Mythbusters! Debunking Top 5 Myths of Pediatric Chronic Pain
Chronic pain in childhood or adolescence can be devastating and scary. It’s so mysterious, we can’t see it, and we might feel alone. We’ll seek out any advice or knowledge to help us make decisions about treatment.
Unfortunately, there are a lot of myths and misunderstandings about pediatric chronic pain that can lead to more frustration, and in some cases, more harm than good.
Here are 5 common myths about pediatric chronic pain, busted!
1) Pediatric chronic pain is rare
Can you believe that doctors used to believe that babies and young children did not experience pain? As any parent, or any human who has been a child can tell you, that is certainly not the case. I’m so grateful to live and work in a time when this myth has been thoroughly debunked.
But whispers of this myth remain. People still believe that children, teens, and young adults cannot experience chronic pain. At best, they think it’s really rare.
For a few decades, researchers have been asking the question of how common or prevalent pediatric chronic pain is. Just last year, a large group of researchers reviewed all of the current scientific literature (Chambers et al., 2024). They concluded that overall, around the world, over 20% of children and adolescents (anyone 19 years or younger) experience chronic pain. That’s one in five!
If you’re interested in knowing more details, the most common presentations of chronic pain were headache and musculoskeletal pain. In many types of pain, pain was more common in girls than boys, but this was not true for all types of pain.
Why do we think that pediatric chronic pain is less common than it really is? Chronic pain definitely affects everyone differently. For some people, the impact on their lives is high, and for others, the impact may be lower. Pain is also an “invisible illness,” so it may not be obvious to people who know or see them. That means there may be lots of other kids in your school who may be experiencing chronic pain, and you just don’t know it! Long story short, your family is definitely not alone.
2) Pain is either physical or psychological
In simple terms, we need two things to experience pain: a body, and a brain. Pain is actually a two-way communication between the brain and body. Therefore, ALL pain is physical, and ALL pain is psychological too!
The International Association for the Study of Pain defines pain as, “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” The very first thing their task force noted about the definition is, “Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.”
Hopefully, this knowledge helps reduce the stress of trying to figure out where the pain is coming from, ascribing blame, or feeling invalidated. It’s certainly possible that pain originated with a physical injury or personal stress, but what matters more is figuring out what factors are contributing or maintaining the pain now.
If you want to read more about this perspective, check out my post on the biopsychosocial model or this one on GI health.
3) Medication or surgery are the only options
One important realization of pain being influenced by biological, psychological, and social factors, is that you and your family have so many options when it comes to understanding and managing your child’s pain.
Your primary care physician or pain specialist should be able to guide you on whether medication or surgery are appropriate for your child’s treatment. For instance, some medications have really significant side effects. Surgery can not only be invasive, but if it’s focused on one part of the body, may not affect a more systemic or centrally-mediated pain mechanism.
Whether it’s in complement to medications or surgery, or as a first step, you have many additional, evidence-based choices to help your child manage their pain and regain their functioning.
The two types of treatment with the best scientific evidence are pain psychology and physical therapy. These have the best, most consistent outcomes for pain reduction and functional improvement (Fisher et al., 2022). Pain psychology can help with the “top-down” processes of helping the brain calm down the stress signals that also carry pain communications. Pain psychological can also help with the “bottom up” processes of relaxing the body together with the mind, and helping children stick with exercise and sleep recommendations. Physical therapy can help with the “bottom up” processes of desensitizing the body to pain and retraining the nervous system; it may also help “top down” processes by helping children and teens regain confidence in their bodies and selves.
If your child also struggles with fine motor tasks or allodynia, they may benefit from occupational therapy.
Other complementary or alternative treatments that have been helpful for some families include yoga therapy, aromatherapy, chiropractor, and massage. These have less scientific research and evidence to support them, so should be pursued based on personal interest, resources, and tolerance for “trial and error.”
4) Your child must rest as much as possible
It’s really easy to believe in this one. After all, it’s what we’re taught to do to care for acute pain, such as pain from a temporary injury or illness. In these cases, rest helps the body recover.
However, with chronic pain, the opposite is usually true. As counter-intuitive as it seems, more rest can actually sensitize the nervous system to more pain. The less we move, the more painful movement becomes.
Now, your child does not have to immediately go from couch to marathon running. In fact, chronic pain can be a helpful wake up call to the busy-ness and over scheduled nature of our daily lives. With the guidance of a physical therapist and pain psychologist, progressing movement and activities gradually and safely, adding in breaks, and learning to pace physical and cognitive activity can be the key.
5) It will be this way forever
If your child’s chronic pain has already been going on for a long time, it can start to feel like it will be this way forever. At this point, you may have already tried many different strategies, and it feels like nothing is changing, or even getting worse.
This mindset can certainly be demoralizing and lead to some hopeless thinking. Unfortunately, this mindset rarely makes things feel better.
Sadly, we know that about 1/3 of adults with chronic pain report that their pain began in childhood (Hassett et al., 2013). So it is true that some people do have a lifelong experience of pain. On the other hand, most of these adults, as children, did not have access to the up-to-date medical and psychological treatments we have today (for reference, the average age in this study was about 50 years old).
We definitely don’t need to veer into any toxic positivity, but there is good news to be found.
In fact, there are 3 trajectories that are most commonly found in pediatric chronic pain, some of which involved recovery, and some of which involved stability (Humberg et al., 2024). How can you know which pattern will happen for your child? There are some stable factors that predict which group they might be in, but also quite a few things that parents can do to promote the best outcomes for their children. A few of these strategies are outlined at the end of this blog post.
But you don’t have to go at it alone! Pain psychologists are here for you to help you navigate all of the information and choices you make for your child’s pain management, and help your child get on the road to recovery and thriving. If you think that your child or family can use some more personalized support, take the first easy step of clicking here to schedule a free consultation call.