Adults are not the only ones to suffer from chronic, disabling pain. Children and teens can also be limited by headache, stomach, and musculoskeletal pain severe enough to keep them from school and participation in sports or recreational activities. Many children experience pain that lasts right on into their adult years.
What can be done to put a stop to this early on? Studies are few and far between on this topic. That’s why this study from Germany is so important. Children between the ages of 11 and 18 participated in an inpatient program lasting three weeks. Besides age, criteria for being in the study included ability to understand German, presence of moderate-to-severe pain lasting more than six months, and school absences of at least one week out of the last four. Anyone with cancer or an eating disorder was excluded from the study.
Two-thirds of the 167 children reported headache pain (tension type or migraine). The pain was enough to disrupt daily activities such as homework, sleep, physical activity, and attending school. In fact, one-fourth of the group wasn’t even in school when the study began.
Before entering the program, each child was tested for baseline pain intensity, level of pain-related disability, depression, and emotional distress. Number of days missed from school and number of pain relievers taken daily were also recorded.
The treatment program was multimodal, meaning a wide range of methods were used. For five to eight hours every day, the children met with behavioral therapists, psychologists, art therapists, and physical therapists. They participated in individual counseling, family therapy, and group therapy. When emotional trauma was present, specific eye-movement therapy was also included.
The children were required to do homework every day. They kept a journal listing what they learned in sessions each day. They practiced new techniques such as distraction, pain coping strategies, and physical exercise. Early on in the three-week program, family members were taught how to stop enabling and stop reinforcing pain behaviors. For example, they learned how to change daily routines to help support the child in going to school despite the pain.
The children were not just in and out of the program. There was a transition period to help integrate the new skills at home and at school. Halfway through the three-week program, they made home and school visits to put into practice what they had learned. Relapse prevention was part of the overall program as well.
Once the children were discharged from the program, they were followed for three months and retested. Three months was used as the time frame because social scientists felt that this time period gave the children enough time to experience the effects of treatment in a way that could be measured. Outcome measures included pain intensity, pain-related disability, use of analgesics for pain, and school absence. A Depression Inventory was also taken by each child to assess emotional distress.
Significant changes were observed in all areas measured. Half of the children taking pain medication when they came to the program were able to get off all pain relievers. Children had less pain and were able to attend school more often. Changes in emotional status were not as dramatic. School aversion and depression were less but still present in two-thirds of the group.
The authors analyzed the data using age and gender (boys versus girls) as predictive factors of outcomes. Neither one of these factors appeared to make a difference in the results. The most deciding factor of overall success was level of pain. Children who started the program with lower pain levels seemed to have the best results.
The authors conclude that a multimodal inpatient program aimed at the treatment of chronic pain in children and teens can be very successful. More than half were symptom-free with improved function at the end of three months’ time. This was true for a variety of pain disorders.
After years of suffering, that was a very positive result for those children. These findings suggest that it is possible to stop the vicious cycle of pain-disability-pain that these children experienced.
It’s not clear if an inpatient program is really needed. It’s possible children suffering from chronic pain could benefit just as much in an outpatient, neighborhood treatment program. The cost would certainly be less, but further studies are needed before this recommendation can be made. And it’s possible that a different combination of treatment approaches would work just as well.
Are family sessions really needed? Can children learn to be more functional despite the pain when pain intensity doesn’t change? What pain-related coping strategies work best? And do some children need one approach while others need something else? How do we sort out who needs what? These are just a few questions that remain to be answered.
The authors propose that their program of early reintegration into family and school contributed to the success of these children. Children seem to do better than adults in a multimodal treatment program. This may be because of the family and social support systems that children have in place that adults may not have.