Child & Family Development Child & Family Development

January 12, 2016

Physical therapy and chronic pain in children and teens

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Erin Harkins DPT ATRIC is a physical therapist at Child and Family Development and helps children and teens with chronic pain and complex regional pain syndrome.   

Pain in Children and Teens

Pain in children is a complex situation.  Due to nervous systems and musculoskeletal systems that are still developing, children‚Äôs and teens‚Äô perception of pain is much different from that of adults.  They are unable to differentiate types of pain ‚Äì sharp, dull, and intensity.  This makes treating pain very challenging in children.  While some types of pain are straight forward, post-injury for example, there are many other types of pain that require a ‚Äúlittle more digging‚Äù from the therapist.  These include pain resultant from migraines, pain after a virus, pain after surgery, fibromyalgia, Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy). 

What is chronic pain?

The simple description of chronic pain is pain that lasts for a long period of time.  Seeing a child in pain is one of the most difficult things a caregiver can experience.  Pain related to an acute injury is not uncommon and a pain response in relation to the level of injury is typical.  Pain becomes more concerning when the response of pain to the level of injury is amplified, the pain is longer lasting than expected, and/or the amount of pain the child is experiencing severely limits aspects of his/her daily life. 

What happens when a seemingly minor injury turns into long lasting, extreme pain for a child?  

When a child has a relatively minor injury, such as a sprained ankle or wrist, a regimen of rest, ice, splinting or casting, gentle range of motion and time are usually recommended as the area heals. However, sometimes the pain seems to get worse instead of better. Further x-rays or testing can reveal that the original injury has healed and there is no obvious cause for the continued, intense pain. A possible explanation for families and medical professionals to investigate is Complex Regional Pain Syndrome (CRPS).  The most important piece to remember is that even though in x-rays and imaging there appears to ‚Äúbe nothing wrong‚Äù ‚Äì the body is reacting in an acute level of distress.  CRPS impacts both the neurological and muscular systems and the body reacts as if there is an acute injury, with the cardiovascular system as well.  Often the child is reluctant to use the injured area, for example, a child may not weight bear on an ankle.  In addition, the child is often very sensitive to touch, not being able to tolerate a sock on the injured ankle or even submerge the injured area into water.  As the syndrome progresses, it is not uncommon to see atrophy of muscles, hair growth, and reddened skin.

What can be done?

Elusive pain disorders can be very upsetting for families and often the child and family feel like there is no end in site.  Doctors may say that there is no musculoskeletal reason for the pain, pain specialists offer various techniques to alleviate the pain, and often the child gets lost in the shuffle.  At the young age of these children, being on pain patches or pain pills indefinitely is not a good answer.  Advance for Physical Therapy and Rehab Medicine published an article, Within Reach, that discusses CRPS as difficult to diagnose, however provides evidence of improvements in patient’s pain level with combinations of education, physical therapy, and other strategies. Treatment strategies for CRPS involve changing pain pathways and messages that the brain sends long after the original injury has healed.  Dependent upon the unique situation of each child, physical therapy may be supplemented with counseling to maximize treatment intervention and allow for faster healing.

Next Steps

Contact a physical therapist at Child and Family Development to discuss your child’s case more specifically and the resources available to help your child get back to their healthy, happy self.  You will be amazed at the ability to retrain the brain and body! 

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