17 Sep What is chronic pediatric pain and symptom management?
Let us start with what pediatric pain management is not. It is not adult pain management for little people! Although strong pain medication and nerve blocks are occasionally indicated the use of these modalities is less common in pediatrics than adult care. So then, what is chronic pediatric pain management?
Chronic pediatric pain and symptom management is the process by which we recognize, assess and treat chronic or recurrent pain, nausea or fatigue in children and adolescents. It first starts off with recognition. The recognition that children and adolescents have pain and other symptoms that interfere with their life, cause them distress and potential harm. It has been estimated that up to 20% of 9-18-year-olds have pain that causes them to miss at least one day of school per month. In children with developmental and intellectual disability the estimate is that as many as 35% have pain on a weekly basis. A significant number of these children are not receiving adequate therapy.
As adults we rationalize not treating the pain because “they’ll grow out of it” or “it is behavioral” or “if we find the source and treat it the pain will go away”. All of these statements are true, sometimes. In studies of patients diagnosed with “growing pains” 60% of them resolve by the one-year follow-up. Children meeting criteria for juvenile primary fibromyalgia 40% resolved at a three-year follow-up. Unfortunately this means that a significant portion of these children continued to have pain. And even those that did resolve how long did it take? Would they have resolved sooner and suffered less with therapy? Are these untreated children at risk for chronic pain as adults? Well, 40% of adults with Fibromyalgia have a history of ‘growing pains’.
Another question is why do we allow children to suffer pain that we can prevent or treat? Contrary to the belief of some, there is no benefit to being in pain. Pain does not teach resolve. Would an adult tolerate missing one day of work every month? Could they stay employed? We need to accept that chronic pain and symptoms exist in children, cause them distress, and can be treated.
Persistent pain in children requires careful assessment. Often there is a combination of physical, psychological and social reasons for a child or adolescent to have persistent pain. Every aspect of an adolescent’s symptoms needs to be investigated. Errors in assessment can occur when assumptions are made in regards to attributing importance to any particular issue. (Pain can lead to depression and anxiety and these disorders can in turn lead to back to pain.) Parental and peer response to chronic conditions can also significantly impact a child’s pain perception. The best assessments acknowledge that once a condition becomes chronic the physical psychological and social issues reinforce each other and need to be treated at the same time.
The overall goal of treatment is to restore all aspects of a child or adolescent’s life that their pain and symptoms have taken away. To do this we need to address any psychological physical and social deficits that have developed over the course of the illness. Medications are used to decrease nerve sensitivity and allow the children to learn the skills to control their systems themselves. Rarely are the medications curative, but more like Band-Aids offering protection while the body learns how to heal itself. The true therapy comes from skill building from the proper mix of mind based therapies such as relaxation, cognitive behavioral therapy, family therapy or biofeedback and body based therapies such as physical therapy, massage therapy, acupuncture or others. The integrated combination of therapies is not necessary for all patients but usually has the best results.
So once again Recognition, Assessment and Treatment individualized and focused on skills building and regaining the childhood that symptoms can rob from your child.