Chronic pain in Children

What is chronic pain?

Chronic pain is any pain that lasts longer than three months. In many cases this means that the pain continues even after the injury or illness that first caused it has healed. Chronic pain includes conditions such as fibromyalgia, complex regional pain syndromes, reflex sympathetic dystrophy, chronic widespread pain syndrome and pain amplification syndromes. Chronic pain may also occur together with other medical conditions including juvenile arthritis, orthopaedic conditions, cancers and their treatments, etc. In these children, dealing with the pain will also include treatment of the medical condition.

What causes chronic pain?

Pain is part of the body’s alarm system. When it happens following an injury or as part of an illness, the pain will usually go away as the body heals. Chronic pain is always triggered by something, even if we can’t always find it. This may be an injury or illness, or a reaction to a distressing event. Pain is a personal experience and is always real to the individual. As pain becomes chronic, changes occur in the nervous system, including in the brain. New pathways are formed and chemicals involved in pain signaling increase. This means that pain can continue to be experienced even after the initial trigger has gone. These changes need not be permanent. The process can be reversed and the pain can improve.

What will happen to my child?

Chronic pain may sometimes be associated with changes in temperature, colour, sweating and sensitivity of the skin, but not always. Pain is an unpleasant experience and therefore frequently results in feelings of sadness, anger, irritability and frustration. Chronic pain can stop a young person doing the things he or she enjoys. When the young person stops doing those enjoyable activities, his/her mood can get worse, and in turn so can the pain. This can be a vicious cycle.

What can be done to help my child?

Helping young people with chronic pain requires multidisciplinary care. A team of health care professionals may be involved in their care and in working with their school. These may include:

• Family doctor
• Rheumatologist
• Pain specialist doctor
• Physiotherapist/exercise physiologist/osteopath
• Occupational therapist
• Psychologist/counsellor/psychiatrist
• Specialty nurse
• Music and art therapist

The team may help your child in some of the following areas:

• Physical Management
  • Graded activity including exercise and stretches
  • Relaxation therapy
• Mood and sleep
  • Good quality sleep
  • Healthy thinking habits
  • Socialising with friends and loved ones
• Medicines
  • A number of medications may have a role under the supervision of a specialised team

What will happen in the future?

For some young people, chronic pain will disappear with time. For others, it may last a very long time or re-occur from time to time. There will be no damage to the body and the body will continue to work normally. Understanding the chronic pain condition, what causes it to flare up for an individual, and how to manage those flares, will enable the young person to lead a full life.

See Managing JIA for more information