NEW ORLEANS — Kenneth Goldschneider, MD, of Children’s Hospital and Medical Center in Cincinnati, told clinicians here at the American Academy of Pediatrics National Conference and Exhibition communicating with patients and parents about something as complicated as chronic pain can be done with simple analogies and stories. He flashed on his childhood to explain that one could counsel pediatric patients who have pain problems that are complicated to treat, such as fibromyalgia, to treat the pain like “selective hearing.”
“When I was younger, I remember reading my Spider-Man comic books, and my mother would be yelling for me to do my chores or whatever, and I couldn’t hear her,” Goldschneider said. “It’s not that I could not hear her, I was just so focused on what I was doing at that time that I was able to block out the other stimuli.”
Goldschneider said he often relays this story to his younger patients who are struggling with complicated issues that cause pain, such as fibromyalgia or irritable bowel syndrome, as a way to explain how some psychological approaches can help reduce the pain. “Activities that involve mental focus can create a selective hearing for pain.”
Regarding fibromyalgia, Goldschneider said this condition is usually diagnosed after 3 months of widespread pain, multiple tender points on exam and several other unpleasant somatic and emotional symptoms. This condition can be difficult for children because it can lead to them missing school, and it may also lead to poor relationships with other children because many are told by their peers, “It’s all in your head.”
Pediatricians can assure their patients that this condition is “not in their head,” and rather is a central sensitization phenomenon. Goldschneider showed MRIs of altered sensory processing in patients with fibromyalgia.
Shifting gears to irritable bowel syndrome, Goldschneider said patients will often ask, “Why does my belly hurt?” For younger children, he often uses a chart that illustrates the multifactorial nature of this condition. “A picture is worth a thousand words, as they say,” he added.
“There are psychological factors, predisposing factors, physical factors,” he said. “I have found when I tell my patients, ‘There are many things causing this condition, so there are many ways we need to approach your treatment.’ They usually understand that, and it can be reassuring for them to hear. They have heard so many times that the tests are normal, so they must be faking or crazy. Sharing evidence for why these conditions hurt legitimizes their concerns and keeps the conversation going.”
Regarding treatments for these conditions, Goldschneider said he takes a holistic approach, using physical, psychological and pharmacologic therapies integrated together. For all chronic conditions, coping strategies, including cognitive-behavioral therapy, can help. Also, he recommended other strategies such as exercise and physical therapy for fibromyalgia.
Data on medications for children with fibromyalgia are not as robust as in adult populations.
Drawing on analogies to diabetes and asthma, Goldschneider said although there may not be cures for all the chronic pain conditions, there are some interventions that have shown to be effective, including changes in lifestyle, exercise, attitude, nutrition and, in some cases, medications.
Summing up his presentation, Goldschneider quoted from the children’s film Shrek, altering the green ogre’s most famous quote just a bit. “Chronic pain, Donkey, it’s like an onion. It has layers; it’s complicated.”
For more information:
Goldschneider K. Abstract F1082. Presented at AAP National Conference and Exhibition; Oct. 20-23, 2012; New Orleans.
Disclosure: Goldschneider reports no relevant financial disclosures.