Much More than 'Just a Stomachache' - For Some Children, Chronic Pain Causes Significant Suffering

By Hugh C. McBride

In their efforts to end the scourge of child abuse, several advocacy organizations have adopted the slogan, “It Shouldn’t Hurt to Be a Child.”

This is truly both a noble goal and an admirable sentiment, but the truth about childhood is far less encouraging. For a surprising number of young people, childhood is indeed a painful experience, even though they have been neither abused nor neglected.

According to the American Pain Society (APS), between 15 and 20 percent of children from infancy through adolescence suffer from chronic pain, a potentially debilitating experience that can inflict significant physical, emotional and financial distress upon young people and their families.

Two Types of Pain

Pain is an intensely personal and subjective experience. Because doctors cannot see pain on an X-ray or measure it with objective diagnostic tools, it is often difficult for them to fully grasp the degree of suffering that a patient is experiencing.

This may be especially true of pediatric patients, some of whom may be unable or unwilling to admit how much pain they are in, while others may be prompted by fear or confusion to overstate the degree to which they are suffering.

For general clinical purposes, though, regardless of whether the patient is an adult or a child, pain can be divided into two distinct categories: acute and chronic.

The APS defines these two types of pain in the following terms:

• Acute pain follows injury to the body and generally disappears when the bodily injury heals. It is often, but not always, associated with objective physical signs of autonomic nervous system activity.
• Chronic pain, in contrast to acute pain, rarely is accompanied by signs of sympathetic nervous system arousal. The lack of objective signs may prompt the inexperienced clinician to say the patient does not "look" like he or she is in pain.

In less clinical language, acute pain is short-term and directly connected to an injury or illness (for example, a child falls on the sidewalk, her knee hurts where she landed on it, the pain goes away when the cut heals).

Chronic pain, on the other hand, endures without being associated with injury or illness (for example, a child hurts his knee, the knee heals, no long-term damage has been inflicted, yet he continues to suffer from discomfort that appears to have no physical cause). In some cases, chronic pain can be linked with a root cause; for example, the long-term discomfort that is often experienced by cancer patients.

The Prevalence of Pediatric Chronic Pain

In an article that appeared in the Spring 2002 edition of The Child’s Doctor (the journal of Children’s Memorial Hospital Chicago), Dr. Santhanam Suresh observed that chronic pain among children is “one of the most ignored and under-treated symptoms of disease,” though he also noted that efforts to identify and measure pediatric pain had made significant headway during the 1990s.

An advocacy statement on the APS website notes both the prevalence and the potential damage that can result from chronic pain among children:

• Chronic pain is a significant problem in the pediatric population, conservatively estimated to affect 15 to 20 percent of children.
• The physical and psychological [conditions] associated with chronic pain may have an impact on overall health and may predispose for the development of adult chronic pain.
• 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.

A July 5, 2005 article on the Medical News Today website reported that many of the children who compose the 15-to-20 percent statistic cited by the APS are suffering from headaches, abdominal pain (stomachaches) and musculoskeletal pain. Though most of these children are able to participate in daily life, the article noted that about 2 percent of children experience “pain symptoms that can be severe enough to interrupt sleep, restrict physical activity and prevent them from attending school.”

“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, Professor Christopher Eccleston, Director of the Pain Management Unit at England’s University of Bath, told Medical News Today.

“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,” Prof. Eccleston added.

The Impact of Chronic Pain

Though research into the long-term effects of pediatric chronic pain is admittedly limited, the ramifications of chronic pain among adults indicate that the experience can lead to a number of negative outcomes.

For many chronic pain patients, their suffering occurs on two levels: the physical and emotional strain that results from the constant presence of pain, and the frustration that results from not understanding the nature of the pain (or from being dismissed by doctors who insist that “there’s nothing wrong”).

Some chronic pain patients attempt to self-medicate or numb themselves by abusing alcohol or other drugs. In many cases, the drug abuse involves prescription pain medications such as Vicodin, Codeine and OxyContin - drugs that may have initially been taken under a physician’s supervision.

Because the explosion of illicit online pharmacies has made it much easier for individuals to acquire prescription medications without having to meet with a doctor, prescription drug abuse has reached epic proportions both in the United States and throughout many other parts of the world.

Unfortunately for those who are desperately searching for something - anything - that will provide them with even temporary relief, access to a virtually unlimited supply of pain medications rarely helps, and can often exacerbate their suffering. Taking pain medications without proper supervision puts people at increased risk for developing tolerance and dependency, both of which can worsen the physical and emotional pain.

In addition to driving some people toward substance abuse, chronic pain has also been associated with depression, anxiety and thoughts of suicide. Enduing continued physical torment while also experiencing the frustration of failing to receive appropriate care (or of having the very existence of one’s suffering called into question) can understandably weaken the resolve of even the strongest individuals.

Dismissing or failing to properly treat a child’s chronic pain can greatly increase the likelihood that the young person will experience myriad pain-related challenges - physical, emotional, behavioral, social and financial - well into adulthood.

Treatment and Relief
 
As members of the medical community continue to gain greater insights into the nature of chronic pain in both adults and children, more effective options are being developed to treat these patients and relieve at least some of their suffering.

If you suspect that your child is suffering from chronic pain, and if this pain appears to be associated with mental health or substance abuse issues, you need to educate yourself about both the problems your child is experiencing and the treatment options that are available to you.

If your child is suffering from chronic pain, it’s likely that you are feeling frustrated, confused and perhaps even powerless. But with education and proper intervention, your child’s life can be significantly improved.

Some chronic pain patients have been greatly helped through cognitive behavioral therapy and other types of therapeutic pain management techniques, while those who are also suffering from depression or substance abuse disorders need to have these problems addressed.

Depending upon the nature and severity of a young person’s chronic pain, and the presence of any co-occurring disorders, these and similar services may be provided on an outpatient basis or as part of a residential chronic pain treatment program such as the one offered at Twelve Oaks Recovery Center in Navarre, Florida.

Though it shouldn’t hurt to be a child, the reality is that it often does. Thankfully, with proactive parental involvement and the assistance of qualified treatment personnel, chronic pain does not have to be an insurmountable problem in any child’s life.