The ripple effect: systems-level interventions to ameliorate pediatric pain.

The focus of this brief review is to highlight to the reader some of the 'ripple effects' of broader systems-level healthcare issues and the implications they may have for effective treatment of pediatric chronic pain. Many healthcare providers focus almost exclusively on the patient, but lack the knowledge of how to intervene effectively at systems levels with families, schools and healthcare institutions surrounding the pediatric patient with pain. We provide a case example and consider this issue across three systems that are particularly relevant to pediatric pain management: the outpatient pain clinic, school and inpatient settings. The information presented will improve the healthcare provider's ability to effectively treat pediatric pain through an enhanced understanding of the multiple systems of care that surround children with pain.