For Physicians

The Center for Pediatric and Adolescent Pain Care (CPAPC) specializes in the care of any child or young adult from newborn and on who is suffering from chronic or recurrent headache, abdominal pain, back pain, joint pain, body pain, fatigue, nausea or behavioral problems. Whether their suffering is from common migraine, rheumatoid arthritis or is purely behavioral, the goal is to maximize their normal development and functioning and minimize their distress and medicalization. CPAPC is a consultative and therapeutic clinic which assists the patients' primary care and other subspecialty providers improve the child's quality of life.

"There are not that many kids with chronic pain are there?" "Oh, you are talking about kids with cancer." Children do have chronic pain, and it is more common than many other childhood illnesses. It has been estimated that when you combine significant chronic abdominal pain, body pain and headache 15 - 20 percent of children 9-18 years of age will be affected (Goodman & McGrath, 1991). This is pain that interferes with every aspect of their life and development. This pain causes missed schooldays, missed work for their parents, repeated doctors visits, and chronic stress all leading to profound suffering.

"It is just growing pains." "They just want to get out of school." No, their pain is real and has real consequences. Pain is defined as an unpleasant sensory and emotional experience associated with real or perceived tissue damage. Basically it is the feeling that something is very wrong inside you. There need not be actual tissue damage for pain to be real. The neural pathways for pain are relatively complicated with multiple nerve pathways to transmit pain to the brain and even more control pathways to try to inhibit that pain. This system does not always function properly. For children and adolescents going through the rapid neural remodeling of normal development the pain system can sometimes be derailed. Trauma, either physical or emotional, at the wrong time in an at risk individual can lead to a lifetime of suffering if not properly diagnosed and treated.

For these patients their pain and medical situation can be incredibly disabling. On measures of health related quality of life adolescents with fibromyalgia were found to have significantly more physical and emotional impairment that adolescents actively going through cancer treatment (Varni et al 2007). Pediatric pain does not only affect the patient but also the family. Mothers also report significantly lowered quality of life and family functioning (Mano et al 2009). Overall chronic pain can create a highly dysfunctional, highly distressed, relief seeking, and potentially over medicalized family system.

Assessment and treatment of pediatric chronic pain requires an understanding and appreciation of the biopsychosocial nature of the distress. Treatment must be based on an approach where the patient is treated as a whole individual living and growing in a family and societal system. The problem is multifactorial and the assessment and treatment must be multifactorial as well.

As a child's nervous system is still developing the overall goal of therapy is facilitate getting the child back on track as much as possible. This is accomplished through maximizing functioning. Using pharmacological, psychological, physical and complimentary therapies the child is assisted in regaining as much function as their disease will allow.

Depending on the duration and severity of the symptoms this multimodal therapy may take weeks to a few months to reach the desired goal. This goal is a child who is not missing school, content and not disabled by pain. This therapy decreases their pain's burden on their future development, on their parents well being and on the health care system as well. For patients and family that can stay on program the result are positive over 90% of the time. Without this type of intervention most of these children would suffer for months to years and some would have a lifetime of pain.

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Goodman, J.E., & McGrath, P.J. (1991). The epidemiology of pain in children and adolescents: A review. Pain, 46, 247-264.

Mano KE, Khan KA, Ladwig RJ, Weisman SJ (2009). The Impact of Pediatric Chronic Pain on Parents' Health-Related Quality of Life and Family Functioning: Reliability and Validity of the PedsQL 4.0 Family Impact Module. J Pediatr Psychol. 2009 Nov 10 [Epub ahead of print]

Varni JW, Burwinkle TM, Limbers CA, Szer IS (2007). The PedsQL as a patient-reported outcome in children and adolescents with fibromyalgia: an analysis of OMERACT domains. Health Qual Life Outcomes,12;5:9.