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InPsych 2016 | Vol 38

Cover feature : Psychology and chronic pain

Helping adolescents with chronic pain

Chronic pain in adolescents is not uncommon, with headaches, abdominal pain and back pain as the main reports (15 per cent to 30 per cent; e.g. Perquin et al., 2000; Stanford, Chambers, Biesanz, & Chen, 2008). Common strategies reported by adolescents used to manage chronic pain include medications, distractions and rest (Fouladbakhsh, Vallerand, & Jenuwine, 2012; Keogh & Eccleston, 2006; Rambod, Forsyth, Sharif, & Khair, 2016)

In order to expand the repertoire of strategies for adolescents, self-management of chronic pain for adolescents are taught via self-guided (Charette et al., 2015; Palermo et al., 2015; Palermo, Wilson, Peters, Lewandowski, & Somhegyi, 2009), individual (Kachko et al., 2014) and group modalities either by a single discipline or multiple disciplines (e.g. psychology, physiotherapy, occupational therapy). An updated Cochrane review of psychological therapies for the management of chronic and recurrent pain in young people outlined key strategies designed to reduce pain perception and pain-related interference with functioning including neurophysiology education, relaxation, cognitive coping strategies and parenting skills training (Eccleston et al., 2013).

HOP Program – Helping Outside of school hours Pain Program

Since 2012, St Vincent’s Private Hospital Brisbane has been running a two-week multidisciplinary group treatment program (LEAP Program) for adolescents with chronic pain. In order to minimise the impact of attending treatment on schooling and to promote prosocial peer interactions, this program is run during the school holidays and designed to help young people and their families re-engage in functional activities including school attendance. As far as we are aware, the LEAP program has been the only group adolescent pain program of its kind in Australia; other adolescent pain management services tend to be part of short-term research trials or individually-based treatments. We have now run 25 cohorts of the LEAP program servicing a maximum five adolescents in each cohort with very promising results (e.g. Nguyen & Lagis, 2013).

This year, building on the learnings of the LEAP program, we developed a new outside of school hours multidisciplinary treatment program (HOP Program) to cater for adolescents with chronic pain who were beginning to experience difficulties maintaining a functional lifestyle balance (e.g. difficulties achieving adequate sleep, limited social and enjoyable activities due to multiple commitments etc.). The new program has a greater emphasis on forming a strong self-management plan, establishing good sleep habits and equipping parents/caregivers with self-management skills. In contrast to the LEAP program, the HOP Program runs one afternoon a week for eight weeks during Queensland school terms and includes a booster session. It consists of group education and individual sessions with a clinical psychologist, physiotherapist and occupational therapist with the aim of helping adolescents establish better biopsychosocial self-management plans for their pain. The HOP Program has now had six adolescent participants and their families, referred from two pain specialists, across two cohorts of the group program.

While pain, pain-related worry and functional impairment for both the HOP and LEAP participants were comparable, HOP program participants were more likely to report higher levels of self-efficacy related to their pain and participating with full-time schooling or occupation (Li, Cooke, & Lagis, n.d.). Preliminary outcomes for the HOP program participants have included reductions in perceived pain but no changes in psychosocial distress. Their parents also reported that carer burden has reduced through their child’s participation in the program (Li, Cooke, & Lagis, n.d.)

HOP Program treatment components

Group psychology sessions focus on:
  • Psychoeducation about the impact of the mind on pain
  • Stress management (including relaxation skills)
  • Cognitive challenging
  • Sleep-hygiene training.
Parent sessions focus on:
  • Promotion of family-wide change in lifestyle factors including sleep, diet, exercise
  • Problem solving any difficulties in implementing the program.
Individual sessions focus on one or more of the following:
  • Improving sleep hygiene
  • Managing associated mental health issues
  • Supporting any other issues such as grief, self-esteem, motivation etc.

Key tips for therapists working with adolescent pain patients

  • Rapport, rapport, rapport.
  • Start with a comprehensive assessment including parents; build motivation for behavioural change at assessment.
  • Delivery of psychoeducation and pain interventions needs to be engaging and flexible because pain and functional issues change all the time. Vary the form of learning, for example, presenting from a PowerPoint presentation, whiteboard, worksheets, games, role plays, arts/crafts and multimedia learning.
  • Incidental learning is key. Use what they bring to make a teaching point. Observation during group and individual activities can shed insight into maintaining factors to both mood and pain.
  • Educating parents about the neurophysiology of pain and self-management strategies is essential. Parents are key allies in the self-management of pain for adolescents.

The first author can be contacted at Hoi.Li@svha.org.au

References

  • Charette, S., Fiola, J. L., Charest, M. C., Villeneuve, E., Théroux, J., Joncas, J., … Le May, S. (2015). Guided imagery for adolescent post-spinal fusion pain management: A pilot study. Pain Management Nursing, 16(3), 211–220. doi.org/10.1016/j.pmn.2014.06.004
  • Eccleston, C., Tm, P., Acdc, W., Lewandowski, A., Morley, S., Fisher, E., … Fisher, E. (2013). Psychological therapies for the management of chronic and recurrent pain in children and adolescents (Review). Cochrane Database of Systematic Reviews, 12, 2012–2014. doi.org/10.1002/14651858.CD003968.pub3
  • Fouladbakhsh, J. M., Vallerand, A. H., & Jenuwine, E. S. (2012). Self-treatment of pain among adolescents in an urban community. Pain Management Nursing, 13(2), 80–93. doi.org/10.1016/j.pmn.2011.08.005
  • Kachko, L., Ben Ami, S., Lieberman, A., Shor, R., Tzeitlin, E., & Efrat, R. (2014). Neuropathic pain other than CRPS in children and adolescents: Incidence, referral, clinical characteristics, management, and clinical outcomes. Paediatric Anaesthesia, 24(6), 608–613. doi.org/10.1111/pan.12375
  • Keogh, E., & Eccleston, C. (2006). Sex differences in adolescent chronic pain and pain-related coping. Pain, 123(3), 275–284. doi.org/10.1016/j.pain.2006.03.004
  • Li, H. K., Cooke, K., & Lagis, T. (n.d.). Helping adolescents with pain after school hours: Preliminary findings of a group adolescent pain program.
  • Nguyen, H., & Lagis, T. (2013). An adolescent pain management program: More family oriented. Poster prestented at the Australian Pain Society 33rd Annual Scientific Meeting, Canberra.
  • Palermo, T. M., Law, E. F., Zhou, C., Holley, A. L., Logan, D., & Tai, G. (2015). Trajectories of change during a randomized controlled trial of internet-delivered psychological treatment for adolescent chronic pain: how does change in pain and function relate? Pain, 156(4), 626–34. doi.org/10.1097/01.j.pain.0000460355.17246.6c
  • Palermo, T. M., Wilson, A. C., Peters, M., Lewandowski, A., & Somhegyi, H. (2009). Randomized controlled trial of an Internet-delivered family cognitive-behavioral therapy intervention for children and adolescents with chronic pain. Pain, 146(1-2), 205–213. doi.org/10.1016/j.pain.2009.07.034
  • Perquin, C. W., Hazebroek-Kampschreur, A. A. J. M., Hunfeld, J. A. M., Bohnen, A. M., Van Suijlekom-Smit, L. W. A., Passchier, J., & Van Der Wouden, J. C. (2000). Pain in children and adolescents: A common experience. Pain, 87(1), 51–58. doi.org/10.1016/S0304-3959(00)00269-4
  • Rambod, M., Forsyth, K., Sharif, F., & Khair, K. (2016). Assessment and management of pain in children and adolescents with bleeding disorders: A cross-sectional study from three haemophilia centres. Haemophilia, 22(1), 65–71. doi.org/10.1111/hae.12765
  • Stanford, E., Chambers, C., Biesanz, J., & Chen, E. (2008). The frequency, trajectories and predictors of adolescent recurrent pain: A population-based approach. Pain, 138(1), 11–21.

Disclaimer: Published in InPsych on August 2016. The APS aims to ensure that information published in InPsych is current and accurate at the time of publication. Changes after publication may affect the accuracy of this information. Readers are responsible for ascertaining the currency and completeness of information they rely on, which is particularly important for government initiatives, legislation or best-practice principles which are open to amendment. The information provided in InPsych does not replace obtaining appropriate professional and/or legal advice.