Pain can become a serious problem for a child with a chronic disease like juvenile arthritis (JA) and can affect many facets of a child’s life.
But do kids with arthritis have to be saddled with pain?
“What I see clinically is that a lot of kids and their families assume that because they have arthritis they need to live with pain and nothing can be done, and that’s not true,” says Lonnie Zeltzer, MD, director of the Pediatric Pain Program at Mattel Children’s Hospital at UCLA in California.
Another reality is that pediatric rheumatologists don’t always think of targeting the pain directly. Instead they focus on disease control with the belief that decreased inflammation is all that's needed to ease discomfort.
While first-line analgesics like acetaminophen, as well as nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, decrease pain for many kids, they don’t help all children with JA. Powerful new medications such as biologic response modifiers (biologics) curb inflammation and pain for a lot of kids too, but “we’ve found that many children continue to have significant pain despite the use of these strong medicines,” says Yukiko Kimura, MD, chief of pediatric rheumatology, Joseph M. Sanzari Children’s Hospital, Hackensack University Medical Center in New Jersey.
Research into pain
Why does pain persist for some children? Researchers in the small, yet growing study of pediatric pain are turning up some intriguing findings.
“A fairly new finding is that pain can lead to more inflammation, so by treating pain in somebody with arthritis, you can reduce some of the inflammation,” says Dr. Zeltzer.
There also may be differences in how pain affects girls and boys. Certain pain conditions like fibromyalgia affect girls much more than boys but not until adolescence and through adulthood. Researchers are trying to figure out why girls are more vulnerable.
“We also don’t know how pain changes developmentally as children mature through childhood into adolescence and young adulthood,” says Patricia McGrath, PhD, scientific director at the Divisional Center for Pain Management and Pain Research, the Hospital for Sick Children in Toronto, Ontario.
Researchers are sure the mind-body connection is strong when it comes to pain in adults and kids.
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