Dr. Megan Greenough is a PhD-prepared Nurse Practitioner and early career researcher with a joint clinician-researcher role with the CHEO Research Institute and the Department of Anesthesia. She completed her PhD at the University of Ottawa’s School of Nursing in 2023, alongside her MScN, Primary Health Care Nurse Practitioner Diploma, and BScN. Since 2016, Dr. Greenough has been actively involved with the Acute and Chronic Pain Services at CHEO, where she contributes to clinical practice, research, and mentorship. Her passion and research focus largely on pediatric pain management, specifically in the development of clinical decision support tools. She is currently launching her program of research entitled PAIN MAPS (Pediatric Assessment and Intervention research in Navigating, Monitoring and Advancing clinical PathwayS), with the mission to harness data-driven insights to develop standardized clinical pathways that optimize patient outcomes, support informed clinical decision-making, and foster innovative approaches to pediatric pain management. As an investigator with the Evidence to Practice Program at CHEO RI and in collaboration with University of Ottawa faculty, she has a promising future in contributing to pediatric pain research, education and mentorship.
Research Projects
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Triage Decision-Making in Interdisciplinary Pediatric Chronic Pain Programs
10/04/2024
Pediatric chronic pain is considered a significant problem worldwide (Tutelman et al., 2021). Chronic pain in children and adolescents not only increases risk of mobility issues, significant fatigue, poor sleep, school absenteeism, decreased cognitive function, and worsening mental health (Miro et al., 2022), but also increases risk for opioid misuse in youth (Pielech et al., 2020). Interdisciplinary pediatric chronic pain programs are the gold standard for the treatment of chronic pain (Law et al., 2013); however the limited number of programs (Caes et al., 2018) may contribute to prolonged wait times. Lengthy wait times to access pain care in children and adolescents have been linked to increased frustration, anxiety, and feelings of hopelessness (Palermo et al., 2019). Because of the variability in complexity and disability between pediatric chronic pain patients (Wagner et al., 2013), it is essential to optimize triage decisions to chronic pain programs to accurately prioritize pain care for patients in highest need. Still there is no established model or framework for this purpose.
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A systematic review of the biopsychosocial dimensions affected by chronic pain in children and adolescents: identifying reliable and valid pediatric multidimensional chronic pain assessment tools
12/01/2023
Pediatric chronic pain is a complex experience that is often challenging to describe and measure. Multidimensional tools that evaluate the biopsychosocial impact of chronic pain in pediatric patients can help clinicians to prioritize and tailor interdisciplinary pain care; yet, the psychometric value and clinical utility of such tools has not yet been systematically studied in the literature. The purpose of this review was to identify multidimensional biopsychosocial tools used in pediatric chronic pain, synthesize their reliability and validity evidence, and draw on this evidence to describe the relationships between chronic pain and biopsychosocial domains. The search involved 2 phases to (1) identify eligible tools and (2) conduct a measured forward citation search of tool development articles. Tool eligibility was guided by the Multidimensional Biobehavioral Model of Pediatric Pain and study eligibility was focused on primary chronic pain diagnoses unrelated to disease. Data extraction was focused on reliability and validity evidence of eligible tools, guided by the Standards for Educational and Psychological Testing. Results yielded 6 tools that included 64 eligible studies, highlighting 84 significant relationships between pain and functional interference across 11 biopsychosocial variables. All tools were shown to have good internal consistency and evidence of validity, primarily through relationships to other variables. Of the 6 tools, the most brief and easy to use were the most under studied. Further psychometric research is warranted for these tools to investigate their clinical utility and psychometric properties in guiding and prioritizing pain care for children and adolescents.
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Attaining expert consensus on diagnostic expectations of primary chronic pain diagnoses for patients referred to interdisciplinary pediatric chronic pain programs: A delphi study with pediatric chronic pain physicians and advanced practice nurses
09/01/2022
Pediatric primary chronic pain disorders come with diagnostic uncertainty, which may obscure diagnostic expectations for referring providers and the decision to accept or re-direct patients into interdisciplinary pediatric chronic pain programs based on diagnostic completeness. This study aimed to attain expert consensus on diagnostic expectations for patients who are referred to interdisciplinary pediatric chronic pain programs with six common primary chronic pain diagnoses. This study demonstrated a general agreement amongst pediatric chronic pain experts regarding diagnostic expectations of patients referred to interdisciplinary chronic pain programs with primary chronic pain diagnoses. Study findings may help to clarify referral expectations and the decision to accept or re-direct patients into such programs based on diagnostic completeness while reducing the occurrence of unnecessary diagnostic tests and subsequent delays in accessing specialized care.