New study shows new treatment for children suffering from chronic pain

A National Institutes of Health initiative has piloted a study that aims to help physicians better evaluate and treat children who are suffering from chronic pain. The study was done using face-to-face interviews with pediatric patients, giving the study a better view of how they see their lives to be.

In the current issue of the Journal of Pain, a paper was published by a collaboration between the University
of Cincinnati's Department of Anthropology, UC College of Medicine Department of Pediatrics, Emory University School of Medicine, and Cincinatti Children's Hospital Medical Center.

The interdisciplinary study was based on individual and group interviews with 32 pediatric patients with chronic pain. These include children who are suffering from juvenile arthritis, sickle cell anemia, and cerebral palsy, says Jeffrey Jacobson, the lead author and a UC associate professor of anthropology.

The main goal of the study was to determine the pain measures as made by the Patient Reported Outcomes Management Information System, abbreviated PROMIS, which is an initiative by the National Institutes of Health. PROMIS was created to make a set of freely available, widely applicable, and top-
notch patient-reported outcomes, which are measures that can be used within and across one patient's conditions throughout his or her lifetime.

Jacobson explains that pain is not something that can be really measured, and these values can only be acquired from reports made by patients. The study focused on children from ages 8-18 and how they talk about the pain that they experience and what kind of vocabulary they like to use during these times. We found that many questions or items from pain measures used with adults, describing pain as ˜gnawing or
suffocating', made younger children uncomfortable. They appeared to relate that to a monster or someone doing something to them. They also have a more limited vocabulary than adults, particularly in relation to the more abstract language of pain quality, he added.

The papers states different categories of pain experience and what type of words children use when describing about the pain that they feel, and the fit of these categories with those used by PROMIS. For ˜Pain behavior', the patients describe that he or she becomes irritable or has no appetite when in pain. In ˜Pain interference', the children describe slower movement, for example in times when they walk, or lack of energy. Lastly, for ˜Pain quality', they describe pain as being sharp, dull, cutting or achy. The PROMIS
domains and those used by the patients were actually found to fit well.

Some children though, would say something like ˜I did better when the teacher gave me permission to be
a little late for class, because it takes me so long to get there'. So they're describing how they're managing
or coping with pain, says Jacobson.

Other pain-coping strategies described by the children include self-distraction or exercise, as well as
cognitive coping methods such as keep going, save it for another day.

Based on the results of the study, several recommendations were made to the PROMIS pain assessment
framework, such as dividing the pain quality into two types: pain-sensory and affective. The authors add that their results on coping with pain needs further studies for more recommendations to the PROMIS initiative.