Children in chronic pain need better support

One in fifty children and adolescents live with severely debilitating and recurrent pain but there is an “embarrassing” lack of data on the best ways to treat them, according to researchers.

As many as 15 per cent of children suffer from headaches, abdominal and musculoskeletal pain but two per cent of children have pain symptoms that can be severe enough to interrupt sleep, restrict physical activity and prevent them from attending school.

Studies have shown that children suffering with this kind of chronic pain frequently become emotionally distressed and have a heightened sense of vulnerability, which can have a major impact on parents and siblings.

But despite the impact of chronic pain in children and adolescents there is a lack of evidence to guide clinical practice in this complex area, and few paediatric centres have chronic pain management programmes.

“Many people used to think that chronic pain was a uniquely adult problem, but recent epidemiological studies have shown that a number of children are severely affected by pain,” said Professor Christopher Eccleston, Director of the Pain Management Unit at the University of Bath *.

“There can be a significant effect on the child’s family and our studies have shown that many parents of children who suffer with chronic pain report higher than normal levels of anxiety, as well as marital and financial problems.

“Many parents that we have spoken to were highly distressed by their inability to alleviate their child’s pain and felt that this contradicted their view of a parent as someone who can ‘make things better.”

Whilst many children in chronic pain can be treated by their family doctor, the medication they prescribe is selected on the basis of on data extrapolated from adults, and the evidence for its effectiveness in children is limited.

“Controlled trials with a focus on safety, as well as efficacy, are urgently needed for all conditions of childhood and adolescence that are characterised by chronic or recurrent pain,” said Professor Eccleston.

“Chronic pain in children is an important problem and more action is urgently required to overcome the embarrassing lack of data on childhood pain.

“The incidence of chronic pain in children is similar to that of adults but our knowledge of how to help children cope with chronic pain is severely underdeveloped.

“Given the probability that that many children with untreated chronic pain will grow into adults disabled by chronic pain, this lack of knowledge potentially has a high societal cost.”

Many doctors dealing with children in pain become concerned about missing a serious underlying disease and so invest time and energy looking for a serious condition and referring to specialists for further evaluation.

“During this time in a ‘diagnostic vacuum’, the child often receives little appropriate pain management which can be incredibly frustrating for all concerned,” said Professor Eccleston.

“Inaccurate and unhelpful diagnoses of ‘functional’ or ‘psychosomatic’ pain can fuel fear and frustration in children and their parents.

“Families often interpret these labels as blaming them for the child’s pain and the labels tend to reinforce their need to move from doctor to doctor in search of a different diagnosis and cure.”

Research by the Pain Management Unit has shown that even for children and adolescents with the most severe pain and disability, it may be possible to reduce the impact of pain on the lives children and their families through psychologically-based treatments.

A recent evaluation of an intensive interdisciplinary programme of cognitive behaviour therapy developed by the Pain Management Unit for adolescents with chronic pain showed that it was effective at improving physical, psychological and social scores – and resulted in 40 per cent of the children returning to full time school.

The emotional condition of parents can have an important role in the success of this type of treatment, but their untreated depression may be both a clinical problem of its own and a barrier to effective delivery of treatment to the adolescent.