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Managing chronic pain in children

When I was a fresh out of physical therapy school, I worked on a skilled nursing unit which serviced a lot of post surgical patients. Pain management was a big part of getting these patients up and going. We would encourage our patients to stay on top of the pain and to take their meds before coming down to physical therapy, and, yes I was called a physical terrorist and the department was described as the pain and torture department. However, that is a story for another day.

In 1997, I was lucky enough to become the physical therapist for the Early Intervention team in Butler County. It became clear that children who had painful conditions or underwent surgery were not treated for pain. I discussed this with my father, a registered pharmacist, and he stated the research demonstrated that children were under treated for pain on a consistent basis. As service providers in the community for children, it is always good to be up on children’s health concerns.

An article by Jen Christensen called “Mom, It Hurts” in pain resource magazine (fall 2012 issue), states that slow progress is being made in this area. A 2009 report by the MayDay Fund noted that about 20% of children suffer from untreated chronic pain. A few of these conditions include fibromyalgia, migraines, digestive problems and rheumatoid arthritis. Part of the issue is that doctors and parents alike tend not to believe a child if nothing obvious can be found as the source of pain. We all know that young children are still learning reality from fiction and that story telling is a part of childhood so disregarding pain is easy when you think about how resilient children are. The opposite concern is called enmeshment. This is when a parent becomes too involved and actually keeps the pain in the forefront of the child’s life. The child learns to    have low self-esteem as they are not allowed to learn coping skills. 

As with most things in life, balance is the key. There are things that we can do to help a child in pain. Remember we are not experts on medications so, if pain management is needed, a physician must be involved. Inappropriate use of meds in children, especially, is dangerous.

Medication is not always the answer anyway, yoga, coping skills and counseling are all good activities that can aid a child’s chronic pain. So what can we do? First, if you are seeing lingering or chronic pain in a child, act quickly, but do not panic. Involve the parent and encourage them to speak to the child’s physician. Do not allow yourself to become enmeshed in the child’s pain. Pain is not the sum total of the child or the child’s needs. Encourage the good days and keep them involved with their world and with their friends. School and daycare are important activities that must be maintained.

Many children hide their pain so look for the signs such as distraction, exhaustion, or excuse making for avoiding interaction with activities and friends. If a child will be undergoing surgery, encourage the parents to plan ahead with the doctors about pain management. Do you have a plan in place for once the child returns to school or daycare? Pain of a chronic nature or post-surgical is a real issue for children, as well as adults. Awareness of that, will help us work with children in a proactive manner and make their world a better place. This post was written by Angela Pulaski, Physical Therapist at Bright Beginnings. Check out her staff profile here.