Pediatric Chronic Pain

Pain is something all of us, no matter who we are, have experienced firsthand. Physical pain is indiscriminate and, unfortunately, children are just as likely to experience pain as adults. However, diagnosing and treating pain in a child is very different from doing so in an adult, and often requires particular attention. Because the presence of chronic pain in a child’s life has the potential to be debilitating on more than just a physical level, a well-rounded approach to treatment is absolutely necessary to promote, to the extent that is possible, a quick recovery and return to normality.

It is important to recognize that pain within the pediatric population is just as severe and debilitating as it is within the adult population, and that a considerable number of children are reported to experience pain which many times goes untreated.  On a global scale, it is estimated that between 20%--35% of children and adolescents experience some form of chronic pain. The most common types of chronic pain experienced by children include headaches, abdominal pain, or a type of musculoskeletal pain. Pediatric chronic pain can also be the result of post-surgical pain that persists and is not treated properly. In any case, regardless of what the origin of the pain may be, the pain itself can have tremendous negative effects on the child. Chronic pain that is experienced during childhood has the potential to remain potent throughout the child’s life, and pain that is not chronic but that is left untreated at a young age can develop into chronic pain at a later point.

While the devastating effects that pain can have upon children and adolescents make the necessity of prompt and proper treatment evident, there are some specific challenges that arise when trying to treat pediatric pain. The first challenge can be diagnosing the pain itself. Oftentimes, the patients in discussion are quite young, and therefore are to some degree unable to properly relate the symptoms which they are experiencing. If the child is so young that they are completely unable to vocalize their pain, parents should be aware of certain behaviors that may indicate the experience of pain. Such behaviors include but are not limited to: irritability, changes in sleep or appetite, avoidance of other children, or physical indications such as rapid breath and flushed skin. If the child is old enough to self-report their pain, guided questions may be asked by parents and doctors to try and evaluate the severity and cause of the pain. Oftentimes a number or picture scale is also used with children as a method to diagnosing pain severity. In any case, three types of pain assessment will be used in judging a child’s pain; the child’s own report (if possible), an observer’s report, and physical responses that can be measured as indications as pain.

Treatment of a child’s pain will vary greatly depending on the cause of the discomfort they are experiencing, but regardless of what the treatment pathway is, it is important to monitor a child’s pain throughout the process and employ appropriate coping methods if necessary. If it appears that a child is experiencing increased discomfort at any point during treatment, then there should be a reevaluation of the pain and methods being used. It is important to remember that within the pediatric population pain management is always an ongoing process. It should also be kept in mind that the amount of physical pain a child experiences can be influenced by a wide variety of factors. For instance, a child’s personality may determine the extent to which they experience pain; some may be more willing to undergo a painful procedure if they know it is to help heal them, while others may become angry and confused. This should be considered when determining treatment options and throughout the treatment process.

For children that require serious procedures or medication, a multifaceted treatment approach is often recommended. “Chronic pain in children is not exclusively a physical condition but a complex syndrome including physical, psychological and social processes,” says Dr. Lynn Rusy, who specializes in pediatric anesthesiology and pain management at the Children’s Hospital of Wisconsin. “The best approach to chronic pain is multidisciplinary, often including specialties such as pain physician, pain psychologist, physical therapist, social work, pharmacy and nursing.” Such an interdisciplinary method that involves both physical and psychological treatment is most strongly recommended, as evidence from studies indicate that this is the most effective approach to lessen the perception of chronic pain in children. Psychological treatments may include the teaching of relaxation and coping methods, cognitive therapy, or recognizing negative emotions and feedback. Such post-procedural therapy is an ongoing process, and is a crucial step in managing pain and reintegrating a child into their normal life and schedule.

While it is true that diagnosing, treating and managing pain is often more difficult with children due to the communication barrier, full cooperation and patience is required from both the parents and the child’s doctors are needed for a successful outcome. All too often misconceptions about how children experience or vocalize pain prevent proper identification of the pain, so it is important for parents to familiarize themselves with their child’s normal behavioral patterns so that abnormalities or sudden changes can be recognized and investigated. Dr. Rusy emphasizes that, especially in cases where a concrete physical diagnosis cannot be given, “one must begin to accept the situation, learning coping skills and pain strategies to remain active with schooling and family life.” When it comes to treating chronic pain in children, recovery encompasses a wide scope and needs to be seen holistically. While treating the physical pain properly is obviously a top priority, the emotional and social aspects of treatment cannot be disregarded; proper support is key so that the child can resume their normal life as soon as possible.  

In Good Health.

Allison Karantzis

Allison Karantzis