Lori Palozzi helps 'kids with chronic pain get their lives back'
By Louise Kinross
For 36 years, Lori Palozzi has worked to ease children’s pain. Her first job out of nursing school was in the burn unit at SickKids Hospital, in a time when it was believed that children didn’t feel pain. Later she became the first clinical nurse specialist on SickKids' acute pain service. She’s now a nurse practitioner with Holland Bloorview’s Get Up and Go service for children with chronic pain. “After all this time, I wish there would be no more stigma about having chronic pain,” she says. “We’ve made some progress, but we still have teens coming here saying they weren’t believed. One of the first things we tell them is ‘We do believe you have chronic pain.’” Lori just received the DAISY award, which recognizes a Holland Bloorview nurse that uses a strengths-based approach and combines top-notch clinical skills with deep connections with children and families.
BLOOM: How did you get into this field?
Lori Palozzi: As a young girl I always wanted to be a nurse. I wanted to help people, and it’s a caring profession. I was the baby of my family, and I never did babysitting, so I wasn't exposed to young children. I remember going into my pediatric rotation at SickKids and being so scared. How do I talk to a two-year-old? I had a nursing instructor who worked in the intensive care unit who made me see how unique children are. They’re so vulnerable, but so carefree, and so honest. They tell you how it is. They don’t have all of these built-up expectations. They’re very natural. I love pediatrics. I love working with children and families.
BLOOM: Your first job was in the burn unit at SickKids.
Lori Palozzi: It was back in 1984. At that time, we weren’t doing a good job with pain management. There was a belief that children didn’t have pain—that was the culture in pediatrics. We were doing these burn dressing changes in big hydrotherapy tubs, and the nurses were required to debride the skin. We weren’t even using simple analgesics. The kids were screaming, and we were holding them down, and doing all of these things we know are so wrong.
It didn’t take me long to develop a real moral distress about that. It prompted me to go back to school to do a master’s degree, and I studied the perceptions of pain in school-age children during burn dressing changes. I observed six kids during the changes. Then after they were back and settled down, I would talk to them. Different themes came up—that they were being punished, that it was like a torture chamber, and that they felt so isolated and no one was hearing about their pain.
Later I was able to share my research in rounds and following that there were small changes in people’s perceptions. We were able to start using morphine, which is now used widely. Today they have a sedation team at SickKids. Anesthesiologists go to the burn unit and give a brief anesthetic to the children during dressing changes. So we’ve moved all the way from nothing to that.
BLOOM: What is our Get Up and Go program?
Lori Palozzi: It’s a month-long, intensive pediatric pain rehab service that runs from 8 to 4 each day. Two weeks are inpatient and two weeks are day patient. Our youngest client is nine and our oldest is 18. It’s about building their toolkit to manage their pain. It might be learning to pace their activity by taking a brief break, stretching, practising deep breathing, and practising mindfulness by being in the moment. They go to school here, exercise and swim. Some conditions might get better and some might not, and it’s hard to tell. We don’t promise a cure. Our kids just want to be able to go back to school every day, or play hockey again, or learn how to pace their day, so they’re not worn out by the end of the week.
BLOOM: What is a typical day for you?
Lori Palozzi: I oversee our patients’ general medical care, so I work with our nurses and a rich group of interprofessionals. I facilitate our weekly team rounds, and there’s a lot of communication in person or by e-mail as we support the changing needs of children and families here. I also look after all the referrals and set up intake meetings. We only get referrals from outpatient chronic pain clinics, so these are kids who have been followed for pain who are really struggling, and not benefiting from outpatient care. I’m the family’s first point of contact—right now it’s over Zoom.
BLOOM: In her DAISY nomination letter, Ardith Baerveldt described your ‘positive attitude, sense of humour and infectious energy,' and how it 'diffused the tension for nervous families at intake meetings and on admission days.'
Lori Palozzi: I try to be with patients where they’re at, and put them at ease. Before they come, I want to find out about them as people. What are their hobbies? What do they like doing? I try to make it personal, and I’ll bring those things up when we meet. If there’s some tension, I will tell a joke. My friends would describe me as fun. I often do make funny jokes about myself.
BLOOM: What's the greatest challenge of your role?
Lori Palozzi: I'm not in a management role, I'm a clinician. But people see me as a leader on the team. What I find challenging is when people bring me issues that I find difficult to address, like difficult practice issues or interpersonal conflict. I want to help them find solutions in an appropriate way, and sometimes that works out and sometimes it doesn't. Maybe it speaks more to my own vulnerability. I don't always have the answer, so it's helping team members see that maybe there's not a clear answer, and that's okay.
The other challenge is helping our team when it's difficult to see a functional improvement in a client and family. The challenging part of that is to have self-reflection on our team. As a team, we're so committed that when we have a challenge, sometimes people take it personally: 'I could have done that better.' It's helping the team to get perspective. A family comes to us for one month in their whole trajectory of years of chronic pain, so realistically, there's only so much we can do in that time period. We need to look at what we did do, and not focus on what didn't go as well.
BLOOM: What's the greatest joy?
Lori Palozzi: I do an exit interview with every patient and family when they leave. It's open-ended, with questions about what they liked, what they didn't like, and suggestions for change. I ask if they felt prepared to participate, and what surprised them the most. When a parent says 'You've changed our life' that's pretty meaningful. So what brings me joy is seeing the kids and families reach the goals they've set.
The other thing is my team of course. We have a shared vision of helping kids with chronic pain get their lives back. We have a high level of trust and psychological safety on the team. If I'm having a bad day or not quite connecting with a patient the way I would want, I know Ardith or Melissa or someone else will have my back. They'll be there to support me.
BLOOM: What qualities do you need to be good in your job?
Lori Palozzi: I think a sense of humour is important. Being open, being receptive, and being a risk-taker. Having leadership skills and wanting to develop others on the team as well.
BLOOM: What emotions come up in the job?
Lori Palozzi: What doesn't come up in the job! Happiness, joy, sadness. Sometimes hopelessness, to be honest. Excitement and feeling energized. It's all over the place depending on what you're doing and what's happening.
BLOOM: Do you do anything to manage stress?
Lori Palozzi: I'm a big nature lover and every weekend I go hiking. I put myself in the forest. It's grounding for me. My social bubble is my six or seven hiking friends and we go to Caledon, Uxbridge, Niagara. That's my main thing for mind and body. I also exercise four times a week at a small gym. The other thing I do is I try to learn a new skill every year or so. I started learning Spanish through the Toronto School Board. I love using Duolingo, which is an app that helps you learn any language. I like learning a new activity that keeps you in the moment, and keeps your brain going. I have four kids. Three are grown and our 16-year-old is with me. She keeps me young in the age of social media and TikTok.
BLOOM: If you could change one thing about how we treat children with chronic pain in our health system, what would it be?
Lori Palozzi: Pain, and chronic pain specifically, is an invisible disability. I wish that one day there would be no more stigma about having chronic pain, and people with chronic pain would be believed. So many kids, even though they've been through the health system and been seen by teams, will sit across the table from me and say 'My teacher doesn't believe that I have pain.' It's the idea that because you can't see something, you're not believed. I don't know how to change that. Maybe through our Dear Everybody campaign, or a specific anti-stigma campaign about chronic pain.
BLOOM: Your position is unique in that you work both at Holland Bloorview and at SickKids.
Lori Palozzi: In 2014, the Ontario Ministry of Health moved to improve funding to access to pediatric pain care. SickKids already had an outpatient chronic pain team. Some money came to develop the Get Up and Go service. We knew we needed kids to have an intensive inpatient experience, but we didn't have that capability at SickKids. Holland Bloorview had the staff, the physical space, the gyms. As nurse practitioner, I'm still paid by SickKids, but I do the work here. Every Wednesday I work in SickKids outpatient chronic pain clinic. I would say two-thirds of our referral base comes from SickKids, so this arrangement is perfect. Sometimes I meet the families before they come here, and I can see them in follow-up after they're discharged. I'm able to be the point of contact between the services and provide continuity of care.