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Pediatric Chronic Pain Program
Referral Form
Physician/Nurse Practitioner Referral Only. Will NOT be processed if incomplete. Patient Identification LaBelle goal of the Pediatric Chronic Pain Clinic
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How to fill out pediatric chronic pain program

How to fill out pediatric chronic pain program
01
Step 1: Gather all the necessary documents and information about the child's medical history and symptoms.
02
Step 2: Schedule an appointment with a pediatric chronic pain specialist.
03
Step 3: Attend the initial assessment session where the specialist will gather information about the child's pain experience and any previous treatments.
04
Step 4: Work with the specialist to develop an individualized treatment plan for the child, considering their unique needs and goals.
05
Step 5: Attend regular therapy sessions with the specialist, which may include a combination of physical therapy, cognitive behavioral therapy, and other pain management techniques.
06
Step 6: Follow the recommended treatment plan, including any exercises, medications, or lifestyle changes prescribed by the specialist.
07
Step 7: Keep track of the child's progress and communicate regularly with the specialist to make any necessary adjustments to the treatment plan.
08
Step 8: Attend follow-up appointments as recommended by the specialist to monitor the child's progress and make any further adjustments to the treatment plan.
09
Step 9: Stay informed about pediatric chronic pain research and resources to further enhance the child's treatment and management of pain.
10
Step 10: Provide ongoing support and encouragement to the child throughout their journey in the pediatric chronic pain program.
Who needs pediatric chronic pain program?
01
Pediatric chronic pain program is beneficial for children and adolescents who are experiencing persistent or recurring pain that lasts for more than three months.
02
It may be suitable for those with conditions such as fibromyalgia, complex regional pain syndrome, chronic headaches, musculoskeletal pain, and other types of chronic pain.
03
These individuals may have difficulty participating in daily activities, have disrupted sleep patterns, experience mood changes, and struggle with their overall quality of life.
04
The program aims to help these children manage their pain, improve their physical functioning, enhance their emotional well-being, and regain a sense of normalcy in their lives.
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