Chronic functional pain

No doubt many of us have come across children who constantly complain of abdominal pain or headache. Despite multiple visits to doctors, including several tests, no cause can be found. These children are normally treated with various types of medication but many are still troubled by the attacks. Children who attend cognitive-behavioural therapy (CBT) sessions at treatment centres do benefit, but due to the physical limitation of how many children can be treated per day and the problem of travelling to the facility involved, some children may miss out, wait a long time for an appointment or may not benefit as much as the sessions are too sparse. In the 21^st century, perhaps access to CBT could be made easier by digital media and the internet, thus, benefiting more people. Two recent reports have shown that using audiotape and the internet at home to deliver CBT can significantly help these children with recurrent pain.

Researchers from Oregon Health & Science University studied 48 children, aged 11 – 17 years, with chronic headache, abdominal or musculoskeletal pain and associated functional disability (Pain 2009; 146: 205 – 213). These children were randomly assigned to a wait-list group or an internet-delivered family CBT intervention group. The wait list group continued with the current medical care only. The internet group, in addition to their medical care, had 8 weeks of online modules including relaxation training, cognitive strategies, parent operant techniques, communication strategies and sleep and activity interventions. The children in the internet group had significantly greater reduction in activity limitations and pain intensity. These effects were maintained at the 3 month follow-up. The rate of pain improvement was also significantly faster than the control group.

Another study from the University of Arizona involved 22 children, aged 5 to 18, diagnosed with functional abdominal pain (BMC Pediatrics 2009; 6: 29). These children were randomized to receive either breathing techniques (control) or guided imagery therapy. Children assigned to the guided imagery group were instructed on progressive muscle relaxation which led into the guided imagery. On achieving relaxation, the children were asked to invite an image to come to mind that represented their pain. They were encouraged to describe the image in great detail. Once this image was established, they were then asked to invite a second image to come that would get rid of the pain. An audiotape of the relaxation and image was given to the children to practice at home twice daily.  Three weekly follow up sessions were done to assess competence. In the control group, children were taught 3 breathing techniques that facilitate relaxation. An audiotape of the breathing exercise was given to the children to practice at home twice daily. These children also had three weekly follow up sessions to assess competence. When compared to the breathing exercise group, children from the guided imagery group had significantly greater decrease in days with pain during the initial month and 2 months of follow up. Those learning guided imagery also had significantly fewer days with missed activities during the first and second months of follow up. At the end of two months, 70% of the children in the guided imagery group were ‘healed’ (≤ 4 days of pain with no missed activities during each month), whereas only 14% were healed in the breathing exercise group.

It is estimated that 10 – 30% of children suffer from functional abdominal pain. Do adults suffer from chronic functional pain? They do! Perhaps what we have learnt from the studies on children with functional pain can be applied to adults.