Build your own adventure

Funding partners allow a learner to create a fellowship in pediatric pain management

Judith Chrystal - 02 July 2019

Tara McGrath's career path started to come into focus when she met several young patients with chronic pain at the Stollery Children's Hospital during her University of Alberta pediatric medical residency. The young people had regular, significant pain that impacted all aspects of their lives. They missed a lot of school, social activities, fitness and friendship that most kids take for granted. These patients, their families, and the care teams all were searching for causes and effective treatments that were not readily available.

Wanting to know more about pediatric chronic pain, and how she could help, McGrath began to search the literature and to look for more learning opportunities. She quickly discovered that this specialized field of study in pediatrics is relatively new and still developing. She was pleased to be able to create a unique learning experience at the U of A, the first of its kind in North America, with support from the Stollery Children's Hospital Foundation.

It turns out that most chronic pain specialists in North America are anesthesiologists. Enter Mark Simmonds, anesthesiologist, adult and pediatric chronic pain physician and medical director of the Stollery Chronic Pain Clinic. McGrath approached Simmonds to supervise and help her build a yearlong curriculum for the new training fellowship. He explained that helping young patients and their families manage chronic pain is time-consuming for practitioners and demands an ability to see and analyze medical problems in a different light, often in situations where many specialists have been unable to help. As such, helping children with chronic pain is complex work, requiring patience, energy, enthusiasm and the ability to work with an interdisciplinary team on both medical and psychological strategies.

Simmonds was impressed with McGrath. "When I met up with Tara and she expressed her very sincere and grounded interest I realized that, for the first time in 10 years here, there was an individual who possessed the personal and professional qualities to become a leader in the field," he says.

As a fellow, McGrath spent time with Simmonds, nurse practitioner Kathy Reid and psychologist Bruce Dick at the Stollery Pediatric Chronic Pain Clinic where they practice an interdisciplinary biopsychosocial approach. She expanded her experience by spending time with the Acute Pain Service, Aid for Symptoms and Serious Illness Support Team and Stollery's child life specialists.

Because chronic pain can underlie many different conditions, Tara also spent time in five subspecialty clinics to learn from patients, allied health professionals and physicians there. "One of the big benefits of building my own fellowship was that I got to put these pieces together and create this mosaic of learning," she explains.

There are only a small number of pediatric chronic pain experts worldwide, so McGrath travelled to the United Kingdom and Australia to broaden her experience. There she discovered that it is not uncommon for pediatric pain physicians to also be rheumatologists, because of the overlap in both clinical practice and research in these areas. Experiencing this international model for a rapidly changing subspecialty helped solidify McGrath's ultimate goal to pursue pediatric rheumatology after her fellowship.

McGrath has seen first-hand the positive impact that helping young people manage chronic pain has had in improving their lives, even when such pain is unlikely to disappear entirely. "I see small gains everywhere," she says. "I think the most significant thing is that these young people feel understood and they learn skills to communicate, to advocate, to eat healthy, to live healthy and to manage every day, every moment with pain."

Simmonds remains enthusiastic about McGrath's choice of career path and hopes that she will be able to return to the Stollery as a staff member to share her experience, continue her research into discovering better ways of managing pain and help attract more physicians into the field.

"I have kind of carved my own path in an area I certainly think is needed," she says. "I hope others will realize that you don't have to be restricted by what existing fellowships offer and instead find a way to build their own adventure."