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John Kelly's Washington

With pain relieved, a teen gets a second chance to be a teen

Francesca Petrizzo, 13, was freed from abdominal pain by Julia Finkel at Children's.
Francesca Petrizzo, 13, was freed from abdominal pain by Julia Finkel at Children's. (John Kelly/the Washington Post)
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Wednesday, November 18, 2009

It should tell you something about Dr. Julia Finkel that when I asked if she had one of those charts used for ranking pain -- you know: On a scale of 1 to 10, how much does it hurt? -- she had to think for a moment before getting up from her chair and retrieving a tiny laminated card . . . from the trash can.

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Dr. Finkel does not have much use for that familiar "pain ladder." Nor for what was on the back of the card: the Wong Baker Faces Pain Rating Scale. Used with children to gauge their pain, it features six crude drawings of a person's face ranging from a smiling "no hurt" face to a weeping "hurts worst" face. Children are asked to point to the face that best describes their "pain intensity."

But, of course, pain is incredibly subjective. All you know is it hurts, and you want it to stop.

As the director of pain medicine at Children's National Medical Center, Dr. Finkel is responsible for making the hurt go away.

I met her recently during a reunion of sorts. For years, 13-year-old Francesca Petrizzo had lacerating abdominal pain. Schoolwork was hard, sports were out. "It was frustrating," said Francesca, whose family has just moved back to the District from Florida. "I couldn't play outside or eat -- and I like to eat. I couldn't do things other kids can do."

I asked Francesca whether the pain ever went away. Sometimes, she said, she could lean forward, her back parallel with the floor, and it didn't hurt quite so much.

This is not a way to spend a childhood.

"We take a mechanistic approach to treating pain," Dr. Finkel said. It starts with diagnosing the cause. In Francesca's case, scar tissue had formed around the site of a hernia repaired when she was 3. By the time she was 7, the scar had entrapped a nerve, causing neuropathic pain.

"Pain is a symptom," Dr. Finkel said. "What really causes it needs to be determined so that you can manage the pain, not simply put a Band-Aid on it."

In a perfect world, a surgeon could free Francesca's entrapped nerve from the thicket of scar tissue. But that would come with its own risks, chief among them creating more of the scar tissue that had started the pain. Instead, Dr. Finkel proposed shutting the nerve down.

To get a sense of whether that approach might work, Dr. Finkel carefully injected the anesthetic lidocaine into Francesca's abdomen in April, turning the nerve off temporarily.

For the first time in years, the youngster was pain-free. But as with Cinderella, the clock was ticking. Francesca and her family -- parents Nicole and T.J., younger brothers Zachary, Nate and Josh -- tried to pack as much as possible into two hours: lunch at the Capital City Brewing Co., a visit to ESPN Zone. Then the pain returned.

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