Chronic pain is a condition that impacts many children and adolescents. Depending on the level of impairment that chronic pain has on daily life, there are different treatment options that will be most effective.
What is Chronic Pain?
Chronic pain is pain that lasts longer than three months. When a child has chronic pain, over time their body’s central nervous system becomes increasingly sensitive and reactive to non-harmful sensations and signals. Chronic pain can also impact a child’s moods, behaviors and interactions with others. Their day-to-day functioning and ability to engage in or even avoid certain tasks due to fear of pain is also impacted.
How is Chronic Pain Treated?
Chronic pain impacts all areas of a person’s functioning, so treatment requires different approaches. The overall goal of treatment is to slowly improve daily functioning back to the child’s baseline before the start of pain concerns. Treatment interventions aim to retrain the brain and the body to desensitize the nervous system. When a child consistently increases daily tasks and function and learns active strategies to better manage and cope with their pain, chronic pain slowly improves.
What are the Various Levels of Treatment Intervention?
A range of treatments are available depending on the degree of impact (minimal to severe) pain has on daily functioning. Examples of minimal impact on daily function include occasional pain complaints, limiting participation in daily activities, or adapting activities to minimize pain experiences. Severe impact on daily functioning could be missing a significant amount of work or school due to pain, difficulties with sleep and mood regulation, frequent pain complaints, and inability to complete typical daily tasks due to pain.
Comprehensive Pain Services at Nationwide Children’s Hospital provides comprehensive treatment options to children and their families in distress from chronic pain. Pain Services focuses on teaching each child to regain the parts of their lives that pain has taken away, through symptom management and rehabilitation. Upon completing an initial team evaluation, each child receives an individualized treatment plan.
Severe Impairment
A number of different treatment specialists may meet with your child for inpatient pain services if they are hospitalized for chronic pain, including physical therapy, a pain physician, occupational therapy, or pain psychology.
The Intensive Pain Rehabilitation and Education Program (iPREP) is a multidisciplinary day-treatment program. It is designed for children 10-18 years of age who have had an inadequate response to an outpatient pain program, providing a combination of individual and group therapy. Multidisciplinary services include physical therapy, pain psychology, biofeedback training, parent education classes, therapeutic recreation, patient academic and school success program, occupational therapy, massage therapy, aromatherapy, and acupuncture.
Moderate Impairment
The Comprehensive Pain Management Clinic is a multidisciplinary outpatient clinic for children and adolescent with a variety of chronic pain concerns. Patients receive individual appointments with a physician, pain psychologist, physical therapist, and acupuncturist or massage therapist during scheduled half-day sessions.
Mild Impairment
The Biofeedback Program is a five-session curriculum for children with mild impairments in function due to their chronic pain. Biofeedback uses noninvasive sensors and a computer to measure the body’s nervous system, providing immediate feedback on how the body is reacting to certain triggers. The program teaches relaxation strategies to turn the dial down on the nervous system and give children more control over their body responses, resulting in improved pain management ability.
Milder impairments in day-to-day function may not require a multi-specialty treatment approach. Outpatient Pain Psychology treatment focuses on identifying how thoughts and feelings impact daily behaviors that in turn impact pain. Children are taught how to apply cognitive and behavioral coping skills to improve mood, which can then improve overall pain management ability. Pain Psychology may also use biofeedback training to teach additional relaxation and pain management strategies.
Dr. Debeljack is a physician on the Pediatric Psychology team at Nationwide Children's Hospital.
Tim Smith, MD
Anesthesiology & Pain Medicine
Dr. Smith is a pediatric anesthesiologist at Nationwide Children's Hospital and a Clinical Assistant Professor of Anesthesiology at The Ohio State University College of Medicine. He completed a pediatric anesthesiology fellowship at Nationwide Children's Hospital. He is board certified by the American Board of Anesthesiology.
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