Pain Neuroscience Education for Children

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

Pain

Pain is a sensation and an emotional response to multiple stimuli created by the conscious brain which is then perceived as threatening. Pain is not a measure of tissue damage, but rather the brain's response to the threat. Therefore, pain is not only physical but an emotional event for the person. Pain is always an unpleasant body sensation, but it can be a challenge to define because it is subjective and ranges in quality, intensity and duration.

See the following videos by Joshua Pate on the science of pain and phantom limb pain:

Chronic Pain in Children

It is estimated that thirty percent of children experience chronic pain, with a higher incidence in girls. Chronic pain is defined as intermittent or continuous pain that has lasted for more than three months. The quality of life of children who have chronic pain is often affected, and they may experience emotional distress, increased school absences, lower reading scores and will be more likely to have chronic pain as an adult. The most common chronic pain complaints from children are headache, musculoskeletal pain and abdominal pain.

Signs of Pain in Children

Children in pain can exhibit different signs of pain based on their age, previous experiences, beliefs and expectations. The following chart by Children's Minnesota lists clues of pain by various ages of childhood and adolescents:

Toddlers (1-3 years) may:

• describe the pain
• cry or whine
• show facial grimacing
• keep their body rigid, refuse to crawl or walk
• be more easily frustrated
• be aggressive
• be restless or unable to sleep
• have poor appetite

"Preschool children (4-5 years) may:

• describe the pain
• show facial grimacing
• keep body rigid or refuse to move
• not want the area touched
• cry or whine
• be restless or irritable
• have nightmares
• have poor appetite
• not report pain if they think they are being punished, or fear the treatment

School-age children (6-12 years) can talk more directly about the cause, type, and amount of pain. Common behaviours may include:

• holding still or guarding the area that hurts
• flat-faced expression
• facial grimacing or crying
• emotional withdrawal
• irritability
• restlessness, thrashing
• disrupted sleep
• poor appetite
• nightmares
• not report pain if they fear the treatment

Teens (13-18 years) may show a combination of adult and childlike behavior. Look for:

• change in activity level
• decreased cooperation or participation
• change in eating or sleeping patterns
• irritability, restlessness
• inability to focus or concentrate
• anger or withdrawal

Pain Education

When working with children who have chronic pain, it is important to educate them and their parents on the concept of pain: how they understand pain, what function it serves and what biological processes are thought to increase it. Practitioners explaining these concepts should use easy to understand terminology for children and more in-depth language for parents Having the child learn and understand pain concepts provides an opportunity for them to become an active participant in managing and treating the child's pain while the therapist acts as a coach. The therapist works more as a coach with the child leading. Encouraging the child to be an involved team member can alleviate barriers to treatment and result in more positive outcomes.

Pain Education for Parents

Parents who have a child with chronic pain will often experience increased stress themselves. Being conscious of how they manage their stress is important because their coping skills are commonly modelled and emulated by their children. Parents who adopt self-care techniques can handle chronic stress with less negative outcomes and are better able to assist with family needs. Alternatively, parents who catastrophise, and have increased stress, and anxiety are less able to support their children. Studies show that 50 percent of parents of children with chronic pain have pain themselves. Parents with chronic pain themselves may bring in their own biases regarding pain and the support they can provide for their child.

How to Help a Child in Pain

UC Davis Health has provided a list of suggestions for how parents can help their child in pain:

• Provide your child with as many reasonable choices as possible and give them some control over treatment.
• Provide your child with honest, accurate, and age appropriate information in regards to their hospital experiences. Some of a child’s anxiety and fear can be subsided when they are properly informed.
• Give your child the opportunity to ask questions and express their feelings.
• Ask your child about their fears and clear up misconceptions they may have. If their fear is based on prior experience, talk through that experience and discuss how you can work together to help to make the next experience a better one.
• Do your best to reduce the extra stimulation and anxiety in the room. Children pick up on the emotions of adults (especially parents), so create a calm environment with those people that can remain relaxed and supportive.
• Encourage your child to practice deep breathing. Breathing creates a sense of relaxation. Bubbles and pinwheels are a great tool.
• Provide your child with items for distraction. Re-focus their attention onto something they enjoy such as playing a game.
• Encourage your child to use their imagination and focus their attention onto telling a story.
• Provide opportunities for comforting touch such as holding and cuddling.
• Remain close to your child. Children often feel more secure when their parents are close by

Resources

• Pain Neuroscience Education
• When Your Child Hurts
• A Journey to Learn About Pain
• Retrain Pain Foundation
• Pain in Children Assessment and Questionnaire