Coping With Pain

About Pain

Pain is subjective — that is, pain is experienced differently by different people and the only way to know if someone is in pain is by talking with them and seeing how they act. Since you know your child best, doctors may rely on you to help them understand your child’s pain.

All pain has three parts:

• Biology
• Emotions
• Thoughts

Feeling nervous, scared or anxious makes pain worse. Thinking a lot about it and paying a lot of attention to your pain also makes it worse. Think about a time when you had to bring your toddler to the doctors’ office for an injection — he or she probably cried and screamed even before they got the shot. They fussed and fussed after getting the shot as if the injection was the worst thing in the world. Now think about a day when you were giving your same toddler a bath and noticed a bump or bruise from falling down while playing — did your child react the same way to the pain from that bruise that he or she did to the pain from the shot? They may not even recall how they received the injury. Feeling scared and paying attention to the pain makes a big difference in how we experience it.

Coping with Pain – What Can We Do About Each Part?

Biology
There are medications and creams that can help block or reduce the pain your child is experiencing, and they differ for different kinds of pains. For a discussion of medical or “pharmacological” options, review the information for a specific test in the Tests and Procedures section.

Emotions
It’s normal to feel scared or nervous before a medical procedure or any other big event. Take professional athletes, for example. Even though they are very good at what they do, they still get nervous and have to manage their feelings so that they can perform well. Have you ever watched a professional athlete right before the big event starts? What have you seen them do? Perhaps you’ve seen some athletes wearing headphones on the sidelines before the game starts. What do you think listening to music does for them — make them more tense? Probably not, or they wouldn’t do it. How about more relaxed? Next time you see a basketball game, watch what a player does as he or she is standing on the foul line ready to take a free throw shot. Most athletes take a slow breath right before taking the shot — just one way of helping their bodies and feelings stay calm.

To help your child feel more calm and relaxed, think about the things that normally relax and soothe your child — music, reading, etc. These things can help keep your child calm before a procedure is ready to begin. One of the most important things you can do to help your child cope is to stay calm yourself. Children and teens read body language pretty well. A grimace when you see the needle or turning away in horror when you see the procedure start, are cues that this is going to hurt! Now, it is very hard to watch your child in pain and it is okay to look away from the needle or whatever is happening, but it’s really important to communicate to your child that this is something they can handle. Staying cool and calm shows that you believe they can handle it.

Remember, you’re not in this alone. Talk with your child’s doctors, nurses, psychologists, social workers or pain specialists about ways to help manage your child’s pain.

Here are some other tips to help your child right before and during a procedure:

• Breathe slowly. When people are nervous or panicking, their breathing gets fast and their heart beat goes up. To stay calm, do the opposite — breathe slowly. It is hard to be nervous or scared when you are breathing slowly and calmly. This also gets a child’s focus onto something besides the procedure—they are thinking about breathing.
• Hold your hand still and make it relax. Give your child the job of holding his or hand still and making it relax. Your child can put his or her hand wherever it’s comfortable — a lap, resting on the arm of a chair or bed, etc. If your child’s hand is really shaky, you can put your hand on top of it to help him or her relax it. As your child calms down, you can remove your hand or keep it on; you can let your child decide. Again, it is hard to be scared when your hands are calm and relaxed. You will also notice that you usually have to breathe slowly to keep your hand relaxed. The beauty of this exercise is that your child can do it anywhere, anytime without anyone even noticing! This makes it a good trick to use when feeling nervous before a test or a presentation at school, or before a big sports event.

Thoughts
Before the procedure begins, thinking about how much it’s going to hurt and how hard it’s going to be to get through it can make your child more nervous, therefore increasing his or her pain. During the procedure, paying a lot of attention to the pain, watching what is happening and thinking a lot about it also make pain worse. Here are some ideas to help your child manage their thoughts and attention to pain.

• Think about something else. If your child is worrying about the procedure, talk about other things or read a book or magazine, tell stories or sing songs. Anything interesting to get his or her mind off it!
• Distraction. Focus your child’s attention on something more fun and engaging — a toy, a video, bubbles, etc. — and away from the pain and procedure.³ The best activities for distraction are simple, very appealing and require some response that you can easily see so you know whether your child is engaged or needs more encouragement. Also, the activity shouldn’t interfere with the medical procedure (so things that require a lot of action are not good for keeping children still during the procedure). Examples are toys, musical toys, party blowers, windmills, videogames, videos, singing, telling stories, books such as “Where’s Waldo” and counting. You can use anything your child really likes. For younger children, introducing a new toy might be appealing. For older children, letting them choose enjoyable music, magazines or videos can be helpful. Special video games or apps are also especially appealing.
• Go to your favorite place. Coach your child to use his or her imagination and pretend to be in a favorite place — this can be anywhere your child likes to go! Your child should relax, breathe slowly, close their eyes and imagine all the things that he or she would be able to see, hear, touch and feel in the favorite place. Older kids are usually pretty good at using their imagination to go to their favorite place. It can be fun to find out what your child’s favorite place is and how it compares to yours. Children sometimes have more “active” scenes that relax them compared to adults (e.g., amusement parks). Just talking about favorite places is distracting even if you don’t go there in your imagination.

3. Blount RL, Piira T, Cohen L. Management of pediatric pain and distress due to medical procedures. Handbook of pediatric psychology. 2003;3:216-233.