{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:51:15Z","timestamp":1782867075151,"version":"3.54.5"},"reference-count":25,"publisher":"American Academy of Pediatrics (AAP)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:p>An adolescent with complex regional pain syndrome, functional neurological symptoms, and significant psychosocial complexity was hospitalized for severe decline. Despite meaningful progress through a structured, multidisciplinary inpatient approach, she was repeatedly denied admission to pediatric inpatient pain rehabilitation programs across the United States\u2014often based on process requirements such as caregiver engagement, outpatient intake completion, and medical or psychiatric complexity. These denials delayed access to intensive, coordinated care previously shown to benefit her.<\/jats:p>\n                  <jats:p>This case illustrates how the intersection of medical and psychosocial complexity can operate as an unspoken exclusion criterion in pediatric pain rehabilitation, disproportionately affecting vulnerable youth. Policies and eligibility checklists intended to optimize outcomes may inadvertently reinforce inequities when applied without attention to context. We argue that readiness should not be defined solely by patient or family characteristics but by the health system\u2019s capacity to respond to complexity with flexibility and equity.<\/jats:p>\n                  <jats:p>We propose system-level strategies to promote equitable access: requiring clinician-to-clinician dialogue before denials are issued, creating formal appeal pathways to reconsider complex cases, clarifying and publishing admission criteria, and designing inclusive rehabilitation tracks. Rather than asking whether patients are ready for our programs, we must ask whether our programs are prepared to meet our patients.<\/jats:p>","DOI":"10.1542\/hpeds.2025-009131","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:02:41Z","timestamp":1782259361000},"page":"e558-e564","source":"Crossref","is-referenced-by-count":0,"title":["Too Complex to Treat? Equity in Access to Inpatient Pediatric Pain Rehabilitation"],"prefix":"10.1542","volume":"16","author":[{"given":"Beth Links","family":"Torwekar","sequence":"first","affiliation":[{"name":"1Division of Hospital Medicine, Oregon Health & Science University, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Chiapa","sequence":"additional","affiliation":[{"name":"2Division of Psychology, Institute on Development & Disability\/Pediatrics, Oregon Health & Science University, Portland, Oregon"},{"name":"3Yale Child Study Center, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Kotel","sequence":"additional","affiliation":[{"name":"4Division of Rehab Services, Oregon Health & Science University, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Verboort","sequence":"additional","affiliation":[{"name":"4Division of Rehab Services, Oregon Health & Science University, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"issue":"6","key":"2026063020003493000_r1","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1037\/h0022701","article-title":"Parents as dispensers of aversive stimuli","volume":"2","author":"Patterson","year":"1965","journal-title":"J Pers Soc Psychol."},{"issue":"2","key":"2026063020003493000_r2","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.mayocpiqo.2017.05.006","article-title":"Development of an interdisciplinary pediatric pain rehabilitation program: the first 1000 consecutive patients","volume":"1","author":"Bruce","year":"2017","journal-title":"Mayo Clin Proc Innov Qual Outcomes."},{"issue":"1","key":"2026063020003493000_r3","first-page":"4","article-title":"Complementary parent components for pediatric pain families: innovations in treatment","volume":"7","author":"Russell","year":"2020","journal-title":"Children (Basel)."},{"key":"2026063020003493000_r4","doi-asserted-by":"crossref","first-page":"101911","DOI":"10.1016\/j.ctcp.2024.101911","article-title":"Social determinants of health and youth chronic pain","volume":"57","author":"Chen","year":"2024","journal-title":"Complement Ther Clin Pract."},{"key":"2026063020003493000_r5","doi-asserted-by":"crossref","first-page":"8769402","DOI":"10.1155\/2017\/8769402","article-title":"Chronic pain in children: a look at the referral process to a pediatric pain clinic","volume":"2017","author":"Cucchiaro","year":"2017","journal-title":"Int J Pediatr."},{"issue":"11","key":"2026063020003493000_r6","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1016\/j.jpain.2010.04.005","article-title":"Systematic review of family functioning in families of children and adolescents with chronic pain","volume":"11","author":"Lewandowski","year":"2010","journal-title":"J Pain."},{"issue":"12","key":"2026063020003493000_r7","doi-asserted-by":"crossref","first-page":"2729","DOI":"10.1016\/j.pain.2011.07.016","article-title":"The epidemiology of chronic pain in children and adolescents revisited: a systematic review","volume":"152","author":"King","year":"2011","journal-title":"Pain."},{"issue":"6","key":"2026063020003493000_r8","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1016\/j.acap.2023.01.013","article-title":"Neighborhood poverty and distance to pediatric hospital care","volume":"23","author":"Brown","year":"2023","journal-title":"Acad Pediatr."},{"issue":"6","key":"2026063020003493000_r9","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1016\/j.acap.2022.03.016","article-title":"Predictors of pediatric frequent emergency department use among 7.6\u00a0million pediatric patients in New York","volume":"22","author":"Anyatonwu","year":"2022","journal-title":"Acad Pediatr."},{"key":"2026063020003493000_r10","doi-asserted-by":"crossref","first-page":"785","DOI":"10.2147\/JPR.S37434","article-title":"Pediatric pain management: the multidisciplinary approach","volume":"6","author":"Odell","year":"2013","journal-title":"J Pain Res."},{"issue":"2","key":"2026063020003493000_r11","first-page":"33","article-title":"Multidisciplinary pain management for pediatric patients with acute and chronic pain: a foundational treatment approach when prescribing opioids","volume":"6","author":"Wren","year":"2019","journal-title":"Children (Basel)."},{"issue":"1","key":"2026063020003493000_r12","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1186\/s12913-016-1403-9","article-title":"Household income determines access to specialized pediatric chronic pain treatment in Germany","volume":"16","author":"Ruhe","year":"2016","journal-title":"BMC Health Serv Res."},{"issue":"7","key":"2026063020003493000_r13","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1136\/archdischild-2015-310280","article-title":"Inequalities in access to a tertiary children\u2019s chronic pain service: a cross-sectional study","volume":"101","author":"Jay","year":"2016","journal-title":"Arch Dis Child."},{"key":"2026063020003493000_r14","doi-asserted-by":"crossref","first-page":"102038","DOI":"10.1016\/j.copsyc.2025.102038","article-title":"Optimizing psychological treatments for pediatric chronic pain to enhance outcomes, availability, and accessibility","volume":"64","author":"Pielech","year":"2025","journal-title":"Curr Opin Psychol."},{"issue":"9","key":"2026063020003493000_r15","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.3390\/jcm8091267","article-title":"Best-evidence for the rehabilitation of chronic pain part 1: pediatric pain","volume":"8","author":"Harrison","year":"2019","journal-title":"J Clin Med."},{"issue":"9","key":"2026063020003493000_r16","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1093\/jpepsy\/jsad054","article-title":"Commentary: actionable steps for addressing pediatric pain in rural and underserved communities: disrupting our approach to psychological science and care","volume":"48","author":"Cunningham","year":"2023","journal-title":"J Pediatr Psychol."},{"issue":"2","key":"2026063020003493000_r17","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s11940-022-00708-5","article-title":"Treatment approaches for functional neurological disorders in children","volume":"24","author":"Vassilopoulos","year":"2022","journal-title":"Curr Treat Options Neurol."},{"issue":"2","key":"2026063020003493000_r18","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1097\/HRP.0000000000000358","article-title":"Evidence-based mind-body interventions for children and adolescents with functional neurological disorder","volume":"31","author":"Kozlowska","year":"2023","journal-title":"Harv Rev Psychiatry."},{"key":"2026063020003493000_r19","article-title":"Ethical Principles of Psychologists and Code of Conduct","author":"American Psychological Association","year":"2017"},{"issue":"11","key":"2026063020003493000_r20","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1001\/jamapediatrics.2024.3039","article-title":"Anxiety and depression in youth with chronic pain: a systematic review and meta-analysis","volume":"178","author":"Dudeney","year":"2024","journal-title":"JAMA Pediatr."},{"issue":"10","key":"2026063020003493000_r21","doi-asserted-by":"crossref","first-page":"2277","DOI":"10.1097\/j.pain.0000000000000642","article-title":"Posttraumatic stress disorder symptoms in youth with vs without chronic pain","volume":"157","author":"Noel","year":"2016","journal-title":"Pain."},{"issue":"5","key":"2026063020003493000_r22","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1176\/appi.ps.201300255","article-title":"Trauma-focused cognitive-behavioral therapy for children and adolescents: assessing the evidence","volume":"65","author":"de Arellano","year":"2014","journal-title":"Psychiatr Serv."},{"issue":"2","key":"2026063020003493000_r23","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1891\/1933-3196.1.2.68","article-title":"EMDR, adaptive information processing, and case conceptualization","volume":"1","author":"Shapiro","year":"2007","journal-title":"J EMDR Pract Res."},{"issue":"1","key":"2026063020003493000_r24","doi-asserted-by":"crossref","first-page":"e000815","DOI":"10.1136\/tsaco-2021-000815","article-title":"Trauma-informed care: recognizing and resisting re-traumatization in health care","volume":"6","author":"Grossman","year":"2021","journal-title":"Trauma Surg Acute Care Open."},{"issue":"1","key":"2026063020003493000_r25","doi-asserted-by":"crossref","first-page":"135","DOI":"10.7812\/TPP\/23.127","article-title":"Effectiveness of trauma-informed care implementation in health care settings: systematic review of reviews and realist synthesis","volume":"28","author":"Goldstein","year":"2024","journal-title":"Perm J."}],"container-title":["Hospital Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/16\/7\/e558\/1941351\/hosppeds.2025009131.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/16\/7\/e558\/1941351\/hosppeds.2025009131.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:58Z","timestamp":1782864058000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article\/16\/7\/e558\/207910\/Too-Complex-to-Treat-Equity-in-Access-to-Inpatient"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":25,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,6,24]]},"published-print":{"date-parts":[[2026,7,1]]}},"URL":"https:\/\/doi.org\/10.1542\/hpeds.2025-009131","relation":{},"ISSN":["2154-1663","2154-1671"],"issn-type":[{"value":"2154-1663","type":"print"},{"value":"2154-1671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]}}}