Chronic Pain in Pediatric Physical Therapy

pediatric chronic pain

- classified as a persistent pain that affects a patient for more than the expected or typical healing time

- usually includes pain that lasts more than 3 months

- can be related to disease process, an injury, surgery, or a stressful event/trauma

chronic pain occurs more in

females than males, often post puberty

types of chronic pain

- headaches

- abdominal syndromes

- musculoskeletal/joint pain

AMPS

amplified musculoskeletal pain syndrom

CRPS

complex regional pain syndrome

EDS

ehlers-danlos syndrome or other types of joint hypermobility

JIA

juvenile idiopathic arthritis

FND/FNSD

functional neurological symptom disorder

specific chronic pain diagnoses

- AMPS

- CRPS

- EDS

- Fibromyalgia

- JIA

- FND/FNSD

why does chronic pain happen?

- overstimulation of the nervous system

- pain-gate theory

pain-gate theory

spinal cord acts as a gate for your brain, letting in certain signals

how do we help with chronic pain?

- eliminate constant "checking in"

- avoid the "don't think about the elephant in the room"

- finding other ways to assess patient performance outside pain scores

- utilizing coping skills to complete tasks as needed

- function will improve prior to pain score improvements, but with time pain will improve as well

patients with chronic pain can present with what impairments?

- impaired mobility

- bilateral coordination

- upper limb coordination

- balance

- UE, LE, and core strength

- grip and pinch strength

- hypermobility

- body awareness

- impaired independent self selection of activities

- poor decision making

- functional endurance limiting participation

- heightened sensitivity

- trophic changes

how do impairments affect a pediatric patient's daily life?

- impaired leisure or sports activity involvement

- inconsistent or no performance of ADL

- extreme mobility limitations

role of PT with patients with a chronic pain diagnosis

- improve functional strength, endurance, and balance through various modalities and appropriate plans of care which allow for progression of gross motor skills

- improve functional independence for mobility

- work with psychology to utilize appropriate coping mechanisms to aid in progression of physical therapy goals

- develop a plan for continued progression of activity upon discharge

- develop rapport to assist in progression of the POC

settings for patients to be seen in

- outpatient at a high frequency

- outpatient with various HEP

- outpatient day programs

- inpatient programs

how is the setting determined?

based on the patient's presentation, available resources, and motivation

additional services children with chronic pain may also receive

- OT

- behavioral medicine/clinical psychology

- holistic health services

- collaboration with all clinicians is super important

PT evaluation

- functional mobility

- ROM

- strength

- balance

- endurance

objective measures to consider

- WeeFIM scores

- 6 MWT

- grip strength

- BOT-2

- timed steps

- Canadian occupational performance measure (COPM)

- physical abilities and motor scale (PAMS)

- functional disability inventory

physical therapy goals

- ultimate goal is working to remind your body how to participate in the way you want to

- goals are established following a physical therapy evaluation with includes a verbal history and specific objective measures

initial treatment ideas to assist in new management of chronic pain and to promote function

- Estim/TENS

- heat

- ice

- braces

- ADs

*we want to get away from these as much as possible to be more functional in everyday life*

other treatment ideas

- desensitization techniques

- graded motor imagery/mirror therapy

- E-stim for functional ROM

- gradual weight bearing in various positions

- progression off assistive devices to improve patient independence

- active engagement of patient in performing ROM in various planes and through functional ROMs in non-weight bearing and weight bearing positions

- progression of endurance activity when appropriate to assist in overall health and wellness

- promoting coping skills to assist with management of pain symptoms in various settings

- goal setting

goal setting for patients with chronic pain

- use COPM for patient goal setting initially

- regular short term goal setting

- can occur daily or weekly

- can work with psychology of the patient's therapist counselor

- ensure patient and caregiver buy in before implementation

- involve patient with treatment planning and leading sessions to promote carry-over outside of therapies and independence

- promote active engagement and ability to improve and reach goals set