Children and Pain
Psychology and CRPS
In pain disorders such as complex regional pain syndrome Type I and recurrent abdominal pain disorders, there are complex relationships between the body and the mind that can influence the child's level of pain. Often, children with these types of disorders struggle with the fact that their symptoms cannot be seen by others and thus often are not "believed" to be real. This experience is very frustrating for children and can contribute to feelings of isolation and sadness. Negative emotions such as anxiety, sadness and frustration can increase pain perception. In this way, a vicious cycle develops between pain and negative emotions.
Psychologists work with children and adolescents with neuropathic pain and recurrent abdominal pain to help them feel more in control of their situations and to help them manage the negative emotions that become part of the pain cycle. They work with these children and adolescents to help them play a more central role in managing their pain and functioning with pain, rather than waiting for doctors to find something that will make the pain go away. Some techniques that are used for these pediatric pain syndromes include:
Psychologists work with children and adolescents with neuropathic pain and recurrent abdominal pain to help them feel more in control of their situations and to help them manage the negative emotions that become part of the pain cycle. They work with these children and adolescents to help them play a more central role in managing their pain and functioning with pain, rather than waiting for doctors to find something that will make the pain go away. Some techniques that are used for these pediatric pain syndromes include:
- Relaxation/self-hypnosis – There are a number of behavioral and cognitive-behavioral strategies that are classified as relaxation techniques. Children initially work with a psychologist or other trained professional to learn such techniques, but once they have mastered these skills, children can use them on their own to help reduce or prevent painful episodes.
- Deep Breathing – Slow, deep breathing can promote generalized relaxation, which can help to dilate constricted blood vessels and reduce muscle tension that contributes to headache pain.
- Progressive Muscle Relaxation – Typically these techniques involve tensing and then releasing large muscle groups throughout the body to heighten awareness of the tension-free state. Children can improve their ability to recognize and reduce muscle tension.
- Guided Imagery – Imagery is a cognitive (i.e., brain-based) technique in which children are coached to imagine a pleasant or happy scene that is inconsistent with feelings of tension and pain. The person guiding the imagery encourages the child to use all his or her senses to develop a vivid image involving sights, sounds, tastes, smells and other sensations. Imagery has been shown not only to distract the child from pain but also to reduce the perception of pain by eliciting descending signals from the brain that can help to block pain signals.
- Self-Hypnosis – Hypnosis is a narrowing of attention or consciousness that can counteract stress and pain. In self-hypnosis, the child learns to focus concentration and reduce energy expenditure. Deep breathing, muscle relaxation, and often imagery are incorporated into this self-guided relaxation technique.
- Cognitive interventions – These are approaches that can be used with children and parents. Generally, cognitive interventions include techniques aimed at helping the child regain the ability to function in his or her daily life. Such techniques involve identifying and changing pain-related behaviors that have developed over time. This can be done by altering how certain behaviors are reinforced at home and school, providing rewards for behaviors that increase functioning, and teaching children self-monitoring strategies to track their own thoughts and feelings related to their pain.