Pediatric Chronic Pain Eased by Early Intervention, Parental Involvement
by Mary Beth Nierengarten
“The monsters of chronic pain”
For children with chronic pain, an innovative pain management program that focuses on self-control of symptoms and strong parental involvement is showing promising effects to reduce pain and improve function in these children.
The key to the program, according to Rachael Coakley, PhD, associate director, Psychological Services, Pain Treatment Service, Boston Children’s Hospital, is changing the mentality of children and their parents to think about pain differently, as well as providing strategies To manage the pain.
A change in the mentality of doctors and other health professionals who care for children with chronic pain is also necessary. The goal of the program is for patients to recognize that pain, regardless of its origin, thus, improves when children and parents know how to handle symptoms adaptively.
Psychological strategies for pain management should be prescribed early as part of a primary intervention for chronic pain rather than waiting until children develop a functional disability or significant symptoms of anxiety or depression, ”he says, adding that the comment that Most often received from parents is that they feel that their children are referred to psychologists only when there is not much more than doctors feel they can do to address chronic pain.
Dr. Coakley, who designed the program, emphasizes that the program is intended to be a primary treatment for chronic pain and pain-related stress and not necessarily as an intervention for mental health problems, such as anxiety or depression.
“Ideally, this intervention works as an integrated part of caring for a child and is not reserved for children who have not responded to standard medical protocols,” she says.
The knowledge of this program by rheumatologists who care for children with chronic pain can provide a necessary resource for these children beyond what has traditionally been available to them.
Called Comfort Ability, the program is designed for children and adolescents 10 to 17 years of age with chronic or recurrent pain syndromes and their parents. Children enrolled in the program have a wide range of pain conditions, including abdominal pain syndromes, neuropathic pain, headaches, fibromyalgia and pain amplification syndrome, as well as disease-related pain. Dr. Coakley emphasized that the strategies used to help these children cope better with their pain are the same regardless of the underlying cause of the pain or the different levels of functional disability.
Held at the Pain Treatment Service at Boston Children’s Hospital, the program runs every eight weeks and consists of a one-day and six-hour workshop that takes place on a Sunday to minimize the interruption of school and work schedules. The workshop is divided into two groups that run separately, but simultaneously, during the six hours. One group is for children, and the other is for their parents or adult caregivers.
Group of children
Directed by clinical psychologists, the group of children uses a framework of motivational interviews to increase the child’s willingness to change his relationship with the pain he is experiencing. The group provides a framework to educate children about how pain works in the body, teaches coping skills to increase their physical comfort and provides guidance on how children can learn to rethink the impact of pain in their daily lives.