Chronic pain

The term ‘chronic pain’ includes a variety of pain syndromes that describe pain that has persisted beyond the expected period of recovery, for example, complex regional pain syndrome (CRPS), musculoskeletal pain, and persistent post-operative pain.

Ordinary pain is what you feel when normally functioning nerves send messages from injured or inflamed tissues, for example pain from an operation. It usually gets better quite quickly. Sometimes pain can last longer if tissues continue to be injured or inflamed. For instance, arthritis produces long-lasting ordinary pain, as there is repeated inflammation in the joints. Ordinary pain usually responds well to medicines.

Chronic pain lasts longer and generally, does not respond well to medicines. It is caused by abnormal messages being sent by the nerves, even when the tissue injury has healed. The brain continues to interpret these messages as painful. Sometimes the pain may have begun following a specific event such as an injury or viral illness, and sometimes no obvious cause for the pain can be identified. That does not mean that your child is making their pain up – they are experiencing real pain!

The symptoms can be very varied and unusual and may be described as burning, tingling, shooting or a numb sensation. Other sensations, such as extreme sensitivity to touch, heat, cold, and temperature and colour changes are all common and part of the body’s way of reacting to and coping with chronic pain.

A child may have reacted to the pain by not moving the painful area and doing less physical activity, which may have lead to reduced muscle strength and stamina, and increased feelings of frustration and hopelessness.

Diagnosis is made on the basis of the history of the child’s pain and clinical examination carried out by a doctor. The child may have already been seen by a number of medical teams and had tests and investigations to rule out other non-chronic pain conditions that may require treatment such as an operation or medicines.

However, children can have chronic pain alongside other conditions. The consultant managing the child’s condition may make a referral for chronic pain management if further help is required.

It has been estimated that up to about one in every 10 children may experience chronic pain at some time or another.

Stress, tiredness, diet and general health can all affect how bad the pain is. Pain is harder to cope with if you are tired, depressed, anxious or having problems at school or home. As there are lots of factors involved, the treatment of chronic pain often includes much more than simply taking medication. In fact medicines may not be very helpful.

Treatments such as exercises to get the muscles and joints moving again (with a physiotherapist) learning coping strategies (with a psychologist) and occasionally taking medication, are some of the possible options for making the pain more manageable.

Input from therapists in the child’s local community is sometimes beneficial, and especially if treatment is going to last a long time.

Getting better can take time and requires lots of effort from parents and their child. There are no quick solutions and we realise that this can be frustrating for families at times. Our emphasis is on treatment options that improve the child’s ability to cope with the pain and have a normal quality of life, including getting back to full-time schooling, carrying on with hobbies and keeping up with families and friends.