Chronic Pain In Children

Guest Blog by Dr Stefan J. Friedrichsdorf, Medical Director, Department of Pain Medicine, Children’s Hospitals and Clinics of Minnesota

“Your pain is real! You are not making it up – you are not crazy! But getting rid of it is hard work: First your life needs to get back to normal, then the pain goes away (and not the other way around…)”

More than 8% of children and teenagers worldwide suffer from “Primary Pain Disorders” such as headaches, migraines, functional abdominal pain, and chronic musculoskeletal pain/fibromyalgia. This also happens commonly to children who in addition have episodic painful conditions and then remain in daily pain, even after the underlying condition is well treated and in remission (e.g. children with rheumatoid arthritis, Crohn’s disease, or sickle cell disease).  A large number of children with these primary pain disorders “drop out of their life” and miss school, sports, have trouble sleeping and spend less time with peers. This film from our interdisciplinary pain clinic at Children’s Hospitals and Clinics of Minnesota shows a successful approach commonly taken by many pediatric pain clinics worldwide. Since the pain has “lost it’s warning sign” and the children are “not going to harm their body” by exercising and going back to school, we found that nearly all of our patients got “pretty much pain free” (meaning: no pain most days most of the time) if they follow up with all (and not just some) of our four key recommendations at the same time:

(1) Gentle physical therapy with daily home exercise

(2) daily practicing of one active integrative modality (e.g. belly breathing, biofeedback, or self-hypnosis)

(3) seeing a pain psychologist trained in CBT to explore the connection between pain and stress

(4) Normalize life and function first, then pain goes down (but may go up for a short while) including Social, Sports, Sleep and School.

Medications are usually not helpful without using the above 4 key recommendations, and opioids (such as hydrocodone, morphine, fentanyl, oxycodone, hydromorphone, methadone, diamorphine etc.) are contraindicated in the absence of new tissue injury.

Learn more about our program at: www.childrensmn.org/services/painpalliativeintegrativemed

A list of Pediatric Pain Clinics in the USA can be found: http://americanpainsociety.org/uploads/get-involved/PediatricPainClinicList_Update_2.10.15.pdf

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