Dealing with chronic pain in children
By Christian Vey Mar 12, 2012, 10:18 GMT
Berlin - It started with a pulling sensation in the back, caused perhaps by picking up something heavy, perhaps by moving badly, but the pain did not go away, returning with increasing frequency.
'The way my daughter walked changed. Her movement was increasingly restricted and things simply got worse,' Karin recalls. 'At some point she became desperate and cried an awful lot.'
At the time, the girl from the German city of Dusseldorf was 15-years-old. She stayed out of school for three months because she could scarcely move. The family tried everything, taking their daughter to orthopaedic surgeons and physiotherapists, and learning relaxation techniques. Nothing seemed to help, and worst of all, none of the experts was able to offer an explanation.
Pain is a completely normal phenomenon and there is a good reason for it. Pain sends a message that there is something wrong with the body. 'But chronic pain is pain that has lost this warning function. The pain is just there,' says Boris Zernikow, a professor at a German centre specializing in children's pain.
All the patients attending the centre have been through something similar to Karin's daughter. On average, they have been suffering pain for more than two years and have been treated by at least three doctors without success.
Chronic pain should not under any circumstances be confused with hypochondria. 'The children really are feeling pain,' says Ria Matwich, a psychologist working in the outpatients section at a university clinic in Germany.
'The pain is caused by something other than acute illness,' she says. But particularly when the cause is unknown it sometimes happens that the pain increases in intensity. Then you get the feeling of being utterly helpless,' Matwich says.
The therapeutic process varies a great deal precisely because the causes of chronic pain are so varied. Medication, physiotherapy and psychological training are all important.
As a first step, Zernikow recommends that children maintain a diary to record their experiences with pain: when do they feel what sort of pain and how intense is it. Then they can learn how to combat it.
Something that diverts attention from the pain often helps. 'If the pain starts when the child thinks about it, then the mind needs to be occupied with something else,' Zernikow says. This could be anything from counting to retreating to a 'safe haven' in the imagination.
The social context is also extremely important. 'The parents also need training in how to cope with their child's pain,' Matwich says. The most important thing is not to react to bouts of chronic pain the same way as to an acute pain event.
Instead, the child must be supported in attempting not to allow the pain to take over. 'Many people find this strange at first,' Zernikow acknowledges. 'But offering careful handling and consolation are the wrong reaction to chronic pain.'
'Many patients benefit rapidly, with the first signs of relief showing after a month or two as a result of outpatient treatment,' Matwich says. Early diagnosis provides the best chance of dealing with chronic pain in a child.
Karin's daughter underwent three weeks of outpatient treatment at Zernikow's centre. 'Now she, not her pain, is the boss once again,' her mother says. The family does not talk about the pain anymore, having banished it from their daily lives. 'And that's the way it should be,' says Karin.