How to help children with chronic pain

Chronic pain is a common complaint in childhood and adolescence affecting between 15-30% of children. Recurrent abdominal pain, tension headaches and musculoskeletal pain are the most common types of pain that occur in the absence of disease or injury, and are frequent presentations at paediatric hospitals. When medical investigations reveal no medical explanation for the pain, children and parents can be left bewildered as to the cause and treatment.

They are usually advised by doctors to learn to manage the pain. While many children adjust well, an estimated 5-8% experience severe pain that disrupts their normal functioning such as attending school and engaging in activities. These children may be referred to Paediatric Psychology for help in managing pain and returning to normal activities.

Validating Children’s Pain

Referral to psychology can sometimes engender anger, fear and confusion for families. Children often say they feel doctors and others don’t believe their pain is real, that “it’s all in my head”. Validating children’s pain by reassuring them you believe it is real is extremely important.

Although chronic pain is medically unexplained, we can understand it in terms of being a normal part of human experience, whereby it functions as an alarm that interrupts normal activities and goals to prioritise avoidance and escape. In chronic pain, the alarm continues to go off and normal activity continues to be disrupted. None of us like pain and we will do anything to try to get rid of it or avoid it. The problem with these strategies is that they don’t work, in that we cannot get rid of pain completely, which frustrates and upsets us, adding emotional pain to the physical pain.

Impact of Pain

Chronic pain can significantly impact some children’s lives. They may miss school because of pain, which can affect their schoolwork. They may be unable to play sports or engage in hobbies, and consequently miss opportunities to see their friends. Dealing with pain and its impact can negatively impact mood, and many children with chronic pain experience anxiety, low mood, and anger.

Pain can also adversely impact families. Parents may feel helpless, and many express concern that the doctors might have missed something. Siblings can feel left out as parental attention is directed towards the child with pain. When pain goes on for a long time, years in some cases, these issues can become entrenched and it can feel like pain is consuming the child’s life.

Responding versus Reacting to Pain

In addition to validating children’s pain and its impact on their lives, I believe it is important to acknowledge how hard children and parents have tried to manage pain. Unfortunately the strategies typically used to deal with pain such as trying to get rid of it or avoiding doing things, don’t work and can make things feel even worse. Although we can’t stop ourselves experiencing pain, we can choose how to respond to it. We can do this using a mindfulness approach towards pain.

Mindfulness Approach to Chronic Pain

There is lots of research that demonstrates the benefits of mindfulness for chronic pain. Most of the research has been done with adults with chronic pain, however there is emerging evidence that it can also help children and adolescents with chronic pain. I teach mindfulness courses for children with chronic pain, and many of them report that practicing mindfulness helps them to cope better with their pain, and that it eventually becomes less frequent and less intense.

So rather than trying to get rid of pain we can choose to bring a gentle, friendly awareness to it. Instead of being hard on ourselves when we are in pain, we can learn to be kind and gentle in our attitude towards pain, and ourselves. The following mindfulness practices can help cultivate this friendly, kind attitude towards pain.

Mindfulness Practices for Children with Chronic Pain:

• Belly Breathing – place a teddy, your hand or a hot water bottle on your belly and feel your belly rise and fall as you breathe. Practice this for a few minutes.
• 7/11 Breathing. Breathe in through your nose and silently count to 7 and breathe out through your nose or mouth and silently count to 11 (or if this is too difficult then breathe in for 5, out for 7). Repeat this at least 5 times.
• Younger children could practice slow breathing using bubbles, a windmill toy or imagining blowing out candles.
• Beditation – lie down on your bed on your back with your arms and legs stretched out. Take a few slow deep breaths. Notice how your body feels without trying to change anything. Is it restless, tense, sore, or relaxed? Then starting with your feet, slowly move your attention up your body – legs, back, stomach, chest, arms, hands, shoulders, neck and head, allowing each part of the body to relax, paying special attention to any part of the body that is in pain.

See dotbe.org for a short, guided Beditation practice for children.

Reclaiming Life

It is recommended that a child continue to attend or return to school despite having pain as it can be a good distraction, and missing out on school will only create additional problems for them. It is advisable to inform the school of this recommendation, and arrange with them for the child to have some downtime if possible, if they experience pain during class. It is also recommended that children gradually begin to engage in activities that they previously enjoyed or perhaps take up new ones. It is important to pace the return to activities, taking things slowly rather than going back to everything straight away, and having a day or two of rest from activity if needed.