What is the Pain Rehabilitation Program?

The Pain Rehabilitation Program (PReP) is an intensive treatment program for children and teens with chronic musculoskeletal and neuropathic pain problems. Many patients in the program have complex pain problems and have tried other treatments before coming to PReP.

Seattle Children’s provides a team of experts from many areas of healthcare who are specially trained to help children and teens reach daily activity goals and regain control of their lives. During the program children work to:

  • Improve physical function, reducing the use of assistive devices.
  • Build confidence and independence, shifting focus away from pain and disability.
  • Restore a normal routine, returning to school, social life and sports.
  • Learn strategies to cope with pain and stress.

Seattle Children’s Hospital is one of fewer than 10 hospitals in the country with an intensive treatment program for children and teens with chronic pain. Patients come to our program from thousands of miles away.

What kind of patients are treated by this program?

We treat children and teens with many types of chronic pain,including complex regional pain syndromecentral sensitizationvisceral hyperalgesia/functional abdominal pain, musculoskeletal pain and headache. We also help patients who have pain related to a disease (such as juvenile idiopathic arthritis or Crohn’s disease) that has become disabling. The focus of treatment is to improve function by retraining the nervous system to respond in a healthier way.

How will this program help my child with chronic pain?

Usually, we think of pain as a signal to protect our bodies by moving less and guarding the painful site. But in the case of chronic pain, not moving makes the pain worse. In order to feel better and live more fully, people with chronic pain need to move because movement improves function. As function improves, pain improves as well. The PReP program helps children and teens debilitated by chronic pain return to their lives – by combining medical care, psychological care, physical therapyand occupational therapy.

Structure of the Program

The Pain Rehabilitation Program (PReP) runs Monday through Friday for 7–8 hours a day. Your child spends most of the time being physically active, with 5–6 hours a day of physical and occupational therapy. There are brief check-ins with a doctor in the mornings to discuss any medical issues that may arise. There are also 1-hour appointments with a pain psychologist 3 days during the week to develop strategies for reducing or coping with pain. Our social worker meets with parents as well to explore the challenges of parenting a child with chronic pain.

It is important for children and teens to take the lead in improving their health, but they also need coaching and support from their parents for long-term recovery. We ask parents to attend some meetings and observe some therapy sessions during the week.

Children and teens work with several members of the team, including doctors, psychologists, nurses, physical therapists (PTs), occupational therapists (OTs) and social workers. Team members work together closely to provide and coordinate your child’s many appointments during the week.

  • pain doctor sees your child 4 mornings during the week to assess progress and address safety concerns. They will also evaluate for and monitor the use of medicines, manage chronic medical issues and respond to medical problems that arise.
  • pain psychologist meets with your child 3 times during the week to teach and promote coping skills. The goals are to improve your child’s function as much as possible and to reduce or change pain. The main approach is cognitive-behavioral therapy, including techniques such as progressive muscle relaxation, deep breathing and guided imagery.
  • nurse prepares patients and families for the program by explaining what to expect. During the program, the nurse works with other team members to manage the flow of care. When your child is nearing the end of their time in the program, the nurse helps design a plan to ensure your child keeps making progress at home.
  • Most of the day is spent being physically active. A physical therapist works with your child to build strength and cardiovascular (heart and lung) fitness, using active methods tailored for those in pain. An occupational therapist works with your child on daily activities to help your child return to a normal lifestyle. Our therapists are very experienced with treating children and teens in pain, and they have found ways to make the days fun and exciting. We create a home exercise program for your child to complete during evenings and weekends while in the program. This helps your child begin to do physical activity on their own.
  • social worker meets with parents or family members once a week during the program to provide support for the challenges you face while parenting a child with chronic pain. The social worker can also provide resources to help meet patients’ and families’ needs.
  • During the school year, a teacher provides 1 hour of school a day to help your child keep up with some of their schoolwork. Our team can also help with issues like talking to teachers and counselors to plan for a return to school.

During the program, you and your child meet with the whole team weekly to discuss progress and answer questions.

How to Enroll in the Program

  1. The first step is an evaluation in the Pain Medicine Clinic. No one is admitted to PReP without this step. If you are interested in the program, call the clinic at 206-987-1520 to set up an evaluation.
  2. Your child will have a half-day evaluation where they will see a doctor, a psychologist and either a physical therapist or an occupational therapist from our team. The team will review all records, take a complete history, do a physical exam and ask your child to do functional tasks (such as walking, running and going up stairs).
  3. Then the team will have a care conference to come up with a plan that matches your child’s needs. They will consider whether PReP is right for your child.
  4. If the team recommends the program, your child will be placed on a waiting list. Because the therapy is so intensive and individualized, we are only able to serve 2 patients per week.

If you are coming from outside the Seattle area, you may want to read the Main Campus Visitor and Family Guide to learn about transportation, places to stay and more.

Who’s on the team?

Program director



  • Amber Johnston, RN
  • Sandy Lehman, RN

Physical and occupational therapists

  • Lisa Alishio, COTA
  • Linda Amazeen, PTA
  • Catherine Bradley, OT
  • Cherie Duval-White, OT
  • Sabina Havkins, PT
  • Michele Larson, COTA

Social worker

  • Kathryn Thurber-Smith, MSW, LICSW