Chronic Pain in Children

What are the signs and symptoms of 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.

What tests are used to diagnose 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.

How do doctors at Children's Colorado diagnose chronic 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 four-hour appointment and then presented with an individualized treatment plan.

How do we treat chronic pain?

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 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).

Why choose Children's Colorado for your child's chronic 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.

• PALS (Parents and Adolescents Living Strongly) is a support group for teens with chronic illness and their parents offered through the Chronic Pain Clinic./li>