children pain

Understanding Chronic Pain in Children

/ Thomas Cohn, MD

chronic pain childrenPreventing chronic pain is a daily battle for many adults, and the symptoms can be even tougher to control in children and teens. Interestingly, new research published in Health Psychology suggests that adolescent pain may be linked to previous experiences with pain, and if we can improve these initial experiences, children may be less likely to experience future pain.

It may sound complicated, but the research wanted to see if there was a link between a previous pain experience and how pain is felt and managed in the future. To do this, researchers examined children who had undergone a major surgery, as these experiences, even if they go as expected, may be traumatic to the child and are likely accompanied with some pain or discomfort.

“This is not to say that every child who has chronic pain had a surgery that led to it,” said study author Melanie Noel. “Rather, it’s that surgery is the only context where we can catch these kids before they develop chronic pain. We know that 15 to 20 per cent of children who undergo these major surgeries will develop chronic pain. So, if we can catch them early and begin to understand the factors leading to their chronic pain, maybe we can prevent it from happening in the first place.”

At the conclusion of the study, researchers found that a child’s memories of pain following major surgery actually influenced their recovery and was associated with an increased risk of the development of chronic pain down the road.

“We’ve discovered that the way children are remembering their pain is an underlying factor in the development of chronic pain,” Noel explained. “It’s not the pain they actually experience so much as the way they process those memories of the pain which is driving whether or not they’re improving, right around the time that pain can transition into chronic pain. At a certain point, these children should be feeling better but those who develop chronic pain are not.”

Managing Adolescent Chronic Pain

The study, which was conducted in Canada, suggests that anywhere from 15-40 percent of Canadian children experience chronic pain at some point during their childhood. Moreover, 60 percent of these children eventually develop chronic pain in adulthood, so it’s important to control chronic pain while kids are young to prevent it from becoming a problem when they’re older.

Researchers believe the findings can help point doctors and parents towards solutions. They believe that psychological and language-based interventions may be able to help kids better cope with post-surgical pain, which will help re-frame their memories of the pain and in turn decrease their likelihood of developing chronic pain in adulthood.

“We can teach kids how to reminisce and talk about their pain experiences in a way that emphasizes anything positive about it,” said Noel. “Maybe the child coped with something well, maybe there was a really friendly nurse. It’s getting them to talk about things that aren’t just focused on the awful after effects of the surgery. It’s a way of catching it, a talk-based intervention that can possibly re-frame the memories. This may actually alter the pain trajectory. It’s one thing we can do to make the recovery and future experiences of pain better.”

This is fascinating research, and I hope the findings are considered by pain professionals when helping children get to the bottom of their chronic pain.

Raising a Child With Chronic Pain

/ Thomas Cohn, MD

Child PainBeing a parent is a difficult job. There are many things to worry about daily when your children are growing up. The challenge is creating the environment for your child to become successful and independent in the future. Furthermore, everyone else has advice on how to raise a child. When you have a child with a chronic medical condition, all these challenges are amplified. The problems associated with a child who has chronic pain may be extremely difficult.

Pain is an extremely complex condition when it is chronic. There are actual physical components to the pain, and then there are all the things that happen in the brain when the signals are perceived and translated. As a pain specialist, hopefully that is what one spends their time learning about and then using to provide care to others. The best specialists can transform scientific data into specific treatment for most of their patients. Of course, one often cannot treat everyone, and sometimes that includes yourself, family, and close friends. Having chronic pain and family with issues does give one special insight into the problems.

The first overall concern for treating any sub-acute and chronic pain is that the person is fully diagnosed. A full history is needed, and exam should correlate to the problems expressed by the patient. Then if possible, appropriate studies should confirm the diagnosis. Without a diagnosis, the best treatment approaches are hard to determine. Unfortunately, many patients who show up at my office know they have pain, but this is a symptom, and determining all the causes is the first challenge before treatment can be fully implemented. If the pain has been an ongoing issue and is chronic (over 3 to 6 months or longer), then there is often more than one problem, and often the problems are not reversible. When the problems are not reversible, then goal is developing a management strategy.

If the patient is a child, one wants to make sure that there is a correct diagnosis for all the problems present. In a child, this may be a very prolonged process, since many problems heal and can be treated. Thankfully, few medical problems result in chronic pain problems for children, as most issues tend to resolve. Pediatric specialists are essential to diagnosing and treating all the issues that can be resolved. Treatment of children is usually a team process, requiring a number of physicians and therapists working together to manage the problems.

A few children do develop conditions that cause sub-acute and chronic pain. Those that have shown up in my office are usually related to musculoskeletal problems causing joint pain, or spine pain. Orthopedic surgery consultation often is involved to determine if surgical intervention is advisable. Ongoing pain that is not surgical is an extremely tough problem to treat. Currently, if the pain is chronic, then a Pediatric Pain specialist is extremely helpful to lead the management.

In the end, helping children with chronic pain comes down to a full diagnosis and a team-based approach. No one person can heal their child’s chronic pain on their own, and working with others can help everyone better understand and treat the condition. If you child complains of frequent pain or headaches, swing into an injury center for an examination.