Chronic or persistent pain

Chronic or persistent pain

The presence of pain can affect all aspects of a child or young person's life and have a big impact on their family/whānau.

Understanding Pain

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Video transcript.

Key points to remember

  • chronic or persistent pain is long-lasting pain (it lasts beyond the normal time of healing)
  • it can be continuous pain (goes on without interruption) or recurrent pain (comes and goes repeatedly)
  • pain is usually considered chronic if it lasts 3 months or more
  • the presence of pain can affect all aspects of a child or young person's life
  • a child or young person's pain can also have a big impact on their family/whānau
  • many professionals may be involved in the assessment or treatment of your child or young person's pain

What is chronic or persistent pain?

Chronic or persistent pain is either continuous or recurrent pain that lasts beyond the normal time of healing. Pain which lasts longer than 3 months is usually considered chronic.

What causes chronic or persistent pain?

There are 3 main causes of chronic pain:

  • tissue damage from an ongoing condition or disease (such as arthritis), or
  • nerve damage, or
  • an altered, sensitised nervous system

Persistent pain is often misunderstood, as the pain system is complex with many pathways in the brain affecting how pain feels. Both physical and emotional stress has an impact on pain through the stress systems of the body. 

How does pain affect a child or young person?

The presence of pain can affect all aspects of a child or young person's life. It can result in them feeling more anxious or distressed, especially if the pain has been present for some time.  Pain can affect a child's mood, concentration, school attendance, sleep and ability to exercise. These factors can make pain worse and create a vicious cycle. A child or young person's pain can also have a big impact on their family/whānau.

Who may be involved in assessment and treatment?

Due to the variety of factors that can cause and worsen pain, there may be many professionals involved in the assessment or treatment of pain, including:

  • family doctors (GPs)
  • paediatricians
  • specialist nurses
  • pain specialist doctors
  • psychologists
  • psychiatrists
  • social workers
  • physiotherapists
  • occupational therapists

What is the treatment?

An assessment is the first step and can take place at a clinic or within a hospital. Further assessments may be necessary to review your child or young person's progress.

Some children or young people are referred to specialist services that can provide more support with chronic pain. They use something called a 'graduated rehabilitation approach' which focuses on 3 areas:

Physical and occupational therapy:

To decrease the pain sensitivity (including at the painful area, within the spinal cord and in the brain), increase fitness and strength (inactivity is the enemy), and help your child or young person return to normal activities such as school and hobbies.

Psychological support:

To help your child or young person cope with the stress of experiencing persistent pain, teach pain management techniques, improve sleep, reduce stress and return to a balanced lifestyle.  This may include the recommendation of relaxation aids/apps such as those listed below.

Medication:

To help reduce pain (often by reducing pain sensitivity), improve sleep and sometimes to improve low mood. Medication, by itself, is not often the whole answer. Overall, medication aims to support participation in physical and psychological therapy.

Treatment usually takes place in the community. This means your child goes to appointments where a rehabilitation plan is developed that you and your young person/tamariki can follow at home and at school. 

Most children will recover with this approach but occasionally, if progress cannot be made, then your child may need to go back to hospital.  A residential rehabilitation centre may be necessary for more intensive assessment and pain management.

Developed by the Paediatric Society of New Zealand 'Pain in Children and Adolescents' Special Interest Group and the New Zealand Pain Society 'Pain in Childhood' Special Interest Group.

This page last reviewed 11 December 2014.
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