“What we think, how we feel, what we believe, how stressed we are and what’s happening to our body in terms of inflammation, for example, are all interconnected,” says Dr. Zeltzer. “We’ve documented with functional magnetic resonance imaging (fMRI) studies that you can change pain systems biologically by what you do with your mind.”

One growing area of research is the long-term effects of untreated pain in kids. It appears that having a lot of untreated or badly treated pain as a child is one of a number of risk factors to being more sensitive to pain as an adult.

Curbing Pain With Medications

What options exist for a child with arthritis who is having difficulty with chronic pain? The wide range of drugs that may help include various NSAIDs, corticosteroids and pain relievers that contain acetaminophen, opioids or acetaminophen-and-opioid mixes. The use of opioids in children is controversial due to worries over addiction or side effects. 

A couple years ago, Dr. Kimura surveyed pediatric rheumatologists about their opioid use. Many didn't agree with prescribing opioids for kids and only used them in the most severe cases.

“In the last five to 10 years, opioid medications have become much more accepted as a treatment for many types of chronic pain in adults including arthritis,” says Dr. Kimura. “Some pediatric rheumatologists who have been using long-acting opioids in children with residual pain have seen beneficial results without a lot of side effects.”

Dr. Kimura is conducting a pilot study on pain treatment for kids with JA using an opioid called methadone. Five-year-old Chandler Leskovar of Plainfield, Ill., who has had JA since he was 16 months old, participated in the study and his mother, Kim, saw great results. “He was happier, more willing to try new things, more mobile, slept better and had more confidence in school because he wasn’t afraid to be around kids for fear of getting bumped.”

Drug-free Pain Management

Non-medicinal methods can offer wonderful results. Physical therapy with a therapist who has experience working with kids is a good approach. Biofeedback and hypnotherapy teach kids to alter pain signals. In biofeedback, a therapist uses a computer or other feedback device to teach the child how to change body functions associated with stress.

Hypnotherapy uses children’s imaginations to teach them to calm their nervous systems and release stress and pain. Massage therapy, which parents can learn to do with their kids, is very helpful in increasing circulation to the joints and in releasing strain and tension that may be in many parts of their bodies. Cognitive behavior therapy teaches kids to reduce feelings of anxiety and to calm themselves. Dr. Zeltzer recommends a particular type of yoga, called Iyengar yoga that is very beneficial for people with arthritis. These non-medication strategies are not used consistently says McGrath.

“Often people try something then give it up because it didn’t take the pain away immediately. If they gave it a chance they might find it would work.”