ACT Offers a Drug-Free Approach to Treating Chronic Pain in Children
By Hugh C. McBride
Difficult to describe and challenging to quantify, yet pervasive in patients, pain remains a challenging issue for many medical professionals. When individuals are suffering from chronic pain (long-term discomfort that outlasts the injury or condition of which it was once symptomatic), the challenge is even greater, as is the case when the patient is very young.
For these reasons, it is hardly surprising that, writing in the Spring 2002 edition of the journal The Child’s Doctor, Dr. Santhanam Suresh described chronic pain in children as “one of the most ignored and under-treated symptoms of disease.”
But a relatively new approach for managing pain in young patients may render Dr. Suresh’s observation obsolete, and could provide relief for children whose pain had previously confounded their treatment providers.
A Widespread Problem
As Dr. Suresh’s observation indicates, the prevalence of chronic pain among children would likely surprise all except those who are intimately familiar with the matter.
The American Pain Society has characterized chronic pain as “a significant problem in the pediatric population,” adding that the estimated 15 to 20 percent of children who experience chronic pain face significant challenges (as do their families):
- Children and their families experience significant emotional and social consequences as a result of pain and disability.
- The financial costs of childhood pain also may be significant in terms of healthcare utilization as well as other indirect costs, such as lost wages due to time off work to care for the child.
- The physical and psychological effects of chronic pain may have an impact on overall health and may predispose for the development of adult chronic pain.
On the APS website, the organization calls for increased education and research, along with changes to policies, to help ameliorate this widespread problem.
A Drug-Free Approach
According to a March 3 article by Time magazine’s John Cloud, a Swedish study into the efficacy of acceptance and commitment therapy (ACT) as a treatment for idiopathic – or unexplainable – pain in children found that the therapeutic approach garnered better results than did medications:
Clinicians who used [ACT] with a group of 16 chronic-pain patients ages 10 to 18 saw remarkable results: After just 10 weeks of ACT sessions, during which patients were taught strategies for accepting chronic pain so they could pursue important goals, those kids suffered less intensely and functioned significantly better day to day than did a control group of 16 chronic-pain kids who had been treated the way kids with persistent aches are normally treated – with drugs and standard talk therapy.
Both groups improved, but the children in the ACT group, who got no drugs, improved more than those who took pills.
These results, Cloud reported, were most impressive considering the degree of pain that the study’s subjects had been in prior to receiving the treatment:
The research team … recruited kids who had truly suffered. The children had headaches, backaches and neck problems; many had widespread musculoskeletal pain; a couple had internal, visceral pain. They had high depression scores; 11 of the 32 had been to the emergency room with pain symptoms; 20 had had MRIs to try to find the source of their pain (without success); 21 had had physiotherapy.
In short, the kids' parents had tried everything, and nothing had worked.
What Is ACT?
The Association for Contextual Behavioral Science describes ACT as “a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility.”
This form of therapy, the ACBS notes, encourages the use of “metaphor, paradox, and experiential exercises [to help] clients learn how to make healthy contact with thoughts, feelings, memories, and physical sensations that have been feared and avoided.”
In the Time article, John Cloud described the result of this approach as enabling children to manage their pain by learning how to “hold it close rather than dragging it behind them at a heavy distance.”
During the sessions, the therapists emphasized that the kids should go out and do what they truly loved even if they were hurting that day – in other words, that they should accept rather than try to avoid their chronic pain.
To shift kids away from focusing only on alleviating their symptoms, therapists discussed how their pain was not caused by a harmful disease or injury and how previous strategies (such as taking painkillers) had not worked. Kids were encouraged instead to notice and accept discomfort and to get back into activities they had abandoned.
The ACBS notes that this effort, which Cloud characterized as “sympathy but never pity,” is grounded in principles that are evocative of cognitive-behavioral therapy and behavioral analysis, and that ACT has roots in Relational Frame Theory.
“The core conception of ACT is that psychological suffering is usually caused by the interface between human language and cognition, and the control of human behavior by direct experience,” the ACBS notes on its website.
Treating Chronic Pain Patients
Because chronic pain often occurs in conjunction with other issues (such as stress, illness, injury, or substance abuse), addressing underlying or co-occurring disorders is essential to treating the pain itself. For that reason, many people have found that the most effective means of overcoming their challenges was to spend time in a residential program for the treatment of chronic pain patients.
If you or someone you love is suffering from chronic pain or a related condition, consult your family physician, contact another healthcare professional, or educate yourself online about the many treatment options that are available.
