Chronic Pain Issues/CRMO

  1. Have you guys ever heard of CRMO? It's Chronic Recurrent Multifocal Osteomylitis. This is a 7th grade kiddo who just hurts all the time. She's on a 504 and we are working with her in every way that we can, I've talked to mom about pain management at school and mom has nothing. She says hot baths are the most effective thing that they have tried. She's already taking the maximum dose of NSAID's that she can. She comes to school 50% of the time as part of her 504, but her grades are slipping because they can't manage the pain when she's at school. She can always come to me or the counselor but she doesn't like that option because she already feels like she doesn't fit in. My principal is asking me for ideas and I'm not sure what to tell him. Have any of you had experience with this kind of thing? I'm new to school nursing this year so I'm not great at out of the box type solutions (yet!).
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  2. 10 Comments

  3. by   OldDude
    This appears to me to be a legitimate cause for homebound status.
  4. by   Flare
    Has she tried managing the pain in school with heating pads? It's not moist heat, but perhaps sitting her near an outlet and allowing her to use a pad that has an auto shut off would probably be best in case it gets forgotten about.
  5. by   JenTheSchoolRN
    Quote from Flare
    Has she tried managing the pain in school with heating pads? It's not moist heat, but perhaps sitting her near an outlet and allowing her to use a pad that has an auto shut off would probably be best in case it gets forgotten about.
    That would be a place I might start. Or an old fashioned hot water bottle for closer to moist heat.

    But if pain cannot be managed at school and is interfering with ability to learn, homebound status may be the option.
  6. by   kidzcare
    Quote from Flare
    Has she tried managing the pain in school with heating pads? It's not moist heat, but perhaps sitting her near an outlet and allowing her to use a pad that has an auto shut off would probably be best in case it gets forgotten about.
    This is how we treated when I had a girl with CRMO. She was distraught because she WANTED to be in school and hated when she had to miss class. So when she came in, I knew it was legit.
  7. by   IDNurseTiff
    I was wondering about Homebound as well. The only reason they haven't gone there yet is because her mom is concerned about social isolation. But that was my first thought.
    Last edit by IDNurseTiff on Dec 6 : Reason: Not clear what I was responding to.
  8. by   wondern
    Prayers for this girl. I'm not a school nurse but have worked some peds. What's 504, a type of disability?

    CRMO sounds terrible. God bless her. Multifocal and recurring, as in all over all the time in her bones?
  9. by   aprilmoss
    504 refers to the federal Rehabilitation Act of 1973 which requires schools to provide educational support the disabled. It's similar to an IEP, but covers a broader area of disabilities where the student's ability to learn isn't directly affected. It's usually less formal in its implementation.
  10. by   ruby_jane
    Quote from IDNurseTiff
    I was wondering about Homebound as well. The only reason they haven't gone there yet is because her mom is concerned about social isolation. But that was my first thought.
    So...what does the girl want? Do we know? I mean, maybe she does want to be at school. If that's the case, she's going to have to employ some coping skills in addition to all that the school can do. Does she not want to be at school?

    This year my school has done a lot of things that parents have wanted...which were not in the best interest of the student. Social isolation is a big deal. Is it better or worse, though?
  11. by   OldDude
    Quote from ruby_jane
    So...what does the girl want? Do we know? I mean, maybe she does want to be at school. If that's the case, she's going to have to employ some coping skills in addition to all that the school can do. Does she not want to be at school?

    This year my school has done a lot of things that parents have wanted...which were not in the best interest of the student. Social isolation is a big deal. Is it better or worse, though?
    Totally agree...but remember - Homebound Status doesn't mean they can't come onto school property; social interaction could easily be plugged into the homebound education program.
  12. by   Amethya
    We kind of a similar case, but not with CRMO. This student has complained of leg pain since last year, and was getting doctor's note from different doctors saying to give her NSAIDs for pain, she needs to use the elevator and given extra time between each class, which I gladly give her.

    Mother told me this year it was a tumor in her leg and that causes the pain, but I haven't gotten any doctor notes that state this and I have explained to her that in order to accommodate her, we need these documents. Comes to now, she's upset because I haven't granted her this request and wants a meeting, but I explained to her I can't do anything without these documents.

    The mother says she's in unbearable pain, but I seen the student and she's happily giggling with her classmates and not complaining of pain, so I'm not sure what's going on, but if this was the case with mine, I would recommend Homebound too.

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