AN Borucki et al. JPGN 2024; 78:169–173. Terminology for discussing chronic pain: Using metaphors to educate families on chronic pediatric pain

This article provides a good review and practical advice regarding chronic pain which “affects 25% of all children in U.S.”

Defining pain: “Acute pain is protective pain, which is related to tissue damage that resolves with healing. Acute pain processes often respond to rest and treatments aimed at reducing inflammation. The problem is when acute pain treatments are applied to chronic pain. Chronic pain is not protective; it is due to functional dynamic changes at the level of the brain and spinal cord that are pronociceptive…When pain persists after the expected time for the tissue to be healed or infection to have cleared, the pain is considered chronic.”

Education on chronic pain: “Patients may also have felt their pain dismissed when medical workup returned as normal. When providers explain the neurobiology of pain, families can be validated that the pain IS real and that pain CAN exist without evidence of structural damage.”

Pain treatment:

• “There is little evidence to support the efficacy of medications within chronic pain treatment. A systematic review including over 1000 children with functional abdominal pain found very low evidence for the efficacy of antihistamines, antiemetics, serotonin agonists, buspirone, melatonin and concluded antispasmodics or antidepressants can be considered given their tolerability.”
• “Cognitive behavioral therapy has the most support in treatment of functional abdominal pain in children.”
• “Metaphors used to distinguish acute and chronic pain …[Alarm metaphor] :Pain is an experience with body, mind, and social factors produced by the brain. Pain is supposed to alert us of bodily harm. If this alarm does not shut off, we have chronic pain. Imagine that you’re in a building and the fire alarm goes off because there is afire. Once the fire is extinguished, then the alarm stops, just like as the body heals, pain goes away. This is acute pain. Now imagine that the fire alarm goes off, firefighters arrive, investigate, and then announce that fortunately there is no fire. But unfortunately, they cannot turn off the fire alarm because it’s broken—the alarm continues. This is chronic pain. With chronic pain, the wiring of the alarm system itself is malfunctioning. The system that detects the fire and then signals the danger is not working and, in fact, is sending a false alarm. This is your nervous system with chronic pain. It is detecting danger to your body and signaling pain when it should not be. Now normal everyday experiences, including thoughts, feelings, and sensations are being interpreted as pain.”
• Three-legged stool for resetting system: 1. Medical treatments, like certain medications, therapies like acupuncture, or procedures 2. Physical/occupational therapy which teaches us how to move more effectively with the pain we are experiencing 3. Psychological interventions like CBT.

My take: This article provides a good approach for addressing chronic pain.

Related blog posts:

• “Golden Half Hour in Chronic Pain”
• #NASPGHAN19 Postgraduate Course -part 3 This highlights a terrific lecture by Dr. Carlo DiLorenzo
• Implementing psychological therapies in Pediatric GI This blog post has links to numerous useful resources
• Prospective Pediatric Study of the Persistence and Progression of Recurrent Abdominal Pain | gutsandgrowth
• Carlo DiLorenzo: Lessons Learnt Over 30 Years