What do you think is a good straight-forward way to explain pain to a child who is learning about pain for the first time? What would you say to them?
I would probably start by asking them, "What is pain? If you looked up the word pain in the dictionary, what do you think it means?" Obviously this depends on their age.
In one of the studies that I did recently, we interviewed a bunch of 8-12 year old kids (so they're old enough to fill out a questionnaire but young enough that they can't think abstractly on average) and we started off with that question. And it's really hard because some children aren't thinking in terms of the dictionary. In order to educate someone you can't just push information on to them, you need to find out where they're at.
So we used a whole range of different strategies. One of the ones that was most effective was to ask children, "Here's a piece of paper, just draw whatever you think of when you hear the word pain." For so many of the children we interviewed (and this is a published paper at BMJ open) it was amazing how much of that drawing activity opened up the conversation, and it provided the starting point for parents and clinicians and whoever's involved to use that language. For example, the children who we interviewed who had had persistent pain, either now or at some point in their lives, all drew emotional elements. They drew things like hearts and tears and sad faces, things like that. Whereas the children who hadn't had an experience of persistent pain would only draw things like injuries. So both groups of kids were drawing injuries as their most common thing (since most people grow up to associate pain with injury) but there's this real unique sense of the suffering that comes when pain persists. It becomes this really emotional experience. And to draw that out of a young child is extremely difficult and potentially risky if you haven't had training.
There's these new tools that are becoming available to clinicians where we do tasks like that to open up the conversation and find out the language that the child is using. If someone has a belief that there's an ongoing injury that is causing their pain that's going to cause an immense amount of fear. Imagine if you thought every time you stood up that you were injuring yourself and you were damaging those discs in your back or something like that. These unhelpful, incorrect beliefs can be so harmful.
But understanding the benefits of movement and the access to synovial fluid that these joints get when you start moving and the healing properties of all of those different things can completely change the game. And kids start exercising because they realize the benefit of it. And I think what we're finding more and more is when we interview the parents as well, seeing how related a child's concept of pain is to the parents.
We're actually doing a study at the moment. I'm working with a team at Stanford in the Biobehavioral Pain Team and we're looking at the scores on this questionnaire I developed between kids and parents in order to work out the starting point. Do we engage with the parents first or do we engage with the child first? And how does that how does that work? Because maybe the child learned stuff and is on a healthy trajectory, but then the parent comes in and says things like, "Be careful, you better not do that. Watch out, you're going to cause more injuries." Those overarching and overriding beliefs from the parent could be impacting the rehabilitation journey.
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