Pain doctor focuses on adding more life to children's days

Dr. Stefan Friedrichsdorf makes ordinary hospital rounds, as thousands of Minnesota physicians do. But the minor miracles he performs along the way are the result of some of the most extraordinary medicine practiced in our state.

On one visit, he relates, he entered the room of a little girl -- very ill -- who was lying still and silent on the bed. "Is she in pain?" he inquired. "She's quiet," came her parents' resigned reply. "Would you like to hold her?" he asked the mother. "Oh yes, but she screams if we touch her."

When Friedrichsdorf walked out a half-hour later, the mother was cradling the child in her arms, while the father played a soothing melody on his guitar.

Friedrichsdorf's speciality -- pediatric pain and palliative care -- is very rare. As director of the pain and palliative care program at Children's Hospitals of Minnesota, he deals with young patients who have acute, chronic pain. Some have migraines. Others have grave illnesses, and are unlikely to survive to adulthood.

"Most children who die in this country still die in pain," Friedrichsdorf says. "While adults at the end of life expect state-of-the-art pain and symptom management, that's not yet the case in pediatrics. Children metabolize drugs differently than adults, and most children don't have access to specialists trained to provide the appropriate care."

At Children's, Friedrichsdorf and his team are working to change that. Children's pain program is one of the best in North America. Its staff has trained 500 medical practitioners in the Upper Midwest, and Friedrichsdorf lectures internationally -- from Brazil to Kuwait.

When he began his career, Minnesota was the last place he expected to find himself. A native of Germany, he was in his first month of medical school there when he saw a heart-wrenching case: a 12-year-old boy who died of cancer, spending his last four months alone. The parents were "rich and high-profile," he says, and they just couldn't cope with their child's agony.

The experience affected him profoundly. "'If I ever finish medical training,' I told myself, 'I want to find a better way.'"

Friedrichsdorf's mission led him into pediatric medicine, and then to a fellowship with a ground-breaking pain program in Australia. A chance encounter at a conference brought him to the attention of doctors from Children's, who invited him to Minneapolis to become director of its pain and palliative care program.

When Friedrichsdorf got their e-mail, he jokes, "I thought Minnea-what? It took me five minutes to find it on the map."

Children's has Minnesota's only licensed pediatric hospice, which is also the nation's largest. On any given day, it serves 80 to 90 children.

A children's hospice conjures up images of Charles Dickens -- gray beds, gray sheets and hopelessness. What could be a sadder place to work?

But pain, and symptoms such as nausea and breathlessness, can stand in the way. "Too many of the families who come to us have heard, 'I'm so sorry, but there's nothing more we can do for the pain,'" Friedrichsdorf says. "Here, we never give up, and there's always a lot we can do."

Often, that means much higher doses of pain medication than is traditional. It also means non-pharmacological treatments -- hypnosis, biofeedback, acupuncture, massage -- that might sound at first like "granola medicine."

In fact, mood and anxiety can influence pain profoundly, Friedrichsdorf says. Think of a football player who's so focused on a game that he doesn't know he's broken his ankle until the game is over, he says. When you have a headache and you're sitting at your cabin, gazing at the sunset, your headache usually gets better, right? When you're stuck in traffic and your boss is shouting at you on your cell phone, it gets worse.

Children's ambitious goal is to train young patients to control their own pain. One tool is "self-hypnosis." Friedrichsdorf teaches children to relax, breathe deeply and achieve tranquility by using imagery. "We teach them to 'go to your favorite place in your mind,' and eventually to find the 'pain switch' in their brain," he explains.

Farsighted leadership

Last week, Children's won the American Hospital Association's prestigious Circle of Life award for its pain and palliative care program. The award goes to outstanding programs that are unique and reproducible, and set the standard of care across the country.

The practice of medicine can involve many uncertainties. But in Friedrichsdorf's work, he says, "I can make promises."

"I sit down in a room with a child screaming in pain. I say, 'I will not leave this chair until your pain is under control.'" When he leaves, he's always kept his promise.