Psychology and pediatric pain
At Boston Children's Hospital, we're well aware that pain is both a physical and a psychological experience. Because the brain plays such a central role in the pain process, interventions (e.g., counseling, relaxation techniques) that target a child's thoughts or feelings related to pain often are effective.
When a physician recommends psychological treatment for families of children with pain, some families feel that their doctor is telling them that the pain is "all in their heads" or that the child is crazy—this is not the case. Psychologists, especially those who specialize in treating pain problems, can provide a number of important services to the child with pain.
Self-management techniques for pain
These include relaxation strategies such as deep breathing exercises, muscle relaxation, guided imagery, and biofeedback. Relaxation techniques can give a child an increased sense of control over his/her pain. This can help to reduce pain levels. With less pain, the child is able to function better.
Self-management techniques can also include cognitive skills such as "thought stopping" or "reframing," which can help children fend off some of the negative thoughts and feelings that often arise as a consequence of living with pain.
Evaluation and Treatment for Pain-Related Disability
There are a number of ways in which psychologists can help work toward reducing the level of functional disability that the child with pain experiences. The psychologist may help parents examine their patterns of responding to their child's pain. They can then suggest ways in which responding differently might help both child and parents to deal with the situation. The psychologist can work with school personnel to find ways of helping a child with pain function in the school environment. Helping children identify their coping skills and create self-reliance through adaptive coping techniques (e.g., problem-focused coping) are other avenues that pain psychologists may pursue when working with children with chronic pain.
Evaluation and treatment for pain-related emotional difficulties
Although chronic pain is not necessarily caused by emotional difficulties, it is very common for children with chronic pain to experience sadness, frustration, anger, and anxiety in response to the challenges of living with pain. Because their symptoms are invisible and difficult to measure, peers, adults and even some health care professionals may question whether the pain is "real." Feeling misunderstood can give rise to experiences of depression and anxiety in the child and in parents who struggle to find explanations for their child's symptoms. Because the mind and the body are so strongly inter-related, emotional distress and pain can interact with and amplify one another so that pain becomes worse as the child's sadness or anxiety increases.
Psychologists can help the family and the rest of the treatment team understand the extent to which mood or anxiety may play a role in the child's pain problem. They can address these issues in hopes that altering mood or anxiety through cognitive-behavioral or family-centered interventions will help with the ultimate goals of reducing pain and increasing function.
Through comprehensive treatment programs that address the physical, psychological and the social/environmental aspects of pediatric chronic pain, children with chronic pain disorders can gain the tools they need to overcome the potentially disabling effects of chronic pain and continue to grow and develop in a supportive context.