Chronic Pain in Children
Dr. Steven Weisman is the Jane B. Pettit Chair in Pain Management at the Children's Hospital of Wisconsin, as well as the Medical Director of the Pettit Pain and Palliative Care Center. Dr. Weisman is Professor of Anesthesiology and Pediatrics at the Medical College of Wisconsin in Milwaukee, Wisconsin. He is also a member of the Pain.com Advisory Board. We recently asked Dr. Weisman to share his thoughts on caring for children with chronic pain.
Pain.com: Dr. Weisman, not much is known about chronic pain in children. Is there any data with an estimated prevalence of chronic pain in the pediatric population? If so, how many children are affected and what types of diseases/reasons exist that cause it?
Dr. Weisman: There is some prevalence data for the Unites States, but there are a number of large reports from Scandinavia and the Netherlands. In our clinic, we mainly see headaches, abdominal pain, and non-specific musculoskeletal pain, including sports-related or overuse injuries, and myofascial pain. Unfortunately, we do see a fair number of children and teens with Complex Regional Pain Syndrome, but we really don't know what the population incidence is for this. We also follow a fair number of patients with sickle cell anemia. The remainder of our patients is quite diverse including hereditary neuropathies, patients with underlying dysautonomia and pain, cancer pain, and post-trauma-related pain.
Pain.com: What treatment barriers exist in addressing chronic pain in children?
Dr. Weisman: The biggest barrier is access to care. There are very few pediatric pain specialists in the USA or even internationally. Most general pediatricians have little or no training in the management of chronic pain. They also are not exposed, usually, to an interdisciplinary approach to pain management that involves medical, physical therapeutic, psychological, and educational integration of services.
Pain.com: What impact does chronic pain have on the long-term health of a child? Or, what psychosocial issues are there for the child/family when dealing with chronic pain?
Dr. Weisman: The goal of therapy for the child with chronic pain needs to be rehabilitation, normalization, and a return to the normal activities of childhood. This includes play, family activities, and, most importantly, school. The long-term negative effects often end up being related to impaired psychosocial development, including the formation of abnormal peer or family relationships. Children with chronic pain who are isolated, develop secondary depression (or have primary depression) as part of their co-morbidities. The effects certainly extend into the families. It is not uncommon for there to be co-pain morbidity with another parent. The most common dyad is mother-daughter. There can also be a negative impact on the parents' ability to function and maintain a normal job and family role for other siblings and partners.
Pain.com: How can clinicians go about properly caring for children with chronic pain?
Dr. Weisman: Clinicians need to become well-versed in the language of explaining the integration of mind and body in the chronic pain conditions. They are never separate and distinct. Failure to address the physical issues and then trying to blame everything on psychological phenomena can be just as unhelpful as over-focusing on various somatic complaints. It is quite common for the somatic symptoms to be way out of proportion to any diagnosable or discoverable physical ailment. There can be a tendency to ascribe all the pain to suffering and psychological comorbidity. This, not surprisingly, can push away families who are quite wedded to the perception that the pain is physiologically-based. It is important for clinicians to learn communication skills that allow them to address both the physical and the psychological manifestations of chronic pain.
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