1 in 4 children suffers from chronic pain − school nurses could be key to helping them manage it

Joint pain, headaches, stomachaches, fibromyalgia – the list sounds like an inventory of ailments that might plague people as they age. Yet these are chronic, painful conditions that frequently affect children.

People often imagine childhood as a time when the body functions at its best, but about 25% of children experience chronic pain. I was one of them: Starting in elementary school, migraines incapacitated me for hours at a stretch with excruciating pain that made it impossible to go to school, much less talk to friends or have fun.

As a licensed pediatric pain psychologist, I develop and test psychological care strategies for children who experience chronic pain. Effective treatments exist, but they are often not accessible, particularly for families that don’t live near major medical centers or have adequate health insurance. My colleagues and I are working to change that by training school nurses and other community health providers to deliver such care.

More than growing pains

Chronic pain in children is not only widespread but also persistent. Many continue to experience symptoms for years on end. For example, one-third of children with abdominal pain experience symptoms that last into adulthood. Children with chronic pain are also more likely to come from families that have less income, have greater health care barriers, report more safety concerns about their environment and experience greater exposure to violence than those without chronic pain.

These conditions interfere with daily life. Children with chronic pain miss about 1 in 5 days of school. Consequently, their academics suffer and they are less likely to graduate from high school. Mental health conditions such as anxiety and depression are common.

Experiencing chronic pain in childhood also puts people at an increased risk for opioid use in adulthood, signaling a major public health concern.

Behavioral therapy for pain

Many adults think nothing of taking medicines such as ibuprofen or acetaminophen for minor aches and pains, but there’s little evidence that pharmacologic treatments work best for children’s chronic pain. Research suggests that such medicines are insufficient for helping children get back to their routines and activities, such as school, sports and hanging out with friends.

The most studied and perhaps most effective approach for treating chronic pain in children is cognitive behavioral therapy. This modality involves teaching children how pain works in the brain, and also training them on problem solving, relaxation methods such as deep breathing, challenging negative thoughts about pain, and pacing activities to avoid pain flares. Unlike pain medications, which wear off after a few hours, research suggests that cognitive behavioral therapy can have a lasting effect. Kids can get back to doing things they need and want to do, and they often feel better too over the long term.

My colleagues and I – along with other researchers – have developed and tested cognitive behavioral approaches for children with chronic painful conditions such as functional abdominal pain and childhood-onset lupus. These interventions not only get kids back to their daily lives but also reduce symptoms of anxiety and depression that often accompany children’s pain syndromes.

To be sure, providing interventions in the form of web-based tools or apps can improve access for children who can’t see a provider. However, we have found that children and their families are more likely to complete the course of treatment with a provider, and that automated self-management tools can complement but not replace care delivered by a provider. In fact, when cognitive behavioral therapy for children’s chronic pain is delivered exclusively through an online tool, only a third of children complete treatment.

How community providers can fill the gap

Despite the proven benefits of psychological therapies for children’s pain, few providers are trained to use them. That’s one of the most common barriers to care.

One potentially untapped resource is school nurses and other specialists who are often the first point of contact for a child with chronic pain, such as social workers and school counselors. Programs already exist to train school providers, including school nurses, in managing children’s mental health, but few of them address chronic pain.

To fill this gap, my colleagues and I have developed a program to train school nurses and other community health experts to teach children cognitive and behavioral strategies to manage their chronic pain. So far, we have trained approximately 100 school providers across Michigan, who report that the training improves pain symptoms and helps keep children in school. We are also expanding the project to address trauma and other mental health symptoms that commonly occur with chronic pain, and to support providers in discouraging substance use to manage pain in these children.

Our work suggests that this approach can empower providers to reach children in rural communities and other settings that lack access to care. By training more boots on the ground, we hope to provide children with the pain management tools they need to grow into healthy and thriving adults.

Natoshia R. Cunningham receives grant funding from the US Department of Defense, the Michigan Health Endowment Fund, and the Childhood Arthritis and Rheumatology Research Alliance-Arthritis Foundation. She was previously funded by the National Institutes of Health, and the Blue Cross Blue Shield Foundation of Michigan.