Chronic Pain

Definition

Chronic pain is pain that lasts beyond 3

months, or pain that persists beyond
normal expected time for tissue healing

Musculoske
letal pain

Cancer pain

Juvenile
fibromyalgi
a syndrome

Juvenile
idiopathic
arthritis

Complex
regional
pain
syndrome

Physical
function

School
participati
on

Social
interaction

Pai
n

Psychologi
cal
function

Family life

Terminology
Nocicepti
ve pain

Neuropat
hic pain

Hyperalgesia increased pain from a painful stimulus

Allodynia pain from a stimulus that is usually not painful
Sensitization - central/peripheral

Acute nociceptive pain

Acute
tissue
injury

Activation
of
nociceptor
s
Signal
transmissi
on by
nociceptive
pathways

Sensitisati
on of
nociceptive
pathways

Central
nervous
system
sensitisatio
n

Augmented
,
persistent,
widesprea
d
inflammat
ory pain

Models of pain
Biomedical model

Cognitive behavioural model

Biopsychosocial model

Cognitive-behavioural model
Pain

Functional
limitations
Maladaptive
beliefs/behav
iours

Distress

Biopsychosocial model

Gatchel, 2004

Biopsychosocial model

Children are not small adults

Predictors of pain
Maladaptive coping mechanisms
Catastrophizing
Anxiety
Depression
Perceived failure

Parental response to pain

Parental coping/psychological distress
Family relationships
Family pain history

Poor sleep hygiene

What we currently know

Psychological stress is associated with pain depression/anxiety/behavioural
problems
Family plays a part if parents/relatives have chronic pain serve as a model
Gender differences become apparent around puberty teenage girls more
affected ~50%
Pain prevalence increases with age

Pain Assessment

Pain assessment
Evaluate primary sources of pain
Comprehensive history - Psychological factors
- Family
- School environment
- Culture

Infant

5-7 years

Chronic pain
management

Management
Child-focused
Holistic
Optimise biological impairments treat the physical source of pain (if any)
Resolve any underlying psychological contributors to pain/pain-related
disability
Improve function

Non-pharmacological Strategies
Physiotherapy
Cognitive behavioural therapy
Mindfulness
Distraction
Guided imagery
Relaxation training
Hypnosis
Biofeedback

Cognitive Behavioural Therapy

interventions that apply psychological
principles to change the overt
behaviour, thoughts, or feelings of
persons with chronic pain

McCracken & Turk (2002

Cognitive Behavioural Therapy

Goal setting
Behavioural
management

CBT

Problem solving
skills

Pacing
strategies
Distraction

Cognitive
restructuring
techniques

Relaxation

Guided imagery

Mindfulness
the awareness that emerges through paying
attention on purpose, in the present moment, and
non-judgmentally to the unfolding of experiences
moment by moment

(Kabat-Zinn, 2003, p. 145).

Graded
activity

Relaxatio
n

Exercise
therapy

Physiother
Physiother
apy
apy

Problem
solving
strategies

Distractio
n

Desensitiza
Desensitiza
tion