In the 18 months since it began, Paediatric Pain Care SA has been working to change children’s lived experiences of pain through a gold standard model of care. 

There are two families who had their lives turned upside down in the past year by chronic pain in their children that immediately spring to mind when Phil Calvert APAM talks about a new service at his shared private practice.

Both families, he says, presented to the chronic pain service in incredible distress. For different reasons, both families had children experiencing chronic or persistent pain that had, by its very definition, been present for three months or longer.

Working both cases was equally challenging and rewarding, Phil says, and ultimately helped the respective young family members get to a point where they had a semblance of a normal life, such as being able to play sport and return to school.

The rewards of such positive outcomes are many, although Phil acknowledges that on the journey to get there, families have often faced significant barriers when initially seeking treatment for their children.

Many families with children experiencing chronic pain are simply not taken seriously, he says.

‘One of the things we work hard to do with our patient group and their families is to emphasise firstly that pain is always real.

'Families may have encountered a level of suspicion or concern that there’s no good cause for the pain; they may have been dismissed or not taken seriously,’ Phil says.

‘We take the stance that pain is always real; we explore with our families the complex nature of pain, how chronic pain works and how you can effectively work with an individual to help improve that.’

Paediatric Pain Care SA manages challenging and complex chronic pain in children in a private practice setting.

The dedicated multidisciplinary paediatric pain service—a recent addition to the services offered at Children’s Physio SA, the business Phil and Karen Schubert APAM purchased nine years ago—features a team that includes senior physiotherapy staff, Dr Nick Mills (specialist paediatrician), Christine Walsh and Rowena Holmes (clinical psychologists) and Sonja Gill (service coordinator).

Clients are jointly assessed by the whole team and a plan is put in place that caters to the individual child and their family. That plan, Phil says, is regularly reviewed, with communication between all team members at the centre of the client experience.

‘One of the things that’s clear about children with chronic pain is that no one child presents the same as another.

'We always work hard to put in place a tailored approach to their treatment,’ Phil says. ‘Sometimes a child may require more pain education support, sometimes more physical support, sometimes more psychological support.

‘It’s also important to control an ongoing push for further medical investigations once the child has been appropriately assessed.

'We know that continually searching for a cure can have a detrimental impact on a family’s having the right buy-in to a chronic pain rehabilitation approach,’ he says.

While the pain service will accept referrals for children at any age, the majority of patients are aged between eight and 16 years old. Often the young clients come to the service without having had any previous pain specialist medical or allied health input.

‘We can have children access our service who are reasonably functional and they are attending school and playing sport but still have significant issues related to their pain.

'Likewise, we can have children who are extremely deconditioned and may, for example, be wheelchair-bound and not have been at school for 12 months.

'There’s great variety in how kids present and how their experience with pain has affected them,’ Phil says.

Part of the reasoning behind establishing Paediatric Pain Care SA was that there wasn’t a multidisciplinary chronic pain private service for children in existence in South Australia, Phil says.

Although the Women’s and Children’s Hospital in Adelaide has very successfully run a publicly funded chronic pain service for children for several years, Phil and Karen felt there was a significant gap in primary care and private practice options for managing chronic pain in children.

The pair thoroughly researched a business model that would strike a balance between accessibility, affordability and profitability.

As part of their research, Phil, the immediate past president of the APA, reached out to the APA Business national group and sought advice from group members including then APA Business group chair Peter Tziavrangos and APA Board of Directors chair Mark Round.

‘There wasn’t a lot of easy-to-access material about similar services in Australia. There certainly was in an adult multidisciplinary model, but not so much in a paediatric sense,’ Phil says.

‘Being a member of the APA Business group, I was able to reach out to some people involved in that group whom I’ve had contact with in the past and I sought advice from them about how to make it work as effectively as possible.

'That was a big factor, particularly getting the advice about how we could best set up the pricing and billing structure for the service.

‘We had to be extremely mindful that the cost to our families is not insignificant. We wanted to make it as effective and as accessible as possible. And that was a real challenge.

'It sounds easy, but it took us a number of months to work through how we could establish a model that achieved what we wanted clinically and that was financially successful at the same time.’

Eighteen months ago, Phil and Karen began collaborating with a paediatrician and a psychology service to bring together the Paediatric Pain Care SA service, which accepted its first client early in 2022.

The service now caters to children from all over South Australia, including rural parts of the state; from interstate; and from some parts of Asia.

Referrals come from GPs, paediatric specialists and clinicians at the Women’s and Children’s Hospital and Phil says the service also receives inquiries from members of the public, who are then helped to negotiate the referral process.

‘Anyone who has set up a private multidisciplinary service will know that there are significant funding challenges.

'We work closely with the families to help them understand how to best access our service and how to do that as financially effectively as possible,’ he says.

The service now has a fulsome client case load, each journey beginning with a face-to-face consultation where possible.

Telehealth has an increasing role to play in the service, with some clients in areas outside metropolitan Adelaide opting to access telehealth for subsequent consultations.

‘Telehealth can be very helpful. But when you’re meeting a family for the first time—and the presentations of these children are often very complex and the history is very detailed— being able to do that as a team with the child and their parents in the same room is always our preference, where we can,’ Phil says.

Phil says that the physiotherapists on the team and in the practice more broadly have significant experience in children’s physiotherapy practice across a range of sectors including public, private, disability and community.

Working in paediatric pain, he says, requires a special set of skills beyond the technical; clinicians need to understand pain science and children’s musculoskeletal and neurological development and they need to possess a good understanding of the principles of rehabilitation in a chronic pain paradigm.

Running parallel to that, practitioners also need a good understanding of the dynamics of the client’s family and school and they need to be calm and supportive, with the ability to guide families along the rehabilitation journey.

‘That sounds easy but it’s often not,’ Phil says.

‘The rewards, however, are huge; you get to make a big impact on a child’s development when you can restore some normality and help improve their quality of life.

'And that’s not just for now, it’s also helping them to achieve to the highest level they can as adults.’