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Pain Management

Pain is a very complex experience - for the child with arthritis it is unpredictable (manageable one day, unbearable the next), closely linked to fatigue, emotions, beliefs and coping responses, and easily misunderstood by others. Keeping pain at a manageable level is an important goal for treatment, and teachers and health professionals can play an important role in monitoring and supporting a child in managing their pain, as well as providing kids and families with additional pain management strategies. Tools, such as body outlines for colouring in areas and intensities of pain, can help kids and teenagers communicate their pain to others. In regards to juvenile arthritis pain is not something to be worked through, but rather a warning of damage or injury. Both preventing (or minimising) pain and managing it when it occurs are important.

When (she) gets tired - pain is severe - has hot bath .... may need antiflamme to be rubbed on joints. Absolute frustration at not being able to fix the pain.
Mother of 12-year old girl with arthritis.

Treatments to Relieve Pain:

Here are a few examples of strategies which may help manage pain:

  • hot packs, hot towels, or hot water bottles can help ease aching, sore or stiff joints, as can warm baths or showers
  • some kids or teenagers may prefer cold packs to cool joints which feel hot or 'burning'
Be aware of the safety precautions of using hot and cold packs - check with the doctor or physiotherapist, however generally these are not applied for longer than ten minutes and are not applied to areas of poor circulation - cold packs are not applied directly to the skin. Girl with arthritis making jewellery
  • splints, to support sore joints
  • warm gloves or socks may help to loosen sore joints
  • gentle exercises and stretches can relieve pain by loosening up sore joints and releasing endorphins (the body's natural painkiller)
  • strategic use of medications, as guided by the child's doctor
  • gentle massage
  • use of assistive equipment to prevent or relieve pain
  • a TENS machine (borrowed or purchased from the doctor or physiotherapist) may provide some relief for a particularly painful joint.

Positive Thinking and Distraction:

The way a child thinks about their pain can have an impact on how they cope with it. If they believe they have no control over their pain they may not be inclined to try strategies for managing it. Parents and others can also influence these thoughts and beliefs. Keeping positive, focusing on health and wellbeing (not sickness), learning from others as to how they manage their pain, using humour, and helping kids and teenagers develop interests which give them enjoyment and keep their minds off their symptoms can be useful. Distraction can be particularly effective as a way of managing pain as the brain has difficulty focusing on pain or negative thoughts at the same time as it completes interesting and engrossing activities.


Relaxation and Conserving Energy:

Relaxation techniques can be another effective way of relaxing the body and mind, and also to help kids sleep at night. These may involve tensing and relaxing muscles, imagining being in an enjoyable and relaxing place, or even involve cognitive techniques by which pain is 'taken away' (i.e. hypnotherapy). Breathing techniques can also be useful for reducing pain and tension. It does take practice for a child to develop relaxation skills, but many do find it useful, and it can be a good alternative when the rest of the class are doing vigorous sports or activities. As discussed previously conserving energy and looking after joints are also important for preventing or minimising pain.

Complementary Therapies:

Unfortunately complementary therapies do not cure juvenile arthritis, but in some cases can help with managing pain and symptoms. There are all sorts of therapies available, which families may have already tried or wish to try eg. massage therapies, aromatherapy, acupuncture, yoga, pain relieving creams, magnets, vitamins and herbs, etc. Some have good evidence, and others have no evidence at all, therefore families are often guided by health professionals. Often doctors are happy for these therapies to be tried, however they should not replace the medications prescribed by the doctor.

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