Finding Peace Through Pain: How Psychologists Help Chronic Pain Patients Cope

The Chronic Pain Treatment Program at Lurie Children’s offers the compassion and experience of pediatric anesthesiologists, advanced practice nurses, nurses, physical therapists and clinical psychologists working together to care for children pre- and post-procedure, and with a range of chronic diagnoses.

Lurie Children’s is also home to the Comprehensive Chronic Abdominal Pain Program and the Pediatric Headache Program, which bring specialized interdisciplinary medical and psychological pain treatment services to patients with chronic pain conditions affecting those respective body systems. Advanced, interdisciplinary care is at the core of the care that each of these programs provide and is part of what makes each of them the best in the nation. The experts that make up each team determine individualized treatment plans that might include medication management, interventional procedures, psychological and health and behavior treatments, and integrative health approaches. Because chronic pain often causes disruption to normal childhood activities and affects a child’s mood, family and peer relationships, and their ability to do the things they care about, psychologists are an integral part of patient care when it comes to pain. Each pain program an embedded mental health professional to address the emotional and mental well-being of its patients.

Lurie Children’s pediatric pain psychologists Bonnie Essner, PhD, (GI Comprehensive Chronic Abdominal Pain clinic), Justin Moore, PhD (Anesthesia/Pain clinic), and Laurie Thompson, PhD (Neurology Headache clinic), work with kids of all ages in their respective clinics helping them not only better manage their chronic pain, but eventually thrive in home, school and social settings. They equip patients with the tools they need to lead full and meaningful lives.

Pain psychology in action will look different patient to patient, the experts say, depending on the unique diagnoses and challenges each child/adolescent is facing. Many patients benefit from treatment with a psychologist that includes having their experiences heard and validated, and with interventions that provide the comfort and mental skills they are seeking while living with pain. This might include things like mindfulness and meditation practices, hypnosis, or focused work on health behaviors such as sleep, hydration, medication adherence, and regular meals. Additionally, psychologists may advocate for the right combination of accommodations at a patient’s school to prioritize make-up work and increase options for the student to manage pain at school.

One way that Lurie Children’s pain psychologists treat patients is by helping them untangle “thinking traps.”

“Thinking traps are the ways that our brains trick us into believing things that aren’t necessarily true,” said Dr. Moore. “For instance: ‘when I move my body and feel discomfort, it means my body is being harmed, which means I shouldn’t move my body.” This is not always the case, Dr. Moore says.

He and his colleagues in the chronic pain programs work closely with a patient’s comprehensive care team to understand when they’ve been medically cleared to return to daily functioning and movement, and then work to re-instill a sense of confidence in their patients and help them re-engage in things they enjoy, despite their pain.

“We build self-efficacy,” said Dr. Moore. “We make manageable goals to increase recovery.”

Psychologist POV

“My psychological interventions are primarily integrative health-based interventions with evidence of efficacy – mindfulness and hypnosis are two methods. The goal of these interventions is to help our patients to manage and function with their pain so they can get back to doing all the things they really love to do,” said Dr. Essner. “The brain-gut connection, meaning there is a direct connection between the central nervous system – including our brain – and our enteric nervous system - in our bellies. Stress responses, thinking patterns, and emotional patterns really affect how our gut behaves. If we can help with a patient’s stress response, it’s a major way to help with abdominal pain symptoms. Mindfulness is about adopting different ways of responding to the world around you. It’s proactive and preventive. When we practice mindfulness through psychological interventions, we make it individualized. We help patients get in touch with the patterns of how they respond to stressors that can help manage their symptoms."

 "As a health psychologist, I work with kids, teens and young adults to help them address their physical symptoms and conditions, whereas a mental health colleague may focus on their mood and depressive symptoms,” said. Dr. Essner.

“Pain is a neurological experience. The brain and other associated parts of the nervous system process pain, and over time, the field of pain has learned that there are many variables that influence that processing, including our thoughts and emotions,” said. Dr. Moore. “Both can lead to the wind-up or the wind-down of the nervous system. We’ve learned that when the nervous system winds up, it becomes on higher alert, and may perceive more things as threatening, triggering more pain signals. The goal is to find strategies for patients to wind down their nervous systems; psychology is well-positioned to do that to improve functioning. We look at how to get patients re-engaged with their values and get them functioning despite their pain.” 

“There are a lot of ways that a psychologist can help reduce pain and increase a kid’s ability to live their life. We may work on building a ‘comfort toolbox’ of things a kid can do when they experience pain to help them feel more in control and the pain feel less intense,” Dr. Thompson said. “Many youths who have been experiencing debilitating pain for a while often have stopped many important and fun activities such as extracurriculars, social activities, time with family, and even school. Life has become centered around headaches, which magnifies the experience of pain and increases negative emotions such as frustration, helplessness, and isolation. We work to slowly return a child to their normal activities, while also building in planned rest times and other coping tools. Headaches become one facet of a full life, rather than the center of life.”

September is Pain Awareness Month, and an estimated 51.6 million Americans live with chronic pain. Typically, pain is considered chronic when it persists for six months or more, but in some cases, chronic pain can last for years or for life. There are many potential causes for long-term pain, including injury, such as involvement in a car accident, or underlying disorders or diseases (Source: U.S. Pain Foundation). Each child’s experience with pain is unique, and there are many different avenues for support and recovery to help improve their quality of life.

For more information about chronic pain and pain management, check out the resources below.

Sites

• Meg Foundation
• Thecomfortability.com
• Mycarepath.ca
• imaginaction.stanford.edu
• GI Kids.org

Books

• The Chronic Pain and Illness Workbook for Teens: CBT and Mindfulness-Based Practices to Turn the Volume Down on Painby Rachel Zoffness, PhD
• When Your Child Hurts: Effective Strategies to Increase Comfort, Reduce Stress, and Break the Cycle of Chronic Pain by Rachael Coakley, PhD
• Managing Your Child's Chronic Pain by Tonya Palermo and Emily Law
• Pain in Children and Young Adults by Lonnie and Paul Zeltzer

Videos

• UNC Kids: “What is Functional Abdominal Pain?”

TED Talks

• Lorimer Moseley: “Why things hurt”
• Joshua W. Pate: “The mysterious science of pain”
• Karen D. Davis: “How does your brain respond to pain?”