Mindfulness for Resilience in Illness: What Is Childhood Chronic Pain?

Welcome to the Mindfulness for Resilience in Illness: Support for Parents series. In this series of four articles, we summarize some of the psychoeducational and stress management skills that can help build resilience when parenting a child with a chronic condition.

This article explains the basics and how expert pediatric pain doctors approach chronic pain management.

Getting a grip on pain

No matter where you are on your journey with your child’s chronic pain, it is important to understand the basics of pain. This will help you with treatment planning, home care, and communication with family, teachers and friends, who may have trouble grasping your child’s pain experience.

When people hear the word ‘pain,’ they usually think of acute pain – pain that often has a clear source (like a burn from a hot stove). In this way, pain is a warning sign to protect your body. With this type of pain, the damage or injury typically heals quickly, the warning signals from the pain alarm system begin to dial down, and the body receives the message that everything is okay. But chronic pain may or may not be a sign of injury or disease. Chronic pain can be caused by an ongoing condition like arthritis or cancer, or it can be pain that persists after an injury—like an ankle or back sprain—has healed. And sometimes chronic pain seems to start out of nowhere. For an excellent explanation of these concepts and how the body’s pain response works, check out this brief video from pain expert Dr. Lorimer Moseley.

With chronic pain, the wiring of the nervous system (the nerves, spine, and brain) becomes faulty and the body’s pain alarm system becomes hypersensitive. This causes the brain to continue to sense pain even if there is no damage or injury. Other factors like mood, thoughts, memories, and behaviors affect how pain is processed in the brain. The way parents respond to their child’s pain—as well as their own pain—may also affect a child’s chronic pain.

A whole child approach

While medical approaches can provide relief for acute pain, medical interventions such as surgery are usually not enough to resolve chronic pain. Treatments that target the whole pain-control system (both body and brain) and address the range of biological, psychosocial, and social factors at play are needed. A common experience in families is that other people don’t believe that their child is really in pain or believe that the pain is “all in their head.” This is not true. Your child’s pain is real and is a combination of what happens in his or her body AND his or her brain. Many factors affect the nervous system and pain wiring, so regardless of the initial cause of the pain, re-wiring and calming down the entire pain system are critical.

Parenting a child who is experiencing chronic pain can be very stressful: There is so much to learn about the condition, and finding the right pediatric specialists can be challenging. Fortunately, we know more about the neurobiology of pain today and the unique needs of children and adolescents. Experts agree that while it may seem counterintuitive, not focusing on the pain condition is an important element of treatment. Children with chronic pain and their parents can use a variety of strategies to draw attention away from the pain and build resilience in their pain response.

“You know you’ve got to keep them active because the more they’re doing the more they are distracted the less it hurts….you just kind of need to mix it up you know try something different.”
-Father of a 16-year-old girl with chronic back pain

Treatment approaches in pediatric chronic pain management

The goal of pain management is to help the body restore its own pain-control and pain response system. Fortunately, there are many different types of therapies and treatments that can target pain and pain processing in the brain. Effective pain management includes using a combination of medication, rehabilitation therapy, psychological, and complementary and alternative medicine (CAM)
treatments, such as the following:

Individual psychotherapy: “cognitive-behavioral” or “CBT” therapy to learn skills to cope with pain, emotions, and difficult situations
Family therapy: similar to individual therapy but focuses on supporting the whole family and teaching the family skills to cope with a child in pain
Physical therapy: exercises taught by a professional to help the child regain strength and prevent injury
Yoga (specifically Iyengar yoga): yoga designed for people with health problems
Biofeedback: learning how to change the body’s physical responses of pain, tension, and anxiety
Hypnotherapy: learning how to get into a very focused state so that you can “reprogram” your body to make it function better
Art therapy: expressing yourself through drawings, paintings, collages, or any type of art
Music therapy: expressing yourself through music, including relaxation techniques
Acupuncture: the placement of small needles at different body points to restore balance and relaxation
Massage therapy and craniosacral therapy: two types of physical massage therapy to relieve tension and improve how nutrients and waste are circulated throughout the body

Key takeaways

Chronic pain is complex, which is why treatments that target the whole pain-control system (both body and brain) are needed.
Not focusing on the pain condition is an important element of treatment, even though it may seem counterintuitive.
The way parents respond to their child’s pain—as well as their own pain—may affect a child’s chronic pain.

Watch and listen to the Week 1 collection in the mobile app.

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Read more from the Mindfulness for Resilience in Illness Series: Support for Parents.

[Part 2] Mindfulness for Resilience in Illness: Managing Parent Stress When Caring for a Child With Chronic Pain
[Part 3] Mindfulness for Resilience in Illness: Creating a Circle of Care
[Part 4] Mindfulness for Resilience in Illness: Parenting With Mindfulness and Self-Kindness

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Resources

In their book Pain in Children and Young Adults: The Journey Back to Normal (2016), Drs. Lonnie and Paul Zeltzer guide parents and their children in taking control of chronic pain and returning to a normal life. While deemed “two pediatricians’ mind-body guide for parents,” this book provides invaluable insight for health care providers as well. You may find this resource helpful when considering the role of complementary and alternative medicine, including mindfulness. (Excerpt here.)

Research reported in this publication was supported by Eunice Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R43HD09774. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.