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Chronic pain is defined as pain that lasts longer than six months. This type of pain is a biopsychosocial experience, which means that there is an ongoing combination of biological, psychological and social factors that determine how a child feels chronic pain.
While acute pain that follows an injury is generally self-limited, in some children the pain continues beyond the expected healing time (usually defined as more than 3-6 months) and develops into a chronic, persistent or recurrent pain syndrome. With chronic pain, pain signals keep firing in the nervous system for weeks, months and even years.
The most common complaints for pediatric chronic pain include headaches, recurrent abdominal pain and general musculoskeletal pain, including limb pain and back pain. Pain without any known cause is also common in children.
In kids, chronic pain is often associated with missing school, difficulty maintaining social contacts, decreased participation in recreational activities, and decreases in health-related quality of life.
Chronic pain can be caused by many different factors. There may have been an initial injury, or disease can also be the underlying cause of chronic pain (e.g., arthritis). Some children also suffer unexplained chronic pain without any past injury or evidence of body damage.
Because of the unique combination of biological, psychological and social factors in each child, the source of chronic pain can be a very complex. Ongoing pain often triggers other patterns (e.g., poor posture, reduced physical activity) or psychological dimensions that make it harder to understand and treat.
Chronic pain affects the entire nervous system and can lead to the nervous system being “wound up” and remaining in a constant state of high reactivity.
Many studies suggest that approximately 30% of children and adolescents experience pain that lasts for three months or longer. Chronic pain is most common in the teenage years (age 14) and is more common in girls than in boys. Children with chronic illness or those who have experienced multiple painful procedures or surgeries are more likely to experience chronic pain.
Symptoms of chronic pain can range from mildly uncomfortable physical sensations to completely disabling pain. Children may feel a sharp or stabbing pain, a burning sensation, or a dull muscular ache.
Affected areas may feel tender or sore to the touch, and the pain may increase with movement. Often, chronic pain is not static (meaning it is not in the same place). It can change and intensify as you move throughout the day. It often prevents good sleep, which in turn makes it more difficult to cope with chronic pain.
The International Association for the Study of Pain recommends a multidisciplinary approach to the assessment of chronic pain. The initial evaluation should include a complete medical and pain history.
At Children’s Hospital Colorado, your child’s doctor will talk to you about the onset of pain, intensity, quality, location, duration, variability, predictability, exacerbating (what makes it worse) and alleviating (what makes it better) factors.
Your appointment will also include a psychosocial assessment of your child and family, including the child’s emotional functioning, coping skills and impact of pain on daily life including sleeping, eating, school, social and physical activities, and family and peer interactions. Our assessment will look at the impact of chronic pain on quality of life and daily function.
While a goal is to reduce the amount of pain a child experiences, the Chronic Pain Clinic focuses on improving function first (e.g., returning to school, being able to be active again). We know from research that these functional improvements are a first step to improved pain.
Children referred to the Chronic Pain Clinic have been seen by their primary care physician and typically multiple other specialists. However, despite previous interventions, their pain doesn’t go away and impacts them on an ongoing basis.
The multidisciplinary care team at the Chronic Pain Clinic (including doctors, nurse practitioners, psychologists, social workers, nurses, and physical therapists) are experts in the biopsychosocial model of pain. They understand the unique, complex way that biological, psychological, individual, social and environmental factors affect chronic pain symptoms and subsequent disability.
Each patient and family is seen in our new patient clinic, where they are evaluated by the team during a 4-hour appointment and then presented with an individualized treatment plan.
Management of chronic pain in kids is based on the pain experience and the contribution of psychological factors, social factors and biological processes. This is more effective than any single stand-alone therapy.
At Children’s Hospital Colorado, the primary goal of chronic pain management is to improve a patient’s functioning and quality of life. Children with chronic pain and disability benefit the most from interdisciplinary programs that incorporate cognitive behavioral therapy (identifying links between behavior, thoughts and feelings) into a program of functional restoration through physical rehabilitation and standard medical care.
Over time, individuals with chronic pain may have restricted their lifestyles and lost strength to the point that even daily activities cause pain. Managing chronic pain requires an active, consistent approach to help individuals cope more effectively with pain. School reintegration and addressing significant sleep disturbances are important treatment targets.
Currently, some of the strongest evidence exists for the efficacy of psychological interventions (e.g., relaxation strategies, parent interventions, cognitive strategies) for reducing pain in children. There are numerous medications that are effective for helping manage pediatric chronic pain (e.g., NSAIDs, neuropathic pain medications, muscle relaxants, and low dose antidepressants).
Opioids are rarely recommended in the long-term treatment of chronic pain in children, although they may be beneficial in certain painful conditions with clearly defined etiologies (e.g., cancer related pain).
The Chronic Pain Clinic is the only multidisciplinary pediatric pain clinic in Colorado and surrounding states. As such, we are the only clinic to offer-evidence based care in one place.
Our patients receive an individualized plan that typically combines medication management, pain procedures/therapeutic nerve blocks, psychological therapies, physical therapy, and acupuncture. Our clinic also provides education and support to help patients and families restore normal daily function.
Certified Pediatric Nurse Practitioner