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The Chronic Pain Clinic works collaboratively in a family-centred approach to manage chronic pain and its related symptoms. Chronic pain can have a large affect on many aspects of children and teen's lives. This includes many things such as: sleep, physical functioning (e.g. walking, participating in hobbies/sports), psychological functioning (e.g. depression, anxiety, frustration) and social functioning (e.g. attending school, seeing friends). Some children may become severely disabled and distressed when facing chronic and its challenges. Chronic pain is incredibly complex and often many factors contribute to its development and persistence. In turn, a comprehensive multidimensional treatment approach is crucial.  

Treatments suggested by the Chronic Pain Clinic always include the "three P's" of chronic pain management: 

Children and families receive individual treatment plans, determined based on the assessment preformed by the multidisciplinary team,  which will focus on these "three P's" to address the child or teen's pain and its effect on their well being and function.

Pharmacological Treatments

bottles of pills

Pharmacological treatments refer to medication used to relieve or help decrease pain. This can include:  pills, liquids, skin patches, creams, or injections. However, its important to note not all pain needs to be managed with medications and medications will be used differently with different children and teens. The type and amount of pain medications used will depend on: the type of pain, your weight, allergies, and any preexisting health condition. Sometimes more than one medication will be recommended and sometimes none at all. Pain-relieving medications are most effective when they are used together with physical and psychological therapies.

Some examples of pain medications include: acetaminophen, ibuprofen, amitriptyline, gabapentin and opioids such as morphine.

Goals of Pharmacological Treatment
In our clinic, the goal of medications to help children increase their function. In other words, the goal is that medications reduce a child’s level of pain so that they are able to go to school, be with their friends and do the physical activities they enjoy. Therefore, when the effectiveness of a medication is evaluated, we not only look at whether a child’s pain is reduced but if the child is able to resume a normal life.

Learn more about pain medications for children.

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Psychological Treatments  

pebbles in the sand

Sometimes pain can persist for a long time making it difficult to stay in school, be with friends and do things you enjoy. This can make people feel frustrated, angry, sad, or upset, which are normal reactions to pain and the impact it has on your life. However, these normal reaction to pain and its impact can actually make pain worse. In order cases, children can become understandably fearful of using or touching the painful area of their bodies. After a while, these efforts to protect the painful area can lead to worsening of pain and to other problems such as muscle deconditioning (weakening of muscles) because kids have stopped using their bodies normally. In these cases, Psychologists help children reduce their fear of pain and assist children in regaining their function. 

Psychological treatments, otherwise know as mind-body treatments, help people reduce pain by learning how to manage stress, relax tense muscles and distract from pain sensations. The goal of psychological treatments is to find strategies that will help you reduce your pain, reduce the control pain can have on your life and get you back to doing what you enjoy and give your life meaning. When psychological methods of pain management are suggested, it does not mean that the Team thinks your pain is “in your head” or imagined.  Psychological methods are one of the three essential approaches to pain management and are considered for all the patients we assess.

How do Psychologists help manage chronic pain?
By doing careful, individualized assessments, Psychologists help children and their families identify factors in their life that contribute to chronic pain. After specific factors are identified, Psychologists can help children and their families reduce these factors by teaching different pain and stress management techniques.

  • Psychologists help children harness the power of their minds to reduce pain.  Some common pain reduction strategies include physical techniques such as deep breathing and muscle relaxation and mind-based techniques such as reducing distressed thoughts and feelings.  
  • Psychologists help children learn motivational strategies to live a life less controlled by pain.
  • Psychologist support children by working with their schools and coaches with the goal of returning children to the activities they enjoy.

Examples of psychological treatments used to treat chronic pain:

Cognitive Behavioral Treatments
When pain persists for a long time, children and their parents can feel angry, frustrated, worried, and/or hopeless.  All of these feelings are triggered by thoughts that pass through our mind.  Examples of such thoughts include:  “my pain will never go away," “I will never be able to do the things I want” or “nothing helps my pain.”  A closer look reveals that these thoughts are not terribly helpful; they only make us feel worse. Often, these thoughts are not even accurate. For example, if kids really think about it, they often can find things that do help their pain. These are things like watching TV (it distracts them from their pain), cuddling with a pet, taking medications or using cold/hot packs. Cognitive behaviour therapy (CBT) helps kids recognize thoughts about their pain that only make them feel worse and then helps kids to change and reduce the power of these thoughts.  Clinical research shows that CBT is an effective treatment for chronic pain conditions.

Mindfulness Techniques for Pain Management
Mindfulness treatments teaches us to become more aware of our thoughts, emotions and physical sensations at the moment they occur without reacting out of habit or in automatic ways. Once we master this skill, we can make choices about how to respond to our experience  so we can enjoy life, even in difficult times.  Mindfulness approaches are based on learning to accept our experience and not react to it.  Through acceptance, people can cope with their pain in new and unexpected ways.

We currently offer a mindfulness group for pain management for adolescents from our clinic. If interested, please contact our clinic coordinator Susan Lawless at 416-813-6975

Learn more about mindfulness treatments with children.

Learn more about psychological treatments for pain management.
 

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Physical Treatments

physio room image

Having pain can make exercising or being active very difficult to do. Nevertheless, regular activity is one of the best ways to help manage most chronic pain conditions.

Research shows that exercise provides multiple benefits:  promotion of general fitness, improved mood, better sleep patterns, a healthy weight, as well as an overall reduction in pain scores. The recommended goal is daily participation in an activity (gradually over time) that increases your heart rate and makes you work your body (muscles, lungs, and heart) so that you feel better overall.

Physical treatments will include starting, or modifying existing, activity programs. This will also include the promotion of good posture in combination with breathing and relaxation routines. There are many other physical interventions that are used in conjunction with physical activity for the management of pain such as: activity pacing, massage, stretching, acupuncture, TENS (transcutaneous electrical nerve stimulation), and the use of heat and or cold just to mention a few.

Therapies that have the most benefit are the therapies that the patient becomes an active participant in so that they are engaged to put them to use at anytime with confidence  – such as deep breathing, positioning, self-massage, relaxation, TENS application, heat/cold application and activity pacing.

How do physiotherapists therapists (PTs) help with chronic pain?

  • PTs have extensive knowledge about pain and the body’s response to pain so they can help to reverse the effects of chronic pain. For example: pain can create tight muscles, these can be relaxed and stretched through deep breathing in combination with massage, stretches and posture correction.
  • PTs can provide treatment strategies to alter the body's response to pain through the use of modalities such as TENS.
  • PTs are specialists in the body’s motor system so they can help a weak and out of shape patient living with chronic pain move through a sequence of graded exercises to become better conditioned and physically active with an overall reduction in pain.

How to continue being physically active despite pain?

  • The combination of calming techniques, distraction, visualization and deep breathing exercises, along with gradually increasing the physical activities or "activity pacing" will assist in a return to functioning more normally despite having pain.

What are the different therapies available to manage chronic pain?

  • Massage
  • Manual therapy (hands-on techniques used by PTs to reduce pain)
  • Acupuncture
  • TENS
  • Heat/cold therapies
  • Graded exercise programs
  • Osteopathy and other holistic modalities

Not all of these therapies have evidenced based research to validate their use in chronic pain treatments.

Learn more about physical treatments for pain management.

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