Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Growing Pains

Is psychopathology the often-denied nidus of chronic pain?

Researchers and clinicians are forever searching for the reasons for chronic pain. Is it something with its origins in the neurobiology of a given sufferer? Is psychopathology the often-denied nidus of chronic pain? Or does chronic pain grow up with the individual—actually, the child?

A study published in the journal “Spine” in 1995 found that lower back pain in 14-year-old children foretold chronic low back, disability and hospitalization by the time they were 40-year-old adults. Another study, published in 2007 in “Arthritis and Rheumatism,” concluded that pain symptoms of seven-year-old children increased the risk of chronic diffuse pain when these individuals reached middle age.

However, the study of children’s pain is encumbered by the moving target of child development: how a child experiences and describes pain at age six is quite different compared to the pain experiences and the self-reported description of the pain by a teen-ager.

But studies of pain in children can be challenging, as such non-therapeutic research raises all sorts of ethical concerns: The absence of direct benefit can be problematic when trying to have a study approved by the local ethics board.

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Still, the health care world has come a long way in recognizing the special needs of the pediatric pain population. It was only three or four decades ago when it was generally believed that children actually did not experience pain. Or, even more interesting, for quite some time it was believed that children were more tolerant of pain compared to adults. This myth also has fallen by the wayside, as research is showing that children lack the adult ability to modulate the pain at the level of the central nervous system; it may be that children suffer more when it comes to dealing with chronic pain.

Everyone, children and adults alike, can benefit from the study of children and chronic pain. What is it that triggers the chronic pain? Once we master the answer to that question, then maybe the research community can focus their efforts on stopping the chronic pain.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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