One of the few certainties in parenting is that when your child is in pain, you hurt too. When a child has long-lasting pain, families can feel helpless. Fortunately, researchers have identified cognitive behavioral therapy as an effective way to help kids cope with chronic painful health conditions.
Here, Natoshia Cunningham explains how common chronic pain is for youth and how a proven approach can help more kids receive pain treatment — such as those in areas like rural communities that are without access to pediatric behavioral health providers. Cunningham is a clinical psychologist and associate professor in the Michigan State University Department of Family Medicine at the MSU College of Human Medicine.
Cunningham provides more detail on treating children’s chronic pain in this article published by The Conversation.
How common is chronic pain in children?
About 25% of children experience chronic pain. It shows up in young people in the same ways painful conditions affect adults: joint pain, headaches, stomach aches and fibromyalgia. Kids’ pain may also result from conditions such as lupus, sickle cell disease, arthritis, inflammatory bowel diseases and severe neurological impairments.
Pain is considered chronic when it lasts at least three months. However, it’s not the same as growing pains and there are risks when chronic pain goes untreated.
Children experiencing painful symptoms miss about one in five school days, so their academic performance suffers. They’re also less likely to graduate from high school. Many kids with chronic pain are affected by anxiety and depression, adding mental health challenges to their physicalchallenges. Also, research shows that later, as adults, people who experienced chronic pain in childhood are at increased risk for misuse of opioids.
Where can kids with chronic pain get help?
School nurses, who are often a child’s first point of contact for health care, may be in an ideal position to help. Although school nurses are not traditionally trained in cognitive behavioral approaches for pain, they are primarily responsible for the management of pain in youth.
Several years ago, I worked with colleagues and community health experts including school-based mental health professionals to teach kids cognitive behavioral strategies they can use to manage chronic pain. We’ve trained nearly 100 school nurses, social workers and counselors so far. They report that the kids who learn cognitive behavioral strategies, like problem-solving, deep breathing and challenging negative thoughts, have fewer pain symptoms and missed days of school.
This success suggests that we can reduce barriers to care for children with chronic pain — especially for those who live far from major medical centers or do not have health insurance — by training more school nurses.
How do school nurses use cognitive behavioral therapy with kids experiencing pain?
Nurses first teach kids how pain works in the brain. Then they equip kids with tools like relaxation techniques for deep breathing and ways to challenge negative thoughts about pain. Another element of the program is teaching kids how to pace their activities so they can avoid pain flares.
It makes sense that learning coping skills to alleviate chronic pain has longer-lasting effects than medicines that wear off in a few hours. Cognitive behavioral strategies for pain management allow the kids to get back to their daily lives. Another benefit to this approach is that it also helps reduce the anxiety and depression that often accompany pain syndromes.
How can this solution be offered to more kids?
More kids can benefit if we expand training for health professionals working in schools. HELP PAIN, our eight-hour training program, teaches school nurses and social workers evidence-based strategies that help kids manage chronic pain.
School nurses aren’t typically trained in non-pharmacological pediatric pain management strategies. We can close this gap. The HELP PAIN pilot succeeded through collaboration with the Northwest Michigan Health Department, the Michigan Association of School Nurses and local school partners. It’s a model that can be replicated by other organizations that want to support school-aged kids with chronic pain.
We are now launching a new program in partnership with the Michigan Department of Health and Human Services, the Michigan Association of School Nurses and MI Cares, called PURSUIT. This program expands our prior work by offering broad training in cognitive behavioral strategies for a variety of health/mental health concerns. Additional training to address childhood trauma and reduce the risk of substance use in youth is included. This project will reach a broad number of health care professionals and mental health professionals who serve children in schools across Michigan.