Chronic pain: How to treat and manage in older childrenCChronic pain: How to treat and manage in older childrenChronic pain: How to treat and manage in older childrenEnglishPain/AnaesthesiaSchool age child (5-8 years);Pre-teen (9-12 years)NANANon-drug treatmentAdult (19+) CaregiversPain2019-01-25T05:00:00Z9.7000000000000050.00000000000001497.00000000000Health (A-Z) - ProcedureHealth A-Z<p>​Find out how to use the 3P approach to manage chronic pain in older children.</p><p> <a href="/Article?contentid=2983&language=English">​Chronic pain</a> treatments involve a mix of psychological, physical and pharmacological (medication) strategies. Together, these are called the 3Ps of pain control. Like three legs of a stool, the 3Ps are complementary, or supportive, to one another.</p> <figure class="asset-c-80"> <span class="asset-image-title">3P approach to managing your older child's pain</span> <img alt="Circles listing psychological, physical and pharmacological methods to manage pain" src="https://assets.aboutkidshealth.ca/AKHAssets/ChronicPain_3Ps_OlderChildren.png" /> <figcaption>The 3P approach combines psychological, physical and pharmacological strategies to manage pain. Each strategy is described below.</figcaption> </figure> <p>No single strategy will likely be the answer, so it is important to be open to a variety of options if your young child has chronic pain.</p><h2>​Key points</h2><ul><li>The 3P approach to pain management includes psychological, physical and pharmacological methods to treat and manage pain.</li><li>Physical approaches include helping your child choose a level of physical activity that will not cause harm and balancing periods of rest with periods of activity.</li><li>Psychological approaches include changing thinking patterns to reduce pain-related fears and stress and using techniques such as distraction, guided imagery and relaxation.</li><li>Pharmacological approaches include over-the-counter and prescription pain relievers.</li></ul><h2>Physical strategies</h2><p>Physical strategies are activities that help the body to function physically. They include conditioning exercises, stretches, endurance activities and nervous system retraining. They are typically guided by physical and occupational therapists.</p><p>"Pacing" is one strategy that can help an older child. It involves learning how to balance activity and rest so that a child can be active in important daily activities (such as participating in school and going outdoors with friends).</p><p>Try using the traffic light analogies below for your child's physical activity.</p><h3>Pacing guidelines for physical activity</h3> <figure class="asset-c-80"><img alt="Traffic lights to pace physical activity and rest" src="https://assets.aboutkidshealth.ca/AKHAssets/TrafficLights.png" /></figure> <ul><li>Red light</li><ul><li>Severe pain increases during an activity and stops activity participation</li><li>Pain persists for day to weeks</li><li>Possible risk of injury</li></ul></ul><ul><li>Yellow light</li><ul><li>Safe pain</li><li>Pain spikes but is tolerable during an activity and will not cause harm</li><li>Pain persists for 24-48 hours after an activity before returning to baseline</li></ul></ul><ul><li>Green light</li><ul><li>Safe pain</li><li>Pain spikes but is tolerable during an activity and will not cause harm</li><li>Pain is no worse after an activity</li></ul></ul><p>Your child should stay in the green light and may edge into the yellow. They should not go in the red light.</p> <figure class="asset-c-80"> <img alt="Traffic lights to pace" src="https://assets.aboutkidshealth.ca/AKHAssets/TrafficLights.png" /> </figure> <ul><li>Red light</li><ul><li>Stop and rest.</li><li>Key phrase: “I need to take a break. I can use my coping strategies for relaxation and recovery so I am ready to go again after my rest.”</li></ul></ul><ul><li>Yellow light</li><ul><li>Be alert.</li><li>Key question: “Am I overdoing it or can I use my coping strategies to keep going a bit longer?”</li></ul></ul><ul><li>Green light</li><ul><li>Be active but save some of your energy.</li><li>Key phrase: “I am being active and I am fine.”</li></ul></ul><p>Make sure that your child has time in the green and red traffic light areas. Yellow reminds them to stop and take a break.</p><h2>Psychological strategies</h2><p>Psychological strategies can be thought of as "mind-body" strategies or "the power of the brain to help the pain".</p><p>They can include therapies to:</p><ul><li>reduce fearful thoughts about pain</li><li>reduce fear of moving a painful area of the body</li><li>decrease stress</li><li>improve confidence in being able to get back into life in areas that pain has disrupted (such as sports, school, sleep or social activities).</li></ul><p>They also include some of the following techniques to support your child and reduce the impact of pain on the family.</p><h3>Distraction</h3><p>Distraction can be a particularly helpful psychological strategy when a child is experiencing pain. Distract your child with an activity or item that is of interest to them. Active distraction (such as doing an activity or talking with friends) is better than passive distraction (such as watching TV).</p><h3>Guided imagery</h3><p>You can help your child use guided imagery to cope with an episode of pain by asking them to imagine that they are in a calm, peaceful environment or to remember a pleasant experience from their past. Encourage your child to describe what they see, as well as any smells, sounds or other sensations. Older children can also listen to online guided imagery scripts.</p> <figure> <span class="asset-image-title">Belly breathing</span> <div class="asset-animation">src="https://www.aboutkidshealth.ca/Style%20Library/akh/animation/belly_breathing_SCD_EN_TEST.aspx"</div> </figure> <h3>Relaxation</h3><p>Relaxation is another psychological strategy that can help your child cope with chronic pain.</p><p>Belly breathing is one such technique, as it helps your child slow down their breathing and become more relaxed. Encourage your child to take a few slow deep breaths into their belly, breathing in through their nose and out through their mouth.</p><p>They can place their hands over their belly to check that it is rising with every in-breath and falling with every out-breath.</p><p>Your child's health-care team may teach you other strategies to support your child and reduce the impact of pain on the family. These include helping to distract your child from pain, remaining calm and developing a plan to cope with pain when it arises.</p><h2>Pharmacological strategies (medications)</h2><p>Pharmacological strategies are the medications that treat your child's chronic pain. They are rarely used alone; they should nearly always support physical and psychological strategies.</p><p>Pain medications are typically divided into:</p><ul><li>simple analgesics (pain relievers)</li><li>opioids</li><li>adjuvants</li></ul><p>Simple analgesics include <a href="https://www.aboutkidshealth.ca/article?contentid=62&language=English">acetaminophen</a> and <a href="https://www.aboutkidshealth.ca/article?contentid=153&language=English">ibuprofen</a> and are available over the counter. They are helpful for mild to moderate pain (especially resulting from tissue inflammation).</p><p> <a href="https://www.aboutkidshealth.ca/Article?contentid=2999&language=English">Opioids</a> are among the strongest pain relievers and are often used after surgery or other major painful procedures. If your child is in moderate to severe pain, their health-care team may prescribe opioids such as morphine, oxycodone or hydromorphone, generally for short-term use.</p><table class="akh-table"><tbody><tr><td>Opioids have risks and side effects, which can be serious. Always talk to your child's health-care provider for advice on taking, storing and disposing of opioids safely.</td></tr></tbody></table><p> <a href="https://www.aboutkidshealth.ca/Article?contentid=3002&language=English">Adjuvants</a> are medications that are shown to work well for pain but are mainly used for other reasons. Examples include anticonvulsants and cannabinoids.</p><p>For all medications, talk to your health-care professional for more information.</p><h2>What kind of improvements should I see in my child's chronic pain?</h2><p>Your child's chronic pain will not always improve consistently. There may be good days and bad days, good weeks and harder weeks.</p><p>Sometimes things might even get worse before they get better. For example, as your child begins their therapies and their body becomes more active, they may experience muscle soreness and throbbing. This is natural in weak or tight muscles that are not used to exercise or stretching and will ease in time.</p><p>To stay focused on managing pain effectively, make weekly goals with your child and remember that improvement can sometimes take time.</p><h3>Improvements in function</h3><p>One important area for goal setting is return to function. This means returning to activities that pain has disrupted, for example going to school, taking part in family routines or doing physical or social activities.</p><p>A return to function, rather than improvement in pain, is actually the first sign that chronic pain treatment is successful. This is because pain can often take weeks to months to improve while weak muscles gradually become stronger. If your child waits for their pain to go away before getting back into life, there is a risk that their pain will get worse.</p>​<h2>Websites</h2><p>Website designed to help children get control of their pain (German Paediatric Pain Centre)<br> <a href="http://www.deutsches-kinderschmerzzentrum.de/en/" target="_blank">http://www.deutsches-kinderschmerzzentrum.de/en/</a></p><p>Website where children can learn the Canadian 24-Hour Movement Guidelines the fun way<br> <a href="http://buildyourbestday.participaction.com/en-ca/tutorial" target="_blank">http://buildyourbestday.participaction.com/en-ca/tutorial</a></p> <h2>Videos</h2><p>How does your brain respond to pain<br> <a href="https://www.youtube.com/watch?v=I7wfDenj6CQ" target="_blank">https://www.youtube.com/watch?v=I7wfDenj6CQ</a></p><p>Seven video mini-series on chronic pain and its management for youth (Pain Bytes)<br> <a href="http://www.aci.health.nsw.gov.au/chronic-pain/painbytes" target="_blank">http://www.aci.health.nsw.gov.au/chronic-pain/painbytes</a></p><p>Video explaining the power of the brain and chronic pain<br> <a href="https://www.mycarepath.ca/understanding-pain/brain-and-nervous-system-change" target="_blank">https://www.mycarepath.ca/understanding-pain/brain-and-nervous-system-change</a></p><p>Video describing pacing<br><a href="https://www.mycarepath.ca/managing-pain/paced-practiced-and-increasing-activities" target="_blank">https://www.mycarepath.ca/managing-pain/paced-practiced-and-increasing-activities</a></p><p>Content developed by Danielle Ruskin, PhD, CPsych, in collaboration with:<br> Anne Ayling Campos, BScPT, Fiona Campbell, BSc, MD, FRCA, Lisa Isaac, MD, FRCPC, Jennifer Tyrrell, RN, MN, CNeph<br> Hospital for Sick Children</p><h3>References</h3><p>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.</p><p>Coakley, R. (2016). When Your Child Hurts: Effective Strategies to Increase Comfort, Reduce Stress, and Break the Cycle of Chronic Pain. Yale University Press.</p><p>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.</p><p>Mayo Clinic: Understanding Pain (<a href="http://www.mayoclinic.org/understanding-pain/art-20208632?pg=1">http://www.mayoclinic.org/understanding-pain/art-20208632?pg=1</a>)</p><p>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.</p><p>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.</p><p>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.</p>

 

 

 

 

Chronic pain: How to treat and manage in older children3650.00000000000Chronic pain: How to treat and manage in older childrenChronic pain: How to treat and manage in older childrenCEnglishPain/AnaesthesiaSchool age child (5-8 years);Pre-teen (9-12 years)NANANon-drug treatmentAdult (19+) CaregiversPain2019-01-25T05:00:00Z9.7000000000000050.00000000000001497.00000000000Health (A-Z) - ProcedureHealth A-Z<p>​Find out how to use the 3P approach to manage chronic pain in older children.</p><p> <a href="/Article?contentid=2983&language=English">​Chronic pain</a> treatments involve a mix of psychological, physical and pharmacological (medication) strategies. Together, these are called the 3Ps of pain control. Like three legs of a stool, the 3Ps are complementary, or supportive, to one another.</p> <figure class="asset-c-80"> <span class="asset-image-title">3P approach to managing your older child's pain</span> <img alt="Circles listing psychological, physical and pharmacological methods to manage pain" src="https://assets.aboutkidshealth.ca/AKHAssets/ChronicPain_3Ps_OlderChildren.png" /> <figcaption>The 3P approach combines psychological, physical and pharmacological strategies to manage pain. Each strategy is described below.</figcaption> </figure> <p>No single strategy will likely be the answer, so it is important to be open to a variety of options if your young child has chronic pain.</p><h2>​Key points</h2><ul><li>The 3P approach to pain management includes psychological, physical and pharmacological methods to treat and manage pain.</li><li>Physical approaches include helping your child choose a level of physical activity that will not cause harm and balancing periods of rest with periods of activity.</li><li>Psychological approaches include changing thinking patterns to reduce pain-related fears and stress and using techniques such as distraction, guided imagery and relaxation.</li><li>Pharmacological approaches include over-the-counter and prescription pain relievers.</li></ul><h2>Physical strategies</h2><p>Physical strategies are activities that help the body to function physically. They include conditioning exercises, stretches, endurance activities and nervous system retraining. They are typically guided by physical and occupational therapists.</p><p>"Pacing" is one strategy that can help an older child. It involves learning how to balance activity and rest so that a child can be active in important daily activities (such as participating in school and going outdoors with friends).</p><p>Try using the traffic light analogies below for your child's physical activity.</p><h3>Pacing guidelines for physical activity</h3> <figure class="asset-c-80"><img alt="Traffic lights to pace physical activity and rest" src="https://assets.aboutkidshealth.ca/AKHAssets/TrafficLights.png" /></figure> <ul><li>Red light</li><ul><li>Severe pain increases during an activity and stops activity participation</li><li>Pain persists for day to weeks</li><li>Possible risk of injury</li></ul></ul><ul><li>Yellow light</li><ul><li>Safe pain</li><li>Pain spikes but is tolerable during an activity and will not cause harm</li><li>Pain persists for 24-48 hours after an activity before returning to baseline</li></ul></ul><ul><li>Green light</li><ul><li>Safe pain</li><li>Pain spikes but is tolerable during an activity and will not cause harm</li><li>Pain is no worse after an activity</li></ul></ul><p>Your child should stay in the green light and may edge into the yellow. They should not go in the red light.</p> <figure class="asset-c-80"> <img alt="Traffic lights to pace" src="https://assets.aboutkidshealth.ca/AKHAssets/TrafficLights.png" /> </figure> <ul><li>Red light</li><ul><li>Stop and rest.</li><li>Key phrase: “I need to take a break. I can use my coping strategies for relaxation and recovery so I am ready to go again after my rest.”</li></ul></ul><ul><li>Yellow light</li><ul><li>Be alert.</li><li>Key question: “Am I overdoing it or can I use my coping strategies to keep going a bit longer?”</li></ul></ul><ul><li>Green light</li><ul><li>Be active but save some of your energy.</li><li>Key phrase: “I am being active and I am fine.”</li></ul></ul><p>Make sure that your child has time in the green and red traffic light areas. Yellow reminds them to stop and take a break.</p><h2>Psychological strategies</h2><p>Psychological strategies can be thought of as "mind-body" strategies or "the power of the brain to help the pain".</p><p>They can include therapies to:</p><ul><li>reduce fearful thoughts about pain</li><li>reduce fear of moving a painful area of the body</li><li>decrease stress</li><li>improve confidence in being able to get back into life in areas that pain has disrupted (such as sports, school, sleep or social activities).</li></ul><p>They also include some of the following techniques to support your child and reduce the impact of pain on the family.</p><h3>Distraction</h3><p>Distraction can be a particularly helpful psychological strategy when a child is experiencing pain. Distract your child with an activity or item that is of interest to them. Active distraction (such as doing an activity or talking with friends) is better than passive distraction (such as watching TV).</p><h3>Guided imagery</h3><p>You can help your child use guided imagery to cope with an episode of pain by asking them to imagine that they are in a calm, peaceful environment or to remember a pleasant experience from their past. Encourage your child to describe what they see, as well as any smells, sounds or other sensations. Older children can also listen to online guided imagery scripts.</p> <figure> <span class="asset-image-title">Belly breathing</span> <div class="asset-animation">src="https://www.aboutkidshealth.ca/Style%20Library/akh/animation/belly_breathing_SCD_EN_TEST.aspx"</div> </figure> <h3>Relaxation</h3><p>Relaxation is another psychological strategy that can help your child cope with chronic pain.</p><p>Belly breathing is one such technique, as it helps your child slow down their breathing and become more relaxed. Encourage your child to take a few slow deep breaths into their belly, breathing in through their nose and out through their mouth.</p><p>They can place their hands over their belly to check that it is rising with every in-breath and falling with every out-breath.</p><p>Your child's health-care team may teach you other strategies to support your child and reduce the impact of pain on the family. These include helping to distract your child from pain, remaining calm and developing a plan to cope with pain when it arises.</p><h2>Pharmacological strategies (medications)</h2><p>Pharmacological strategies are the medications that treat your child's chronic pain. They are rarely used alone; they should nearly always support physical and psychological strategies.</p><p>Pain medications are typically divided into:</p><ul><li>simple analgesics (pain relievers)</li><li>opioids</li><li>adjuvants</li></ul><p>Simple analgesics include <a href="https://www.aboutkidshealth.ca/article?contentid=62&language=English">acetaminophen</a> and <a href="https://www.aboutkidshealth.ca/article?contentid=153&language=English">ibuprofen</a> and are available over the counter. They are helpful for mild to moderate pain (especially resulting from tissue inflammation).</p><p> <a href="https://www.aboutkidshealth.ca/Article?contentid=2999&language=English">Opioids</a> are among the strongest pain relievers and are often used after surgery or other major painful procedures. If your child is in moderate to severe pain, their health-care team may prescribe opioids such as morphine, oxycodone or hydromorphone, generally for short-term use.</p><table class="akh-table"><tbody><tr><td>Opioids have risks and side effects, which can be serious. Always talk to your child's health-care provider for advice on taking, storing and disposing of opioids safely.</td></tr></tbody></table><p> <a href="https://www.aboutkidshealth.ca/Article?contentid=3002&language=English">Adjuvants</a> are medications that are shown to work well for pain but are mainly used for other reasons. Examples include anticonvulsants and cannabinoids.</p><p>For all medications, talk to your health-care professional for more information.</p><h2>What kind of improvements should I see in my child's chronic pain?</h2><p>Your child's chronic pain will not always improve consistently. There may be good days and bad days, good weeks and harder weeks.</p><p>Sometimes things might even get worse before they get better. For example, as your child begins their therapies and their body becomes more active, they may experience muscle soreness and throbbing. This is natural in weak or tight muscles that are not used to exercise or stretching and will ease in time.</p><p>To stay focused on managing pain effectively, make weekly goals with your child and remember that improvement can sometimes take time.</p><h3>Improvements in function</h3><p>One important area for goal setting is return to function. This means returning to activities that pain has disrupted, for example going to school, taking part in family routines or doing physical or social activities.</p><p>A return to function, rather than improvement in pain, is actually the first sign that chronic pain treatment is successful. This is because pain can often take weeks to months to improve while weak muscles gradually become stronger. If your child waits for their pain to go away before getting back into life, there is a risk that their pain will get worse.</p>​<h2>Websites</h2><p>Website designed to help children get control of their pain (German Paediatric Pain Centre)<br> <a href="http://www.deutsches-kinderschmerzzentrum.de/en/" target="_blank">http://www.deutsches-kinderschmerzzentrum.de/en/</a></p><p>Website where children can learn the Canadian 24-Hour Movement Guidelines the fun way<br> <a href="http://buildyourbestday.participaction.com/en-ca/tutorial" target="_blank">http://buildyourbestday.participaction.com/en-ca/tutorial</a></p> <h2>Videos</h2><p>How does your brain respond to pain<br> <a href="https://www.youtube.com/watch?v=I7wfDenj6CQ" target="_blank">https://www.youtube.com/watch?v=I7wfDenj6CQ</a></p><p>Seven video mini-series on chronic pain and its management for youth (Pain Bytes)<br> <a href="http://www.aci.health.nsw.gov.au/chronic-pain/painbytes" target="_blank">http://www.aci.health.nsw.gov.au/chronic-pain/painbytes</a></p><p>Video explaining the power of the brain and chronic pain<br> <a href="https://www.mycarepath.ca/understanding-pain/brain-and-nervous-system-change" target="_blank">https://www.mycarepath.ca/understanding-pain/brain-and-nervous-system-change</a></p><p>Video describing pacing<br><a href="https://www.mycarepath.ca/managing-pain/paced-practiced-and-increasing-activities" target="_blank">https://www.mycarepath.ca/managing-pain/paced-practiced-and-increasing-activities</a></p><p>Content developed by Danielle Ruskin, PhD, CPsych, in collaboration with:<br> Anne Ayling Campos, BScPT, Fiona Campbell, BSc, MD, FRCA, Lisa Isaac, MD, FRCPC, Jennifer Tyrrell, RN, MN, CNeph<br> Hospital for Sick Children</p><h3>References</h3><p>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.</p><p>Coakley, R. (2016). When Your Child Hurts: Effective Strategies to Increase Comfort, Reduce Stress, and Break the Cycle of Chronic Pain. Yale University Press.</p><p>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.</p><p>Mayo Clinic: Understanding Pain (<a href="http://www.mayoclinic.org/understanding-pain/art-20208632?pg=1">http://www.mayoclinic.org/understanding-pain/art-20208632?pg=1</a>)</p><p>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.</p><p>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.</p><p>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.</p>Chronic pain: How to treat and manage in older childrenFalse