Chronic pain in children often goes untreated

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Monica Brown has had stomach aches ever since she was a little girl, but the pain that shot through her in Grade 8 one day was unlike anything she had felt before.

Chronic pain in children often goes untreated

Monica Brown has had stomach aches ever since she was a little girl, but the pain that shot through her in Grade 8 one day was unlike anything she had felt before.

"It felt like someone was ripping my insides out," she says. She couldn't stand. She couldn't sleep or eat. But none of the X-rays or CAT scans or upper gastrointestinal tests could find any sign of a diseased organ.

She missed so much school that the rumour was she was dead or had cancer. On the days the pain was bearable enough that she could make it to class the other kids teased, "Don't touch her! You could catch it."

The family's pediatrician in Lower Sackville, N.S., insisted there was nothing physically wrong. "Look at her," Monica's mother Margi remembers telling him. "She's not functioning."

"You're scared to death about what's being missed or that this could be her future with no hope down the road."

Studies suggest up to one-quarter of children have recurrent or chronic pain and that six to eight per cent of all children suffer pain that is frequent, intense and severe.

Yet, doctors are trained to look for the underlying disease, and see pain only as a symptom. But since many cases of chronic pain have no clear or treatable physical cause, doctors may see nothing to treat.

"Usually there's no X-ray, no blood test, no evidence that you can stand there and look at to explain what's going on," says Dr. Allen Finley, professor of anesthesiology and psychology at Dalhousie University in Halifax, and a member of the Canadian Pain Society. The coalition of doctors, scientists and other health professionals are gathering in Ottawa Wednesday for an annual conference whose theme is: Pain Relief: A Basic Human Right.

With no physical evidence to explain the pain, "it's often difficult for health professionals of all types to really feel comfortable about the patient's report of pain," Finley says.

In other words, they don't believe them.

Frustrated and distraught, parents move from doctor to doctor in search of a diagnosis - a fracture, a lesion - to somehow legitimize their child's agony.

"We had a doctor very early on who said the kid is just malingering, send him back to school," says Sharon Adams, whose son, Spencer Spearman, has been living with chronic head pain for four years. "If you put your palm right across your forehead, that's the size of it," says Adams. Spencer, 18, describes it as a huge pressure. "Not like a throbbing or piercing headache," his mother says. "It just feels like it's going to burst."

It started with a cold and a headache, but then Spencer got sicker and sicker. Eventually he was diagnosed with a sinus infection. But when the infection went away, the pain didn't.

"He's getting worse instead of better," his mother says.

The family still has no diagnosis.

According to the Canadian Pain Society, people in pain can wait two to five years for effective treatment.

According to a recent report in Pediatrics & Child Health, the journal of the Canadian Paediatric Society, children still too frequently receive no pain medication after surgery, or are given painkillers at too low a dose to have any effect. Some doctors are reluctant to use even gels or local anesthetics before painful needle procedures, thinking it's "just a little poke." This despite evidence that needle procedures, from vaccinations to IV line injections, hurt and that some kids are terrified of them.

Chronic pain in children can result from musculoskeletal pain such as fibromyalgia, injuries, headaches, migraines, cancer or other illnesses. Some children suffer neuropathic pain where the nerves don't function properly and end up firing off pain signals in situations that normally aren't painful - a light touch, a brush of the skin.

Monica Brown, now 16, couldn't focus when she felt the pain behind her belly button coming on. She would tell herself, "You can get through this, wait for the next period when you can go to the bathroom."

"The pain would go from one to 10 within five minutes," remembers Monica, now 16.

Since undergoing treatment at the multi-disciplinary pain clinic, "everything is great and new and different," Monica says.

"You feel, for the longest time, the no one feels this but you."

Organizations: Canadian Pain Society, Dalhousie University, Pediatrics & Child Health Canadian Paediatric Society

Geographic location: Lower Sackville, Halifax, Ottawa

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