Pain management for all conditions

Where does it hurt?

Pain is a complex and unique experience that affects all areas of a child’s life. Whether the pain is caused by an injury or illness or extends beyond the expected time of healing, it can affect your child’s activities, eating and drinking, and impact relationships, school, family life and sleep.

At Children’s Hospitals and Clinics of Minnesota, we treat pain in kids due to any cause. From small injuries and blood tests to complex diseases, there are countless reasons a child may experience pain.

Some of the painful conditions we address in the hospital and pain clinic include:

Acute pain

Acute pain is caused by damage or inflammation of tissue and needs to be aggressively treated to ensure that children heal faster. Examples include:

  • Pain after surgery
  • Pain with illness such as infection
  • Cancer pain
  • Injury including broken bones and tissue damage
  • Painful flares of disease such as sickle cell anemia and ulcerative colitis
  • Nerve pain

Chronic pain

Longer lasting pain, which continues after the expected time of healing, is often called chronic or complex pain. Research has shown that this in fact is real pain, and may be triggered by injury or illness, or may just occur “out of the blue.”

Children and families who experience chronic pain may see an increase of hopelessness, loss of dreams and goals, increased stress, sleep disturbances and symptoms of depression or anxiety. Without an effective and intense intervention, the cycle can continue. Kids with chronic pain become adults with chronic pain. But we won’t let that happen. Instead, we see children at the pain clinic and through an interdisciplinary approach, we teach them to manage their pain.

Types of chronic pain include:

  • Functional or recurrent abdominal pain
  • Complex regional pain syndrome, a chronic pain condition that may be due to damage or dysfunction within the peripheral and central nervous systems. It most often affects one of the limbs such as the arms, legs, hands or feet
  • Muscle and joint pain such as arthritis and fibromyalgia
  • Tension headaches, chronic daily headaches and migraines
  • Pain from conditions that may be in remission but still cause daily pain (e.g. inflammatory bowel disease, sickle cell anemia and rheumatoid arthritis)

Procedural pain

Research at Children’s in 2013 showed that children consider needle pokes as the worst pain experience in a hospital and clinic. We are working on improving procedure pain with procedures such as:

  • IV starts and lab draw
  • Vaccinations
  • Sutures
  • Urinary catheterizations
  • Wound dressing changes

Age considerations

We always consider a child’s age when determining the best way to control pain. What works for a newborn is different from what works for a toddler and what works for a teenager. For instance, when it comes to preventing procedural pain due to a vaccination, a patient’s age largely determines the pain-control techniques we use. Breastfeeding or sucrose pacifiers often work to soothe infants, blowing bubbles distracts toddlers, while older kids find relief in playing video games or reading a book.

Kid-friendly treatment

We take an interdisciplinary approach and combine as many services as needed to give children and families power over pain. Evidence-based research shows that the most effective pain management combines medication management with supportive and integrative, non-drug therapies to manage a child’s pain. Here are some of the techniques we use to address different types of pain:

Acute pain

  • Acupuncture and acupressure
  • Massage therapy
  • Clinical hypnosis and mental imagery
  • Aromatherapy
  • Breathing techniques
  • Distraction techniques
  • Heat and cold
  • Medication
  • Nerve blocks and epidural analgesia

Chronic pain

  • Physical therapy
  • School re-entry and re-engaging with peers
  • Breathing techniques
  • Distraction techniques
  • Massage therapy
  • Stress management and family therapy
  • Clinical hypnosis and mental imagery
  • Aromatherapy
  • Biofeedback
  • Cognitive behavioral therapy
  • Acupuncture and acupressure
  • Medication
  • Psychological counseling
  • Teen groups

Procedural pain

  • Anesthetic creams / Topical anesthesia (such as Lidocain 4% cream)
  • Sucrose solution and pacifiers
  • Comfort positioning
  • Distraction technique
  • Clinical hypnosis and mental imagery
  • Breathing techniques
  • Nitrous oxide (mild sedation) and moderate to deep sedation techniques
  • Medication

Medical Marijuana

The medical staff at Children’s Pain, Palliative Care and Integrative Medicine Clinic does NOT certify patients for medical marijuana. We have carefully reviewed the existing research and do not find that it supports the use of medical marijuana in children and teens with chronic or intractable pain. More importantly there is research that indicates there is a relationship to lower IQ, testicular cancer (in males), marijuana dependence, and mental health issues. Most importantly we feel that intractable pain, or pain that won’t go away, is uncommon in children and teens and that there is good evidence that a program the includes psychology, medical follow up, physical therapy, psychology and family support and non-medicine/integrative strategies does significantly improve pain. We will continue to review the data as more research is published.

In 2016 the American Academy of Pediatrics updated their handout for parents, which states “Despite relaxed regulations, marijuana harms developing brain” It can be found here.

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