Chronic Pain

Last modified by Lisa Stromquist on 2017/09/15 21:20

UNDER CONSTRUCTION

Welcome to the Chronic Pain Toolkit. The goal of this resource is to bring together research evidence and products that support primary care clinicians to:

  • Learn about and better understand chronic pain in their clinical context (e.g. what it is, different types, biological basis, most frequent chronic pain conditions);
  • Be aware of red flags in chronic pain presentations and exacerbation of chronic pain;
  • Have access to assessment tools that are appropriate for chronic pain;
  • Understand appropriate referrals for this population and types of clinicians to consider referring to (e.g. general pediatrician, pediatric chronic pain clinic )
  • Have access to simple management strategies; and
  • Have contact information for chronic pain clinics across Canada.

Summary

As outlined by the American Pain Society 1, “chronic pain (defined as persistent and recurrent pain) is a significant problem in the pediatric population, conservatively estimated to affect 20% to 35% of children and adolescents around the world. The most common chronic pain conditions are musculoskeletal pain, headaches, and abdominal pain. Infants, children and adolescents may experience physical and psychological sequelae and their families may experience emotional and social consequences as a result of pain and associated disability. Childhood pain brings significant direct and indirect costs from healthcare utilization and lost wages due to taking time off work to care for the child. In addition, longitudinal studies provide convincing evidence to suggest that childhood chronic pain predisposes both for the continuation of pain and the development of new forms of chronic pain in adulthood.”

Contents

As you move through this Toolkit, begin with the Position Statement from the American Pain Society, it will inform your assessment and management of chronic pain in the children that you see in primary care. 

In this kit you’ll find:

  • American Pain Society – Position Statement on the Assessment and Management of Chronic Pain, outlines common chronic pain conditions in pediatrics and how to navigate assessing and managing chronic pain by making informed referrals and working with families to support their child.
  • Family resources that introduce chronic pain, assessment and management of chronic pain, living without a diagnosis and many helpful links to evidence-based chronic pain information sources from across the country. 
  • Clinician Resources to support chronic pain assessment, webinars, books, clinical practice guidelines and the Pediatric Pain Letter which provides free, open-access, peer-reviewed commentaries on pain in infants, children and adolescents. 
  • Educational PowerPoint presentations developed by your clinical colleagues to support education about chronic pain, creative ways to address chronic pain, chronic pain in the ER and the use of cognitive behavioural therapy in children with chronic pain. These slides can be modified and delivered for your needs and context but please acknowledge the original authors and the CAPHC Pain CoP for their contributions.
  • Videos explaining what chronic pain is, how to get it under control and how the brain and nervous system change with chronic pain; all which can be shared with families or health care providers.
  • Background articles  outlining the current best research evidence to support the assessment and management of chronic pain, many of which are open access.
  • Condition Specific Resources for clinicians that may wish to take a deeper dive into Complex Regional Pain Syndrome, Functional Abdominal Pain, Headaches, and Hypermobility Syndromes, background articles and other resources are provided. 

Please note, examples of guidelines, tools and resources are provided for reference purposes, only. We encourage all users of the toolkit who wish to adopt  similar practices at their institution to review, adapt, and modify the examples, as needed. The providers of these examples do not endorse their use outside of the institution for which it was originally created

If you have any comments, questions or additions for the kit, please contact CAPHC at info@caphc.org. 

Thank you for supporting the CAPHC Pain Community of Practice’s mission to to improve health outcomes for infants, children and adolescents by reducing pain experienced during medical procedures, healthcare interventions and chronic conditions. 

1. American Pain Society. (2012). Assessment and Management of Children with Chronic Pain: A Position Statement from the American Pain Society. Retrieved from: http://americanpainsociety.org/uploads/get-involved/pediatric-chronic-pain-statement.pdf

                                          
American Pain Society – Position StatementAmerican Pain Society. (2012). Assessment and Management of Children with Chronic Pain: A Position Statement from the American Pain Society. Retrieved from: http://americanpainsociety.org/uploads/get-involved/pediatric-chronic-pain-statement.pdf
  
Family Resources

Books

  • Palermo, M. T., & Law, F. E. (2015) Managing Your Child's Chronic Pain. Oxford, UK: Oxford University Press. 
  • McGrath, P. J.,  Finley, G. A., Ritchie, J., Dowden, S. J, (2003) First Edition 1994, Pain, Pain, Go Away: Helping Children With Pain (Please note that, as of 2013, Health Canada does NOT support the use of codeine in children <12 years of age)
 

Links

 About Kids Health Parent Resources (aboutkidshealth.ca)
 Brochures and Handouts
Chronic Pain Postcard - Holland Bloorview Kids Rehabilitation Hospital
My Pain Toolkit - For young people and teenagers living with pain (By Pete Moore and Jessica Bird 2014)
One Family's Story: Learning to Live with Chronic Pain (2016) ECHO (www.echo.ualberta.ca),  Stollery Childrens’ Hospital Foundation Women and Children’s Health Research Institute (WCHRI)
Living Without a Diagnosis Road map and navigation tools for families (Kelsey Lynch, Jennifer Thompson, and Millan Patel for the Rare Disease Foundation)
 Clinical Resources Clinical Practice Guidelines
Assessment and Management of Pain Third Edition, Registered Nurses Association of Ontario (RNAO) December 2013
Pain Assessment and Management Clinical Practice Guidelines (2012) Winnipeg Regional Health Authority 
 Family Engagement
Meaningful Family Engagement handout - Champions for Community Wellness
 Pediatric Pain Letter
http://childpain.org/ppl/ 

Pediatric Pain Letter
(PPL) provides free, open-access, peer-reviewed commentaries on pain in infants, children and adolescents. Book reviews and announcements of events related to pediatric pain are also accepted. Links are provided to Medline abstracts for articles cited or reviewed in PPL.   PPL was founded in 1996 by Patrick J McGrath and G Allen Finley, Centre for Pediatric Pain Research, Dalhousie University and IWK Health Centre, Halifax, Canada. It was transferred in 2008 to the Special Interest Group on Pain in Childhood, International Association for the Study of Pain, www.childpain.org. Carl L von Baeyer, PhD, served as editor for Vol. 7 through 15.

PPL is published online in February, June, and October.  Proposals for commentaries are welcomed by the editor: see For authors.
 Websites and online resources
Child Kind International
Chronic Pain Assessment Toolbox for Children with Disabilities   
Pain Resource Centre     
Sick Kids Online Pediatric Pain Curriculum        
 Paediatric Chronic Pain recommended texts and books for Healthcare Professionals

Oxford Textbook of Paediatric Pain Hardcover – Nov 15 2013 by Patrick J. McGrath (Editor), Bonnie J. Stevens (Editor), Suellen M. Walker (Editor), William T. Zempsky (Editor)

Managing Pain in Children 2nd ED (2014) Twycross, A., Dowden S., and Stinson J. (Eds) 
 Chronic Pain Webinars

Title and video link: Education, Expectation and Motivation: Vital Drivers For Change in Pediatric Chronic Pain
By: Canadian Institute for the Relief of Pain and Disability
Presenter:  Gillian Lauder, MB BCh, FRCA, FRCPC, CPE, Pediatric Anesthesiologist, Director Acute Pain Service, Pediatric Complex Pain Physician, BC Children's Hospital, Clinical Associate Professor, Faculty of Medicine, University of British Columbia

Title and video link: Return to Functioning in Children and Teens with Chronic Pain: The Role of Parents
By: Canadian Institute for the Relief of Pain and Disability
Presenters: Dr. Sue Bennett and Dr. Erin Moon, work in Medical Psychology at BC Children’s Hospital. Both take a family- centered, evidence-based approach to the care of children and youth with chronic pain and their families.

Title and video link: Kids get Chronic Pain Too: Assessment and Management of Paediatric Chronic Pain
By: Canadian Association for Paediatric Health Centres
Presenters: Jennifer Stinson RN PhD, Allen Finley MD, Bruce Dick PhD, Anne Ayling Campos PT
  
Canadian Paediatric Chronic Pain ClinicsAlberta
Stollery Children's Hospital (Edmonton)
Alberta Children’s Hospital

British Columbia
BC Children's Hospital                      

Saskatchewan
Saskatoon Heath Region

Ontario
Hospital for Sick Children (Sick Kids)  
Children's Hospital London Health Sciences Centre   
Children's Hospital of Eastern Ontario (CHEO)
McMaster Children’s Hospital:  
Holland Bloorview Kids Rehabilitation Hospital 
Quebec
CHU Sainte - Justine  
Montreal Children’s Hospital 

Nova Scotia
IWK Health Centre 
  
Educational PowerPointPediatric Chronic Pain - Pediatric Chronic Pain Program, Stollery Children’s Hospital, Edmonton AB
Chronic Pain in the Peds ER - Pediatric Chronic Pain Program, Stollery Children’s Hospital, Edmonton AB
Creative Approaches to Pain Neuroscience Education - Pediatric Chronic Pain Program, McMaster Children’s Hospital, Hamilton, Ontario
  
 VideosTitle: The Mystery of Chronic Pain
Developer: Elliot Krane, Pediatric anesthesiologist,  Lucile Packard Children's Hospital, Stanford
Link: https://www.ted.com/talks/elliot_krane_the_mystery_of_chronic_pain 
 Title: Chronic Pain 35
Developer: Edmonton’s Stollery Children’s Hospital, Alberta Distance Learning Centre
Link: https://www.adlc.ca/chronicpain/ 
 Title: How it works and how to get it under control!
Developer: Deutsches Kinderschmerzzentrum
Link: https://youtu.be/JrCdyuDsg6c 
 Title: What is Chronic Pain?
Developer: Pediatrics
Link: https://vimeo.com/162893676 
 Title: Brain and Nervous System Change
Developer: Pediatrics
Link: https://vimeo.com/162893705
 Title: Understanding Pain in less than 5 minutes, and what to do about it!
Developer: Live Active, NSW Government, Hunter New England Local Health District
Link: https://www.youtube.com/watch?v=C_3phB93rvI 
 Title: Understanding pain – and what’s to be done about it in 10 minutes!
Developer: German Pediatric Pain Centre
Link: http://www.deutsches-kinderschmerzzentrum.de/en/about-us/videos/video-understanding-pain/
 Title: Tame the Beast - It’s time to rethink persistent pain
Developer: Professor Lorimer Moseley, Professor of Clinical Neurosciences and Chair in Physiotherapy School of Health Sciences, University of South Australia
Link: https://vimeo.com/212350345 
  
Condition Specific ResourcesComplex Regional Pain Syndrome
Functional Abdominal Pain
Headaches
Hypermobility Syndromes
  
Background ArticlesChronic Pain Background Articles - Download and print PDF

Andreae MH, Andreae DA. Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD007105. DOI: 10.1002/14651858.CD007105.pub2.

Agoston, A M., Gray L S., Logan D E., (2016) Pain in School: Patterns of Pain-Related School Impairment among Adolescents with Primary Pain Conditions, Juvenile Idiopathic Arthritis Pain, and Pain-Free Peers, Children 2016, 3, 39; doi:10.3390/children3040039

Coakley, R., Schechter N.,(2013) Chronic pain is like… The clinical use of analogy and metaphor in the treatment of chronic pain in children, Pediatric Pain Letter, Vol. 15 No. 1

Coakley R., Wihak T., (2017) Evidence-Based Psychological Interventions for the Management of Pediatric Chronic Pain: New Directions in Research and Clinical Practice, Children 2017, 4, 9; doi:10.3390/children4020009

DiLorenzo M, Pillai Riddell R., Holsti L.,(2016) Beyond Acute Pain: Understanding Chronic Pain in Infancy, Children 2016, 3, 26; doi:10.3390/children3040026

Donnelly T J., Jaaniste T.,(2016)  Attachment and Chronic Pain in Children and Adolescents, Children 2016, 3, 21; doi:10.3390/children3040021

Fisher E., Palermo T M., (2016) Goal Pursuit in Youth with Chronic Pain, Children 2016, 3, 36; doi:10.3390/children3040036

Friedrichsdorf  S J., et al(2016)Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints, Children 2016, 3, 42; doi:10.3390/children3040042

Hauer J, Houtrow AJ, AAP SECTION ON HOSPICE AND PALLIATIVE MEDICINE, COUNCIL ON CHILDREN WITH DISABILITIES. Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System.Pediatrics. 2017;139(6):e20171002

Kingsnorth S., et al ,(2015)  Chronic Pain Assessment Tools for Cerebral Palsy: A Systematic Review, PEDIATRICS Volume 136, number 4,

Martin, A.E., Newlove-Delgado, T. V., Abbott, R. A., Bethel, A., Thompson-Coon, J., Whear, R.,& Logan, S. (2017). Pharmacological interventions for recurrent abdominal pain in childhood. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD010973. DOI: 10.1002/14651858.CD010973.pub2.

McKillop H N., Banex G A., (2016) A Broad Consideration of Risk Factors in Pediatric Chronic Pain: Where to Go from Here? Children 2016, 3, 38; doi:10.3390/children3040038

Miró J, Castarlenas E., de la Vega R., Roy R.,  Solé  E., Tomé-Pires C.,  Jensen M P., Psychological Neuromodulatory Treatments for Young People with Chronic Pain Children 2016, 3, 41; doi:10.3390/children3040041

Pediatric Chronic Pain Task Force: Palermo T.,Eccleston E., Goldschneider K, Larkin McGinn K., Sethna N., Schechter N.,Turner H.,(2012)  Assessment and Management of Children with Chronic Pain, A Position Statement from the American Pain Society

Pielech  M, Vowles  K E., Wicksell R., Acceptance and Commitment Therapy for Pediatric Chronic Pain: Theory and Application, Children 2017, 4, 10; doi:10.3390/children4020010

Reid K., Simmonds M., Verrier M., Dick B., Supporting Teens with Chronic Pain to Obtain High School Credits: Chronic Pain 35 in Alberta, Children 2016, 3, 31; doi:10.3390/children3040031

Robins H., Perron V., Heathcote L C., Simons L E., Pain Neuroscience Education: State of the Art and Application in Pediatrics, Children 2016, 3, 43; doi:10.3390/children3040043

Simons L E., Basch M C., (2015) State of the art in biobehavioral  approaches to the management of chronic pain in childhood. Pain Manag. (2016) 6(1)

Stahlschmidt L., Zernikow B., Wager J., Specialized Rehabilitation Programs for Children and Adolescents with Severe Disabling hronic Pain: Indications, Treatment and Outcomes, Children 2016, 3, 33; doi:10.3390/children3040033

Stinson, J., Connelly, M., Kamper, J. S., Herlin, T., & Toupin April, K. (2016). Models of Care for addressing chronic musculoskeletal pain and health in children and adolescents. Best Practice & Research Clinical Rheumatology, 30(3),468-482

Vinall J., Pavlova M., Asmundson G J G., Rasic N., Noel M., Mental Health Comorbidities in Pediatric Chronic Pain: A Narrative Review of Epidemiology, Models, Neurobiological Mechanisms and Treatment, Children 2016, 3, 40; doi:10.3390/children3040040

CL von Baeyer. Understanding and managing children’s recurrent pain in primary care: A biopsychosocial perspective. Paediatr Child Health 2007;12(2):121-125.
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Created by Lisa Stromquist on 2017/07/24 21:25