Treating Chronic Pain in Kids and the Elderly: A Multimodal Approach is Best

The extremes of age provide special challenges to treating chronic pain.

An individualized, multifaceted approach is best for treating pediatric and geriatric patients with chronic pain, according to a review published in the Medical Clinics of North America.1

“It is important that clinicians recognize that one-size-fits-all treatment plans do not appropriately address or treat chronic pain in these special populations,” lead author Renee Manworren, PhD, APRN, BC, PCNS-BC, FAAN, from the division of pain and palliative care medicine at Connecticut Children’s Medical Center in Hartford, Connecticut, told Clinical Pain Advisor.

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Children may benefit from a multimodal treatment approach with medical, physical, psychological, and behavioral components. Elderly patients require a combination of cognitive behavioral therapy, self-management programs, rehabilitation, and exercise programs in addition to medication. 

The difficult-to-treat nature of chronic pain in these populations underscores the need for further research to better understand its development and evolution, as well as identify underlying psychosocial, physiologic, and genetic mechanisms, Dr Manworren pointed out.

“More research is needed to truly understand the vulnerability of these special populations for chronic pain, and to determine the best treatments to relieve their suffering,” Dr Manworren added.

Measuring Pediatric Chronic Pain

Pediatric chronic pain can have debilitating medical, emotional, social, functional, and economic consequences. Up to 40% of children report significant effects on school attendance, social engagement, appetite, sleep, and health service use that can persist as they grow older. Moreover, periods of rapid development may represent times of enhanced vulnerability to chronic pain, the authors write.

At least 2 measures of physical functioning have been validated for children and teens with chronic pain: the Functional Disability Inventory and the Pediatric Quality of Live Inventory (PedsQL). The PedsQL is also considered a valid measure of emotional, social, and school functioning for children aged 2 to 18.

Other well-validated measures of emotional function included the Children’s Depressive Inventory and the Revised Child Anxiety and Depression Scale, the authors note. Assessment of pain quality, timing, location, and aggravating/alleviating factors may provide vital information for diagnosis and treatment.