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, Kim Jackson and Ewa Jaraczewska

Introduction[edit | edit source]

Chronic pain in children is very common and can lead to numerous negative influences on their quality of life including school absences, lower reading scores, 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]

Below are a few factors that can contribute to how one responds to chronic pain:

  1. Genetics; individuals may have a certain predisposition to a certain disease, illness or pain receptors
  2. Personality traits- 5 personality traits help children feel safe but can be energy depleting
    1. Achiever: indeed to do more
    2. Perfectionist: need to make everything just right
    3. Helper: need to assist others
    4. Anxious: thinking way into safety
    5. Controller: controlling environment and everyone around

While it is not necessary to rid oneself of these traits, it is important to notice them when they spring up and keep them in check so they do not take over

3. Load

  • Physical- too much sport or even too little
  • Emotional/cognitive what is happening in their life; any adverse childhood experiences[4]

Pillars of Health[edit | edit source]

Working with children that have chronic pain, it is important to assess their four pillars of health to see if any of them could be contributing factors.

  1. Sleep - quality and duration  

Children with chronic pain commonly have disturbances in sleep which can lead to negative behavioural, emotional and cognitive consequences [5]

2. Physical activity- too little or too much[4]

3. Stress- taking into account the amount of stress they are under; psychological symptoms can be a determinant of chronic pain[5]    

4. Diet- are they eating a well-balanced diet[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 learning the child’s concept of pain and aiming to improve 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 understand their pain experience with pain science education. “ An established form of education – pain science education – aims to provide a framework to understand one’s pain condition, by exploring what pain is, what function it serves, and how it works”[7]  Pain education can be further separated into two factors:

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

Pain science education's overall theme is to change the concept of pain from a biomedical model to a biopsychosocial model assessing factors such as genetics, beliefs, cognitions, school and family.[7]

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 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.
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