Chronic Or Persistent Pain

Key points about chronic or persistent pain

• chronic or persistent pain is long-lasting pain (it lasts beyond the normal time of healing)
• it can be continuous pain (goes on without interruption) or recurrent pain (comes and goes repeatedly)
• pain is usually considered chronic if it lasts 3 months or more
• pain can affect all aspects of a child or young person's life
• a child or young person's pain can also have a big impact on their family and whānau

What is chronic or persistent pain?

Chronic or persistent pain is either continuous or recurrent pain that lasts beyond the normal time of healing. Pain that lasts longer than 3 months is usually considered chronic.

What causes chronic or persistent pain?

There are 3 main causes of chronic pain:

• tissue damage from an ongoing condition or disease (such as arthritis), or
• nerve damage, or
• an altered, sensitised nervous system

Persistent pain is often misunderstood, as the pain system is complex with many pathways in the brain affecting how pain is felt. Both physical and emotional stress has an impact on pain through the stress systems of the body. 

How does pain affect a child or young person?

Pain can affect all aspects of a child or young person's life. It can result in them feeling more anxious or distressed, especially if the pain has been present for some time.  Pain can affect a child's mood, concentration, school attendance, sleep and ability to exercise. These factors can make pain worse and create a vicious cycle. A child or young person's pain can also have a big impact on their family and whānau.

Who may be involved in the assessment and treatment of chronic or persistent pain?

Due to the variety of factors that can cause and worsen pain, there may be many healthcare providers involved in the assessment or treatment of pain, including:

• family doctors (GPs)
• paediatricians
• specialist nurses
• pain specialist doctors
• psychologists
• psychiatrists
• social workers
• physiotherapists
• occupational therapists

What is the treatment for chronic or persistent pain?

An assessment is the first step and can take place at a clinic or within a hospital. Further assessments may be necessary to review your child or young person's progress.

Specialist services can also provide more support for chronic pain. They use something called a 'graduated rehabilitation approach', which focuses on 3 areas.

Physical and occupational therapy

Physical and occupational therapy aims to decrease pain sensitivity (including at the painful area, within the spinal cord and in the brain). It also helps increase fitness and strength and can help your child or young person return to normal activities such as school and hobbies.

Psychological support

Psychological support can help your child or young person to:

• cope with the stress of experiencing persistent pain
• learn pain management techniques
• improve sleep
• reduce stress
• return to a balanced lifestyle

This may include the recommendation of relaxation aids and apps such as those listed below.

Medicines

Medicine, in some cases, can help reduce pain (often by reducing pain sensitivity). It can improve sleep and sometimes improve low mood. Medicine, by itself, is not often the whole answer. Overall, medicines aim to support participation in physical and psychological therapy.

Treatment usually takes place in the community. This means your child goes to appointments where they will receive a rehabilitation plan that your family can follow at home and school. 

Most tamariki will recover with this approach, but occasionally, if your child does not make progress they may need to go back to hospital.  A residential rehabilitation centre may be necessary for more intensive assessment and pain management.