Understanding Chronic Pain and Health Challenges in Children

Original Editor - Robin Tacchetti based on the course by Tracy Prowse
Top Contributors - Robin Tacchetti, Jess Bell and Kim Jackson

Introduction[edit | edit source]

Chronic pain in children is very common and can negatively influence their quality of life, leading to decreased school attendance, lower reading scores, and increased pain-related disability and emotional distress.[1] Children experiencing chronic pain are at an increased risk for developing mental health issues, such as depression and anxiety, and for opioid misuse.[1] [2] Studies show that chronic pain in children and adolescents is a predictor for chronic pain in adults.[1] [2]

Pain[edit | edit source]

The International Association for the Study of Pain has defined pain as: “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Pain is always subjective.”[3] In addition, they believe six key factors play a role in how an individual experiences pain. These factors are listed below:

  • "Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
  • Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
  • Through their life experiences, individuals learn the concept of pain.
  • A person’s report of an experience as pain should be respected.
  • Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
  • Verbal description is only one of several behaviours to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain."[3]

Factors in Chronic Pain[edit | edit source]

According to author and therapist, Alex Howard, the following factors that can contribute to how an individual responds to chronic pain:[4]

1. Genetics: individuals may have a certain predisposition to a specific disease, illness or pain receptors.

2. Personality traits:[4]

  1. Achiever: need to do more
  2. Perfectionist: need to make everything just right
  3. Helper: need to assist others
  4. Anxious: thinking your way into safety
  5. Controller: controlling the environment and everyone around

Although these five personality traits are energy depleting, they can also help children feel safe. While it is not necessary to rid oneself of these traits, it is important to notice them and keep them in check, so they do not take over.

3. Load:

  • Physical load - is there too much sport /exercise or too little?
  • Emotional/cognitive load - what is happening in a child's life? Are there any adverse childhood experiences?[4]

Pillars of Health[edit | edit source]

When working with children who have chronic pain, it is important to assess the four pillars of health to see if any of these areas could be contributing factors.[4]

  1. Sleep - quality and duration; children with chronic pain commonly have disturbances in sleep which can have negative behavioural, emotional and cognitive consequences[5]
  2. Physical activity- too little or too much[4]
  3. Stress- it is necessary to consider the amount of stress a child is under; psychological symptoms can be a determinant of chronic pain[5]    
  4. Diet- is the child eating a well-balanced diet? As is described here, it can be useful to talk to children about "eating the rainbow"[4]

Treatment of Chronic Pain[edit | edit source]

The gold standard for chronic pain treatment includes a multidisciplinary pain management approach.[1] [6] Understanding the child’s previous pain-related experiences can help guide treatment. An important part of the treatment approach is gaining insight into the child’s concept of pain and aiming to improve their pain and function by teaching pain science education.[6]

Pain Science Education[edit | edit source]

Healthcare providers can help children and adolescents dealing with chronic pain understand their experience through pain science education. Pain science education is an established framework that helps individuals understand their pain condition by exploring what pain is, how pain works and what function it serves.[7] Pain education can be further separated into the following:

  1. Pain science education: how and why is pain produced?
  2. Pain management: what should you do about your pain?

The overall aim of pain science education is to change the concept of pain from a biomedical model to a biopsychosocial model, which assesses factors such as genetics, beliefs, cognition, school and family life.[7]

DIMS and SIMS[edit | edit source]

The Neuro Orthopaedic Institute (NOI Group) created a patient-targeted book called Explain Pain to help individuals understand and manage their chronic pain.[8] This book "emphasizes that any credible evidence of danger to body tissue can increase pain and any credible evidence of safety to body tissue can decrease pain".[9] Perceived dangers are called DIMS (danger in me) and safe feelings are called SIMS (safety in me).[8] Our bodies monitor the balance of DIMS to SIMS, which is referred to as the protectometer.[4] When individuals feel more danger than safety, their protective mechanisms kick in. Protection can be in the form of anxiety, muscle spasm, fatigue, pain, etc. In order to self-manage chronic pain, the goal is to decrease DIMS and increase SIMS.[8]

See the video below by Mathew Richardson on the Protectometer: DIMS and SIMS.

Resources[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 Pate JW, Hush JM, Hancock MJ, Moseley GL, Butler DS, Simons LE, Pacey V. A child’s concept of pain: an international survey of pediatric pain experts. Children. 2018 Jan;5(1):12.
  2. 2.0 2.1 Tutelman PR, Langley CL, Chambers CT, Parker JA, Finley GA, Chapman D, Jones GT, Macfarlane GJ, Marianayagam J. Epidemiology of chronic pain in children and adolescents: a protocol for a systematic review update. BMJ open. 2021 Feb 1;11(2):e043675.
  3. 3.0 3.1 The International Association for the Study of Pain, July 2020.
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Prowse, T. Pain in Children Course. Physioplus 2022.
  5. 5.0 5.1 Harrison LE, Pate JW, Richardson PA, Ickmans K, Wicksell RK, Simons LE. Best-evidence for the rehabilitation of chronic pain part 1: Pediatric pain. Journal of clinical medicine. 2019 Sep;8(9):1267
  6. 6.0 6.1 Pate JW, Noblet T, Hush JM, Hancock MJ, Sandells R, Pounder M, Pacey V. Exploring the concept of pain of Australian children with and without pain: Qualitative study. BMJ open. 2019 Oct 1;9(10):e033199.
  7. 7.0 7.1 Leake HB, Heathcote LC, Simons LE, Stinson J, Kamper SJ, Williams CM, Burgoyne LL, Craigie M, Kammers M, Moen D, Pate JW. Talking to teens about pain: A modified Delphi study of Adolescent pain science education. Canadian Journal of Pain. 2019 Jan 1;3(1):200-8.
  8. 8.0 8.1 8.2 Hunter JP. The Explain Pain Handbook: Protectometer by GL Moseley and DS Butler. Physiotherapy Canada. 2016;68(3):310.
  9. Moseley GL, Butler DS. Fifteen years of explaining pain: the past, present, and future. The Journal of Pain. 2015 Sep 1;16(9):807-13.