Pain, Pain, Go Away!

Danielle Eaves Hernandez, CCLS, CTRS

9/20/2014

•Graduated from University of Florida in 2004 with a Bachelors of Science in Therapeutic Recreation.• She is dually certified as CCLS, CTRS and completed her internship at St. Joseph Children’s Hospital in Marshfield, WI. •Danielle has been with Community PedsCare since October 2008. •She was published in the August 2010 issue of Children’s Project on Palliative/Hospice Services.• Co-Presented the “Hospice Child Life Specialist” for the Child Life Council in November 2011.•Presented at the Pediatrics Bioethics Conference at University of North Florida in November 2012.•Presented at FACLP conference in September 2013.•Elected President-Elect of Florida Association of Child Life Professionals (FACLP) in 2013.

Objectives•Identify the different types of pain.•Review research and statistics regarding children in pain.•Discuss therapeutic interventions Child Life Specialists can provide.•Allow for discussion and hands-on participation of activities to incorporate with children who experience pain.

“Although the world is full of suffering, it is also full of the

overcoming of it.”

-Helen Keller-

Eye-openers

According to the American Pain Society:•Pain is a serious problem in one of every five children and adolescents in the United States.•Of U.S. children aged 5-17 years, 20% suffer chronic headaches.•Twenty percent of children complain of stomach pain at least three times a week for a period of at least three months at a time. •Juvenile arthritis (JA), one of the most common chronic diseases of childhood, affects as many as 200,000 to 300,000 U.S. children.•The prevalence of fibromyalgia in children has been estimated to be as high as 6% in school-age children.•Recent evidence suggests that a high percentage of children and adolescents with Asperger’s syndrome and autism spectrum disorders also have chronic pain.•In 2010, 1 of every 1,000 children will be a survivor of childhood cancer.•Each year, 1.5 million children have surgery, and many of them have inadequate pain relief. For about 20%, the pain becomes chronic.

Referenced in “Conquering Your Child’s Chronic Pain” by Dr. Zeltzer

•Generally divided into:•Acute (protective) pain•Recurrent pain•Chronic (often non-protective) pain

“A Child In Pain: What Health Professionals Can Do to Help” by Dr. Leora Kuttner

Pain

•Indicates an episode of tissues injury, potential tissue injury or inflammation.•Causes often include surgery, a burn, a fracture, or a cut.

Acute Pain

•The American Pain Society’s position state of children’s acute pain (2001) explains:•“Acute pain is one of the most common adverse stimuli experienced by children, occurring as a result of injury, illness and necessary medical procedures. It is associated with increased anxiety, avoidance, somatic systems, and increased parent distress. Despite the magnitude of effects that acute pain can have on a child, it is often inadequately assessed and treated.”

Acute Pain continued

•Pain that alternates with pain-free periods, during which there is commonly complete recovery with no residual pain or disability. •Common types include headaches, abdominal pain, irritable bowel syndrome, back pain and limb pain.

Recurrent Pain

•Far more common in children than chronic pain.•“Prevalence estimates of recurrent pain can range from one out of three young school children once a week.” (Petersen,Brulin & Bergstrom, 2006) to 45% of adolescents (Fitchel & Larsson, 2002)

Recurrent Pain

Chronic Pain

•Chronic pain has no apparent protective purpose and persists long beyond its initial useful, protective and informative function.•Neuropathic pain often results from damaged, abnormally functioning nerves. •Considered chronic when pain lasts longer than three to six months•Examples include rheumatoid arthritic pain, complex regional pain syndrome, hypersensitivity in a limb following trauma, and a disease causing pain such as Crohn’s disease.

Chronic Pain Continued•The American Pain Society’s position statement on chronic pain (2005) reads:•“Chronic pain is a significant problem in the pediatric population, conservatively estimated to affect 15% to 20% of children (Goodman & McGrath, 1991.)”

The ABCS of Pain1. Pain perception is regulated by the brain.

2. Pain is physical and psychological.3. Feelings and thoughts increase or decrease

pain.4. Memories can affect pain.5. The body has a natural pain control system.6. Pain can be controlled.7. Different types of pain react to different

treatments.

“Conquering Your Child’s Chronic Pain” by Dr. Lonnie Zeltzer

Common Child Life Interventions

•Procedural/ Surgical Support•Guided imagery•Deep breathing•Pain journals•Medical play •Distraction•Comfort positioning•Music•Active listening

Art Interventions to Help Children & Adolescents Process Pain

Pain Monsters

Pain People

Celebrity Pain Scale•Have children/teens select favorite and least favorite celebrities to categorize pain on a 1-5 scale.

•Can also customize with other categories- sports, animals, food, etc.

Dr. Jekyll & Mr. Hyde

Pain Jars

•Write fears or worst part about pain on strips of paper.

•Also can write positive coping techniques to help cope with pain.

•Can keep private or share.

Give Me Five

•Have child/teen trace hand and list five things about pain that they would like others to know.

•Decorate and discuss coping.

Works Cited

Fichtel, A., & Larsson, B. (2002). Psychosocial impact of headaches and comorbidity with other pains among Swedish school adolescents. Headache, 42, 766-775.Goodman,J. & McGrath, P. (1991). The epidemiology of pain in children and adolescents: A review. Pain, 46, 247-264. Kuttner, L. (2010). A child in pain: What health professionals can do to help. Bancyfelin: Crown House Publishing.Petersen, S., Bulin, C., & Bergstrom, E. (2006). Recurrent pain symptoms in young schoolchildren are often multiple. Pain, 121, 145-150. Zeltzer, L., & Schlank, C. (2005). Conquering your child's chronic pain: A pediatrician's guide for reclaiming a normal childhood. New York: HarperResource.

Contact Information

Danielle Eaves Hernandez, CCLS, CTRSCommunity PedsCare Certified Child Life SpecialistJacksonville, Florida (904) 874-7939Deaves@communityhospice.com