical marijuana, low dose naltrexone), behavioral therapy, and coordination of team/family meetings with key participants among additional interventions. A guideline was created for community pediatricians to assist in management and a database was established in Redcap to collect relevant clinical information as we move forward. Results: Our program remains in its infancy and we continue to collect data as we increase awareness of our program. In the first 3 months since its publication, the guideline was viewed 53 times by 44 unique users. We will include further data on guideline and clinic utilization when presenting.
Conclusion(s): We aim to provide a novel clinical experience for patients and families experiencing neuroirritability with the goal of better addressing distressing symptoms and improving overall patient care. The number of guideline views since its publication supports its value to the broader community. By updating the guideline for pediatricians and collecting data as we grow our program, we hope to eventually establish data-driven recommendations for optimal management which could be disseminated into the broader pediatric community.
