Managing pain through psychosocial intervention

We often tend to believe that pain is only physical. However, it also has an important psychological aspect. In fact, pain is always physical and psychological. To address this more global perspective, the team at the Edwards Family Interdisciplinary Centre for Complex Pain of the Montreal Children’s Hospital (MCH) will be launching the Comfort Ability Program on May 26.

Pediatric Pain Management

In many forms of chronic pain, pain itself does not necessarily represent a symptom of another problem; it can simply be the problem. 

Recurring symptoms such as chronic pain, nausea, dizziness, fatigue and muscle weakness can be like a central nervous system glitch. To reset this glitch, it’s necessary to address not only the physical but also the psychological aspects of these symptoms, such as stress, fear, anxiety, frustration, depression and isolation from age appropriate activities and tasks.

Psychologically based interventions such as mindfulness, relaxation, biofeedback and cognitive behavioural skills are research-proven to help children diminish the intensity or frequency of symptoms, and can also reduce psychological distress related to illness. This is true regardless of what started the problem in the first place.

Non-opioid medications, physical therapy and cognitive behavioural therapy are a trifecta of interventions that currently comprise the gold standard of care for kids with functional symptoms.

That’s why Nathalie Myara, psychoeducator at the Centre for Complex Pain, and Rebecca Pitt, nurse clinician at the Centre for Complex Pain, decided to make the MCH an accredited provider of the Comfort Ability Program and recently completed training at Boston Children’s Hospital.

“Some families believe that the pain must be stopped before the child can resume activities. In fact, you should have a plan for resuming activities and the rest will follow,” explains Rebecca.

Information and tools

Already in use in pediatric centres in Canada, the United States and Australia, the Comfort Ability Program is one way families are learning how to better approach the challenge of ongoing symptoms in order to help children with complex pain and their parents return to their full lives.

Proposed to children aged 10 and over, the Comfort Ability Program offers an in-person one-day workshop (six  hours) and many other resources to help adolescents and their parents learn how to better manage recurring pain symptoms. The program provides families with a foundation for understanding the various ways psychological interventions can improve symptom management. It also provides adolescents and their families with the concrete skills necessary for improved emotional and physical functioning.

The workshop provides accessible neuroscience education, teaching teenagers and parents how the nervous system works and why persistent symptoms can be such a challenging problem to overcome. Beyond education, the program is designed to arm families with a set of research-proven mind, body and behavioural interventions that can reduce symptoms and improve day-to-day function.

“The first part aims to give the teenager awareness of how their brain works, how they process pain and the effect their behaviour can have on their pain, for example if they’re experiencing anger. In the second part, we put in place strategies to improve the situation,” explains Nathalie.

While the child is attending the workshop, a separate workshop is offered to parents.

“We already had our own program, but we were missing that ‘together, but apart’ aspect for the child and the parent. The Comfort Ability Program meets that need,” says Rebecca.

An adapted environment

The activities will take place in a comfortable space set up for the occasion and equipped, for example, with bean bags and stress balls. Sessions will include different interventions such as cognitive behavioural therapy, art therapy, aromatherapy and biofeedback.

Cognitive behavioural therapy suggests that the thoughts we have about a situation affect how we feel (emotionally and physically) and how we behave in that situation. By first identifying these thoughts, we can curb their effect.

Biofeedback, on the other hand, is a technique for visualizing the physiological effects of stress on the body. Various monitors are connected to the patient, measuring heart rate, muscle tension, brain activity and so on, and results can be viewed on a computer. The goal here is also to enable young people to see in real time the concrete positive effects of the strategies they are learning.

Once the workshop is completed, the teenager leaves the hospital with new insights, tools and expertise to manage their pain.

“The Comfort Ability Program is all about rehabilitation. That’s why we are doing it. We want our patients to get better and be happy,” emphasizes Nathalie.

A survey will be carried out among the teenagers who benefit from the program to assess their satisfaction and the results will be shared in several months. In the longer term, the team hopes to extend the program to patients in other MCH divisions who experience pain, but do not attend the Centre for Complex Pain.Thanks to the Montreal Children’s Hospital Foundation and the Louise and Alan Edwards Foundation for their support.