Chronic pain is common and affects one in five children and teens. In teens, it can take many different forms, including:
- pain in the musculoskeletal system (bones, muscles and tendons), often described as aching or soreness
- nerve-type pain, often described as tingling, burning or like an electric shock
- abdominal pain
- headaches
Over time, chronic pain can worsen through a “vicious cycle” of thoughts, feelings and behaviours about the pain itself. These factors may be different for each child.
The illustration below shows how the vicious cycle of pain can occur. There are several points along the cycle where you and your child’s health-care team can intervene to help your teen manage their chronic pain so it does not become worse.
No medical test can tell us how much pain a teen is experiencing. Instead, we rely on teen self-reporting (what they say about their own pain) and behaviour.
Assessing chronic pain at home
Verbal signs of pain
Teens vary in how they express their chronic pain. Some will complain about their pain directly and pinpoint the pain in their body. Others may repeatedly ask to see a doctor or need to be reassured about their health.
Emotional signs of pain
These typically involve changes in mood, such as:
- irritability
- anger
- frustration
- anxiety
- sadness
- silence
- sensitivity
Behavioural signs of pain
- Withdrawing from school or social situations
- Reducing participation in sports
- Avoiding situations that may provoke pain
- Protecting the body during activities
- Regressing, for example needing help dressing and bathing or wanting to sleep with a parent
- Being secretive
- Withdrawing to bedroom more often
Disruptions in routines
- Your teen might spend too much time sleeping or resting.
- Your teen might experience changes to their appetite.
Changes in coping strategies
- Increased use of substances
- Resorting to self-harm
Assessing chronic pain in medical settings
Chronic pain is complex. As a first step, several health-care professionals may be asked to see your child to check for any underlying causes of pain that could require treatment. If they do not find a specific cause, your child may be diagnosed with "chronic pain", which is a disease in its own right.
If your teen is diagnosed with chronic pain, they may be seen by a specialist health-care team that includes doctors, nurses, psychologists, psychiatrists and physiotherapists. These health-care professionals will want to learn about your teen's level of function – how much your teen's pain disrupts their everyday movements and use of their body for different tasks as well as their sleep, attendance at school and their social or physical activities. They will also want to find out the possible physical factors that affect your child's pain, such as poor strength, and any psychological factors, such as protectiveness or fear of further injury.
To get this information, the health-care team will:
- ask your teen a number of questions
- use different assessment tools
Once your teen's health-care team understands these factors, they can better identify targeted treatments for your teen's needs.
What would a doctor or nurse ask about?
- When and how the pain started, where it is located, what words would describe the pain, how strong the pain is
- Impact of pain on your teen's sleep and schooling
- Any allergies or other conditions that your child might have or any conditions that run in the family
- If your teen is taking medications for pain or other conditions
What would a psychologist ask about?
- How your teen's mood and stress levels might be impacting their pain (for example if they feel bad about missing school or social activities)
- Your teen's thoughts and behaviours related to the pain
- Which coping strategies your teen might already use
- How you as a parent or caregiver are responding to your teen's pain
In some cases, the symptoms of chronic pain can be amplified by psychological distress. The term for this is somatization.
What would a physiotherapist ask about?
- Where in the body your child experiences pain
- How pain is limiting your child's physical activities
- Which physical treatment approaches your child has used in the past (see below)
Physiotherapists would also usually examine your child to assess their quality of movement, strength, range of motion and sensations (for example over-sensitive or under-sensitive to touch).
Because your teen is developing their independence, their health-care providers will want to hear from them directly. This not only builds your teen's confidence in providing their health-care information but can also help them feel more engaged with their treatment.
Websites
Website designed to help children get control of their pain (German Paediatric Pain Centre)
http://www.deutsches-kinderschmerzzentrum.de/en/
Website where children can learn the Canadian 24-Hour Movement Guidelines the fun way
http://buildyourbestday.participaction.com/en-ca/tutorial
Videos
How does your brain respond to pain
https://www.youtube.com/watch?v=I7wfDenj6CQ
Seven video mini-series on chronic pain and its management for youth (Pain Bytes)
http://www.aci.health.nsw.gov.au/chronic-pain/painbytes
Video explaining the power of the brain and chronic pain
https://www.mycarepath.ca/understanding-pain/brain-and-nervous-system-change
Video describing pacing
https://www.mycarepath.ca/managing-pain/paced-practiced-and-increasing-activities
Teenagers talk about their chronic pain (longer video)
https://www.youtube.com/watch?v=56aWuEt4NA0
Teenagers talk about their chronic pain (shorter video)
https://www.liveplanbe.ca/real-stories/growing-up-with-pain/ryans-story
Content developed by Danielle Ruskin, PhD, CPsych, in collaboration with:
Anne Ayling Campos, BScPT, Fiona Campbell, BSc, MD, FRCA, Lisa Isaac, MD, FRCPC, Jennifer Tyrrell, RN, MN, CNeph
Hospital for Sick Children
References
Coakley, R., & Schechter, N. (2013). Chronic pain is like… The clinical use of analogy and metaphor in the treatment of chronic pain in children. Pediatric Pain Letter, 15(1), 1-8.
Coakley, R. (2016). When Your Child Hurts: Effective Strategies to Increase Comfort, Reduce Stress, and Break the Cycle of Chronic Pain. Yale University Press.
Carney, C., Carney, C. E., & Manber, R. (2009). Quiet Your Mind & Get to Sleep: Solutions to Insomnia for Those with Depression, Anxiety, Or Chronic Pain. New Harbinger Publications.
Mayo Clinic: Understanding Pain (http://www. mayoclinic.org/understanding-pain/art-20208632?pg=1)
Mindell, J. A., & Owens, J. A. (2003). Sleep problems in pediatric practice: clinical issues for the pediatric nurse practitioner. Journal of Pediatric Health Care, 17(6), 324-331.
Paruthi, S., Brooks, L. J., D'Ambrosio, C., Hall, W. A., Kotagal, S., Lloyd, R. M., ... & Rosen, C. L. (2016). Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 12(6), 785.
Valrie, C. R., Bromberg, M. H., Palermo, T., & Schanberg, L. E. (2013). A systematic review of sleep in pediatric pain populations. Journal of developmental and behavioral pediatrics: JDBP, 34(2), 120.