This page has information to help you understand chronic pain. Families are encouraged to read the information together. You can find additional resources here. If you have further questions or concerns, please talk to your healthcare team.
What is chronic pain?
Everybody experiences pain related to injury or illness. This pain serves as a warning signal for the body to stop the harm and is called acute pain. Acute pain gets better and finally goes away when the injury heals, the illness resolves, or the symptoms of a chronic, long-standing disease become controlled.
Chronic pain is different and more complicated. Chronic pain is sometimes defined by how long the pain has been present, usually more than three months. It can affect the head, abdomen, joints, muscles, or the entire body.
Chronic pain often starts with an injury, surgery, or illness. Chronic pain may also occur without an injury or illness. In either case, the main feature of chronic pain is that the pain continues even though the injury to the body has healed. A chronic disease may be still present, but may not be solely responsible for the intensity of pain someone experiences anymore.
We consider chronic pain a disorder or illness itself when it causes a person to step back from daily life activities such as attending sports or school.
What causes chronic pain?
Researchers are working to help us to understand how chronic pain develops. Today, it is believed that just as biological, mental and social factors influence someone’s well-being, so do they influence their pain experience. Chronic pain may develop as a result of negative influences, called stressors or stress factors, working in combination. The so-called bio-psycho-social model of pain includes the stressors:
- Biological: injuries and illnesses; the way, the nervous system deals with pain signals
- Psychological: mood, emotions, the way someone can cope with social stressors, depression, anxiety.
- Social: stressful life events such as a death of a close person or break-up with a significant other, conflicts with family members or friends, learning difficulties, perfectionism, high pressure to succeed, overly full daily schedule, bullying, gossip and lack of support and connections in and outside school.
What are symptoms of chronic pain?
Along with pain in one or more areas of their body for a long time, many children and adolescents often experience one or more of the following symptoms:
- The body may be very sensitive to pain. Experience of pain can be caused by light touch and other non-painful stimuli such as clothes touching the skin.
- Poor sleep
- Daytime tiredness
- Low energy
- Poor appetite
- Mood changes: unusually quiet, frustrated, sad, depressed, anxious, worrisome, moody, irritable, angry,
- Relationships: low or no interest in friends, family or social activities
- Problems with school: focusing and concentration can be difficult. It can be challenging to keep up with school work or even to attend school.
Pain may cause these symptoms, but the symptoms also work together to make the pain worse. For instance, pain can make it difficult to sleep, and lack of sleep may increase the pain. Anxiety and depression may develop with pain but also make the pain worse. We know today that many children experience symptoms of anxiety or depression before developing chronic pain.
How is chronic pain diagnosed?
Chronic pain is usually diagnosed through a detailed history and physical exam. Healthcare providers who are experienced in making a diagnosis of chronic pain will ensure that all necessary tests have been done before they confirm such a diagnosis.
Despite having a diagnosis of chronic pain, patients and their families may feel frustrated over not knowing why the pain is there. Concerns may arise that a serious health problem has been missed. To be concerned is a common feeling. Patients should feel encouraged to talk about their feelings and concerns with their healthcare team. However, additional testing is usually not recommended once a diagnosis is made. Additional testing increases stress and leads to further frustration with each normal test result. At this point, tests won’t provide more information but will rather delay treatment and recovery.
How is chronic pain treated?
A bio-psycho-social approach is used to treat chronic pain, mirroring the stress factors that have contributed to the pain. This treatment consists of physical and psychological therapies.
The treatment of chronic pain requires teamwork. The patient and his/her family work together with their healthcare providers to create a treatment plan. Healthcare providers on the team may be a physician specialized in pain, a physiotherapist, an occupational therapist, a psychologist or psychiatrist, a nurse, and often a social worker.
Treatment goals commonly aim to improve daily functioning rather than to lessen the pain itself. The pain often begins to diminish once daily function has been restored.