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Hicks, M.D., vice-chairman of the Anesthesiology Institute in the pain management department at the Cleveland Clinic. Without coverage, treatment very quickly becomes expensive, placing a huge burden on families. “The industry gets surgery. It gets pills. But massage, hypnotherapy, yoga—it’s not there yet.”


How kids are different While non-drug therapies can be powerful pain re-


“Chronic pediatric pain violates our view of childhood as something that’s always carefree,” says psychologist and pain expert Patrick McGrath.


lievers for kids and adults alike, medication remains an important part of a pain-care plan in most cases. But managing aches in children can be tricky. While narcotic opiates—among the most widely used tools for fighting severe and chronic pain in adults—can be given to children for a short time after an acute injury like a broken bone, kids quickly develop a tolerance to these drugs, meaning they need more of the medication to achieve the same relief. Parents needn’t worry, though, about addiction. “Addiction is a psychological craving. For the majority of patients, opiates are not addictive,” explains Zelt- zer. “Children may need higher doses over time because they quickly build up a tolerance, but that’s not bad. That’s a normal physical reaction.” If your child does need medication, don’t be sur- prised if over-the-counter acetaminophen is the standard treatment, with intermittent use of non- steroidal anti-inflammatory (NSAIDs) medications like ibuprofen, says Jennifer Strickland, Pharm.D., B.C.P.S., founder/chief product officer at PlusDelta Technologies, in Raleigh-Durham, North Carolina. What’s most important is that your child finds relief that matches how much she hurts. “Treatment for kids is driven by the intensity of the pain,” says Strick- land, adding that for a child in serious pain, as with cancer or following surgery, morphine is “the gold standard.” Prescribing for children is made even more difficult by the fact that there are far fewer guidelines for doctors to follow. “Many analgesics have adult- only indications; they don’t come with pediatric indications,” Strickland explains. That’s largely be- cause it’s not easy to study drugs in kids; among other reasons, it can be hard to find parents willing to enroll their child in a trial. Another way children are different from grown-


ups is, they follow directions better, making it much more likely that a prescribed treatment, no matter what it is, will work. “Behavioral measures like bio- feedback and group therapy sessions are very effec- tive in children,” says Stanton-Hicks. “Their brains are open to suggestions. They believe you when you


60 PAIN RESOURCE FALL 2012


tell them, ‘Do this and you’ll get better.’ Adults have more doubts. If you say to an adult, ‘Stand in the corner on your head,’ they will question you, where- as the child will just do it and respond even better.” Because their nervous systems are still developing, kids may benefit faster from both behavioral and physical approaches than adults; if they are treated well and quickly they may get, and stay, well. All in all, the treatment picture for most kids with chron- ic pain is very bright. Pain that’s left untreated or undertreated, though, could continue to bother them. Kids also have you—their parent, a tireless support and champion. Remember that your love and atten- tion are invaluable. “Mom has always been an amaz- ing advocate for me,” says Jessica Mullin, a 20-year- old who was diagnosed with rheumatoid arthritis (RA) when she was six. When Mullin’s pediatrician told her mom that her daughter was just going through bad growing pains, her mother didn’t believe it and sought out another doctor, who discovered the RA. “Mom’s done a ton of research to help me find the right care,” adds Mullin. In a few cases, though, parental involvement can go a step too far. Most pain clinics now routinely screen kids and families for Pain-Associated Disability Syndrome (PADS), in which a child’s pain appears to be dispro- portionately severe. PADS may be a reaction to a situation in which a child is under pressure to be very high achieving, or even perfect, and/or a parent becomes overly involved in their child’s pain. “Psy- chologists call this enmeshment, when a father or mother is so caught up in a child’s pain that the parent’s attention to it becomes the source for main- taining that pain,” explains Stanton-Hicks. “A child needs to develop their own self-esteem and stand on their own, [but] they can’t do that if their parent is stuck to the child day and night,” he says.


On the horizon There’s a lot to be hopeful about when it comes to


treating a child dealing with serious pain, and doc- tors, patients and parents continue to come up with innovative approaches to improve diagnosis, treat- ment, awareness and support for families. Patrick McGrath is developing an iPhone application to help his tech-savvy teen patients manage their headaches. “When they feel pain they can click a button and get suggestions on how to ease that pain,” such as trying deep-breathing exercises, he explains. Lonnie Zeltzer started a mentoring group for her young patients at UCLA; both Haley Esparza and Georgia Huston are mentors to new patients. ”I felt so alone during this whole process,” Huston says. “My dad and other adults have been great, but (continued on page 62)


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