Last update: 24 September, 2020
Pain is such an individual and complex experience that the presence of the right attention and communication with the patient is essential in order to satisfy their needs. However, in the case of chronic childhood pain communication is often impossible because children do not know the words to explain it. They only know the cry. That is why we can say that, during the XNUMXth century, chronic childhood pain was too often forgotten by modern medicine and psychology.
Fino in the mid-50s, children were believed to have lower pain sensitivity than adults. This statement was accepted by the community and had serious consequences: in many hospitals, surgeries were performed on children under the age of two without the use of any type of anesthesia or with minimal anesthesia.
Even if they cannot put it into words, a child or infant feels pain like an adult.
Tools for measuring chronic childhood pain
Currently, in medicine and psychology, it is recognized that chronic childhood pain has the same characteristics as chronic adult pain and, therefore, it is believed that it should be given the same importance. In other words, we speak of chronic childhood pain when it lasts for 6 months or more, whether it has a clear physiological cause or not.
The problem lies in the absence until not so long ago of protocols or tools to measure pain chronic childhood, because in general they resorted to adaptations of the tools designed for adults. Fortunately, the situation is changing and clinical psychology plays a fundamental role in this change.
From projective techniques to those of recognition and emotional expression, expression and the recognition of chronic childhood pain begins to spread, to be studied and treated. Pain is no longer seen as a simple unimportant complaint or a simulation process to try to get parental attention.
Drawings, faces or colors, rather than terms referring to pain in the adult world, are the most useful and most used means to help children recognize, express and control chronic pain.
When we talk about infants or children under 3 or 4 who do not yet have sufficient linguistic or cognitive development to convey their pain in words or drawings, we are mainly based on behavioral profile relationships and physiological variables. With older children and adolescents, self-relationships of various kinds are used; among them the most used are:
- Pain thermometer: usually numbered from 0 to 10, where 0 represents "no pain" and 10 "worst pain possible". The child emphasizes the intensity of his pain by coloring the mercury bar of the corresponding thermometer.
- Eland's play of colors: is a color scale in which children choose one of eight colors that correspond to the different pain intensities, from total absence of pain to acute pain.
- Nine Face Scale: used from 5 years of age. Nine faces of which four represent different intensities of positive affect, four of negative affect and one neutral. The child chooses the face that most closely resembles the pain he is experiencing at that moment.
- Pediatric Pain Questionnaire: used with older children or adolescents, collects 8 questions directly related to pain.
- Pain Diary: self-written report in personal diary format that includes a response scale ranging from 0 "no pain" to 5 "very severe pain", along with the question: "How much pain are you in now?". Pain is assessed twice daily during the post-surgical period.
Psychological treatment of chronic childhood pain
When we talk about the treatment of chronic childhood pain, we come across an alarming reality, as most drugs do not have pediatric indications. This is why particular emphasis is being placed on multidisciplinary treatment of pain in children.
Clinical psychology has contributed by adopting a series of cognitive-behavioral techniques considered effective and efficient for children over the age of 7 and with very promising results in younger children. Treatment, in general, depends on the type of pain and the analysis performed. In this sense, some of the most used techniques are:
- Biofeedback training: mainly used for tension, functional or migraine headaches. It consists in controlling a physiological signal of voltage or temperature within certain parameters.
- Relaxation techniques: deep breathing or muscle relaxation. Very effective in children because it reduces the activation of the organism caused by pain.
- Mindfulness: the few published studies indicate significant improvements in variables such as the intensity and frequency of pain episodes, as well as in physical and psychological functioning.
- Hypnosis: the psychotherapeutic goal is usually aimed at controlling physiological responses, managing attention and cognitive aspects related to the perception of pain or strengthening coping strategies.
- viewing: it involves using mental images or internal representations to modulate the painful experience and, therefore, produce an analgesic effect.
- Distraction: because it has been shown that focusing attention on a painful stimulus increases the sensation of pain.
- Contingency control: Through the functional analysis of the subject, an attempt is made to reorganize the environment to facilitate adequate and proportionate behavior to situations of pain, avoiding reinforcing or rewarding unbalanced situations.
Despite all these advances and the proven efficacy of psychological treatment of childhood pain, this remains scarce. Multidisciplinary progress and increased studies in this area are the future against the fight against chronic childhood pain.
