Pain is the commonest complaint children with rheumatic disease offer.
We should not forget that children can experience pain on a chronic basis. Joint pain is a leading cause of disability in children with arthritis, even after definitive treatment for the arthritis has been initiated. Pain limits the activities of children, disrupts their school attendance, and affects the emotions. Studies have shown that even the smallest decrease in the severity of pain can result in a significant increase in a child's sense of well-being.
Chronic pain in children with arthritis stems from a combination of biological phenomena, psychological factors, and the cultural milieu. Continuous pain can actually result in changes in the nervous system, which in turn can have an impact on potential future disability. The degree of active arthritis does not necessarily correlate with the amount of pain: other factors that play a role in pain include the child's age, ability to cope, level of development, mood, and levels of stress with which the child must deal.
It is the job of the physician to gain a thorough understanding of the nature of the pain the child experiences, and the impact the pain has on the child's life: How does this pain affect school work, play, interactions with others, sleep, etc.?
Unfortunately, guidelines on treating chronic pain in children with chronic arthritis are virtually non-existent. A majority of pediatricians prefer to not use opioids to treat the chronic pain; there is a persistent fear of addiction.
Nonsteroidal anti-inflammatory drugs are very popular in the treatment of children with arthritis. Tylenol, of course, can be used in combination with nonsteroidal anti-inflammatory drugs.
Behavioral therapy is an integral part of the management of chronic pain: the doctor strives to affect the regulation of pain perception by encouraging adaptive behavior and discouraging so-called "sick" behavior. The physician must also be willing to talk to family members and others who can shed light on the social context in which the young patient is experiencing his pain. It is also crucial to develop a sense of how a child's pain is impacting his family members and peers.
Chronic pain can be as disabling in children as it is in adults. Family members, friends, and physicians must learn how to deal with chronic pain and all its ramifications.
We will all feel better when this lesson is learned.