The Intensive Pain Rehabilitation and Education Program (iPREP)

What Is iPREP?

iPREP is an intensive outpatient pain rehabilitation program that includes both individual and group therapies. iPREP provides the highest level of outpatient chronic pain treatment that is offered at Nationwide Children’s. iPREP offers help and hope to patients who may not have experienced success with lower levels of chronic pain treatment. iPREP is one of the most comprehensive programs of its kind in the country, and the only of its kind in Ohio.

iPREP is a three-week pain rehabilitation program that combines traditional and alternative therapies. These therapies include physical therapy, occupational therapy, pain psychology, music, therapeutic recreation, acupuncture, and massage therapy. Nationwide Children’s unique facilities provide real-life integration of skills, such as a test kitchen, community reintegration activities and a patient academic and school success program. 

The iPREP team communicates with the patient, family, referring provider and the primary care provider to provide a seamless transition as the patient starts and completes the program. The iPREP team interacts with the patient’s school to help them re-integrate back into school successfully.

Who May Benefit From iPREP?

Patients must have a physician referral. The program is designed for patients who:

  • Are ages 10-18
  • Have limited daily functioning
  • Are medically stable
  • Had an inadequate response to previous pain treatments

What Are Some of Patient Outcomes From iPREP?

Both patients and families benefit from the support of others who are experiencing similar journeys. In addition to peer support, patients who complete iPREP show remarkable outcomes including:

  • Successful school re-integration
  • Patient reports of improved mental health and coping skills
  • Fewer missed days of school
  • Improved peer relationships

What to Expect During iPrep?

Patients participate in iPREP from 8 a.m. to 4 p.m. daily, Monday through Friday, for three weeks. Services focus on physical therapy, occupational therapy, therapeutic recreation, pain psychology, music therapy, massage, acupuncture, academic success program and medical supervision. This treatment model has proven effective in the treatment of pediatric chronic pain. 

Parents receive extensive education regarding the causes and effective treatment of chronic pain. Parental education and participation maximize the chance of continued success and improved overall daily functioning upon their child’s graduation from the program. 

While the child is the primary treatment target, the family plays an important role in the management of pain and functioning. Family participation in daily afternoon educational groups is required.

Family group goals:

  • Educate caregivers on the skills and knowledge that the child learns
  • Provide support and instruction on how to successfully adapt and implement skills learned during the program into the home upon iPREP graduation
  • Promote the overall quality of life and functioning of the child

Each child’s caregiver can meet with the iPREP psychologist and medical provider individually at the end of the week to discuss their child’s progress and plan for the weekend. Each patient will have follow-up appointments one, three, six and 12 months after completing the program.

Here is an example of a daily iPREP schedule.

Schedule

Monday

Tuesday

Wednesday

Thursday

Friday

8a-9a

Group Therapeutic Recreation

Occupational Therapy

Group Music Therapy

Group Music Therapy

Music Therapy

9a-10a

Physical Therapy

(9a-9:45a)

Biofeedback with Psychology

Group Occupational Therapy

Group Psychology

Physical Therapy

10a-11a

Medical appointment

(9:45a-10:30a)

Physical Therapy

Group Physical Therapy

Group Physical Therapy

Acupuncture

11a-12a

Psychology

(10:30-11:15)

Massage Therapy

Group Psychology

PASS

(School time)

Psychology

Therapeutic recreation

(11:15a-12p)

12p-1p

Lunch

Lunch

Lunch

Lunch

Lunch

1p-2p

PASS

 (School time)

PASS

(School time)

PASS

 (School time)

Nutrition group lecture

PASS

(School time)

Physical therapy

Community Engagement activity

2p-3p

Group Physical Therapy

Group Physical Therapy

Psychology

Group Physical Therapy

Meet with social work

3p-4p

Patient/Parent Combined Group

Patient group

Patient group

Patient group

Patient/Parent Combined group

Parent group

Parent group

Parent group

Our Therapies

Accupuncture

The general theory of acupuncture is that proper physiological function and health depend on the circulation of nutrients, substances and energy called Qi (pronounced “chee”) through a network of “channels” or “meridians.” Pain and ill health result when the flow of Qi through the body is disrupted or blocked by many things, including disease, trauma/injuries and medication (side-effects) as well as lifestyle factors such as poor diet, emotions, lack of rest and stress.

Acupuncture involves the stimulation of specific body locations (acupuncture points) to improve the flow of Qi. Insertion of sterile thin needles, heat or finger-pressure achieves this stimulation. For many children and teens, acupuncture can improve pain and assist in helping their body regain a more natural balance.

Watch This Video About Acupuncture

Aromatherapy: Use of Essential Oils

Aromatherapy is the use of pure organic plant extracts called essential oils. Aromatherapy is used to create a healing environment for emotional, psychological and physical well-being. Only real essential oils are used for aromatherapy.

Biofeedback

Biofeedback is a technology that allows your child to gain greater awareness and control over the body’s physiological stress response. Biofeedback uses sensors to monitor changes in how the body reacts to stress and/or pain, including heart rate, muscle tension, breathing rate, temperature, sweating and blood pressure.

Biofeedback helps your child immediately see the benefits of relaxation on the body. Relaxation can reduce the negative reactions of stress on the body by decreasing or regulating muscle tension, heart rate, breathing rate and blood pressure.

Massage Therapy

Massage Therapy (MT) is a form of therapy that uses the gentle application of systematic touch, focusing on specific areas of the body, or the whole body, for the purpose of promoting healing and relaxation.

Massage therapy reduces stress, relieves tension and pain and increases the circulation throughout the body.Patients may benefit from feelings of safety, comfort, well-being, enhanced self-esteem and reduced anxiety and depression. Massage services are delivered by licensed massage therapists, who provide children with many different types of touch therapy.

Occupational Therapy

Occupational therapists (OT) evaluate a child’s motor, social, mental and emotional skills as well as their ability to understand and appropriately react to information related to their five senses. They then examine how difficulties with these functional skills may impact the child’s participation in their daily activities in their homes and communities.

Occupational therapists support the child in developing new skills or making adjustments to their activities or environments to help them improve their performance and independence in daily activities. OTs may provide services individually, within a group setting or in family sessions.

Patient Academic and School Success (PASS)

School plays a critical role in every child’s life. Maintaining educational needs throughout a hospitalization is important and can provide structure, distraction and motivation for a future outside of the hospital.

The Patient Academic and School Success program, or PASS, provides educational instruction to students enrolled in kindergarten through 12th grade. The PASS teacher will communicate between families, schools, and medical teams to receive direct feedback on academic skills and progress. Developmentally appropriate educational activities will be implemented in a group setting that will allow students to continue to achieve their academic goals while interacting with peers. The teacher will share information on educational and community resources with caregivers and can help to facilitate the transition from hospital to home and/or school.

Physical Therapy

Research has shown exercise is an important part of managing chronic pain, yet fear of pain often keeps people from wanting to begin an exercise program. A physical therapist (PT) can help an individual learn to interpret pain signals and manage and decrease symptoms through exercise. 

The physical therapist’s role is one of assessment and treatment. The physical therapist performs an assessment on the patient’s initial intake and at interval times throughout the patient’s course of rehabilitation. Following the initial intake, a plan of care for future visits will be established. 

Treatment interventions will be activity based and will focus on restoring normal function and movement patterns. Treatment interventions utilized may include range of motion/flexibility, strengthening, core stabilization, functional progression, low-impact aerobic exercise and development of a home exercise program.

Consistent performance of a home exercise program will be an essential piece of your child’s rehabilitation program. Proper pacing will also play a key role in your child’s rehab process. 

Psychology

A pediatric pain psychologist provides a range of assessment and treatment services to each child or teen and their family. Assessment occurs at the time of the initial appointment and at regular times to examine psychological issues related to coping and adjustment to chronic, acute and recurrent pain.

Individual sessions focus on teaching specific pain management strategies, such as muscle relaxation or visual imagery, distraction and meditation. Individual sessions allow your child to explore their personal pain experience and expression to then create targeted treatment strategies. In addition, stress management and emotion regulation training is provided to manage changes in daily functioning as a result of pain, including scholastic performance and peer relations.

Individual and family counseling may also be provided to address personal and family factors either contributing to or resulting from pain and/or medical procedures. Finally, the psychologist provides education to you, your child or teen and health care providers about the developmental and psychological factors related to pediatric pain in general.

Therapeutic Recreation

Therapeutic recreation (TR) specialists evaluate a child’s ability to participate in positive and healthy leisure activities within their homes and communities.

Therapeutic recreation supports children and families by helping them identify meaningful leisure and social activities, connect with resources to support access to leisure and reduce barriers to healthy leisure participation. Therapeutic recreation specialists also focus on teaching new skills to help the child be successful in leisure activities that support their health as well as their family and peer connections. TR may provide services individually, within a group setting or in family sessions.