Pain Rehabilitation Program Restores Functionality in Adolescents with Chronic Pain

A pediatric pain rehabilitation program at Mayo Clinic provides an innovative treatment for adolescents with chronic pain. The three-week, hospital-based outpatient program in Rochester, Minn., helps restore children's ability to function despite persistent pain and symptoms such as nausea, fatigue, and dizziness.

The program also teaches family members coping skills and shows parents how to support the child's return to normal activities and move out of the sick role.

Studies indicate 15 percent to 20 percent of children and adolescents experience chronic pain. Up to 5 percent can be so debilitated by pain that they are unable to attend school, maintain social relationships or participate in daily exercise or activities.

Children and adolescents with chronic pain benefit from rehabilitation programs that achieve important functional outcomes. Unlike adult programs, however, successful pediatric pain management programs require parental involvement.

Clinically Effective and Cost-effective

Medical care for children with chronic pain is often interventional or pharmacologic, focusing on pain management medications. It often does not address coping, and it may not acknowledge the impact a child with chronic pain has on family life.

"Our data suggest that an interdisciplinary pain rehabilitation approach with considerable family involvement is both clinically effective and cost-effective," says Tracy E. Harrison, M.D., a pediatric anesthesiologist and medical director of the pediatric pain rehabilitation program at Mayo Clinic.

Programs that focus on pediatric rehabilitation are few, despite extensive literature on the effectiveness of comprehensive pain rehabilitation in adults. "This program is designed to address children's particular barriers and to allow them to do so along with their peers, who experience some of the same difficulties. We continually evaluate how the program affects each patient," says Dr. Harrison.

Each patient is seen by members of the interdisciplinary treatment team, including child psychologists, pediatric anesthesiologists, advanced-practice nurses, physical therapists, occupational therapists, recreational therapists, biofeedback therapists, and other specialists, who then collaborate on recommendations. "We let children and parents know that many tools are available to them to help manage pain, even if medications have not been effective. And if medications aren't effective, we may consider discontinuation to minimize side effects," says Dr. Harrison.

Life with a child who is experiencing chronic pain often spirals into serious family stress. "As the child withdraws from normal routines, the focus of both parents and siblings becomes the affected child. Home schooling is common," says Dr. Harrison. "Often the child and parents begin a seemingly endless series of visits to new doctors, seeking a cure for the pain."

Getting Children Back to School

Participants attend the program every day, 8 a.m. to 5 p.m., Monday through Friday, for three weeks. Parents are in classes approximately 20 hours a week as well. "Our No. 1 goal is to get children back to school fulltime. If they can attend school, everything else starts to fall into place," says Barbara K. Bruce, Ph.D., a psychologist and clinical director of the pain rehabilitation program.

Sessions in the three-week program focus on physical reconditioning, relaxation training and biofeedback, stress management, pain management training such as activity moderation and the elimination of pain behaviors, and occupational therapy and recreational therapy for school, leisure and home activities.

Study Results

Patient and Parent Satisfaction

• 82 percent of teens said they agreed or strongly agreed with the statement "The pain rehabilitation program has been beneficial in helping me to learn how I can live well in spite of chronic pain."
• 82 percent of teens said they agreed or strongly agreed with the statement "I feel my quality of life has improved using the tools I have learned and practiced in the pain rehabilitation program."
• 76 percent of teens said they agreed or strongly agreed with the statement "I feel better prepared to plan for and handle 'difficult pain days.' "
• 79 percent of parents said they would definitely recommend the pain rehabilitation program to family members or friends with chronic pain.