Child life specialists at Holland Bloorview Kids Rehabilitation Hospital are empowering young patients to take control of their pain and helping parents develop strategies to support their kids.

The response to pain is not simply a result of tissue or nerve damage, but rather a combination of both physical and psychological variables. “Literature shows that the best approach to pain management is a blend of pharmacological and non-pharmacological interventions,” says Breanne Mathers, child life specialist at Holland Bloorview. “With this in mind, we create individual plans to proactively manage pain rather than chasing it.”

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While strategies are patient-directed, families can also play an important role in pain management. This is especially true when a patient has communication challenges since parents can often recognize subtle pain indicators. Mathers says that patients and families should not resign themselves to a certain level of expected pain since patients as young as four years old can be taught pain management strategies.

“Parents often report that they feel there is nothing they can do about watching their child in pain. When parents are taught non-pharmacological pain management techniques, they can proactively coach their child to manage pain. Parents are then empowered when hospital staff is not at the bedside or when the child is at home.”

Mathers and other child life specialists at Holland Bloorview run a group for patients and families to teach them about pain management. Patients and families attend 30 minute sessions to become familiar with a variety of non-pharmacological techniques to reduce acute, chronic or recurrent pain. Session topics include humour, multisensory environments like Snoezelen, distraction boxes and advocacy. Feedback from the sessions shows it has been an effective way to provide information to patients and their families while helping them learn how to support each other.

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Patients can experiment with a variety of techniques to find those best suited to their needs. Some patients may find cognitive techniques like distraction and imagery to be most effective while others may prefer behavioural techniques like meditation or deep breathing. There are also a range of biophysical techniques like heat therapy and massage as well as emotional expression strategies such as art. Once learned, pain management strategies have also been shown to be effective tools for managing stress, anxiety and nausea.

Successful pain management requires a plan that outlines personalized goals that can be assessed and adjusted regularly. Communication both ways between the health care team and the patient and family is paramount to the success of the plan. Honest explanations from clinicians about procedures that may cause pain can go a long way in reducing the patient’s anxiety. In fact, the act of developing a plan in itself helps to minimize fear and can give patients a sense of control over the situation.

The individualized plan should also include an outline of which medications will be used and an explanation of how each works. Explaining to patients the type of pain a medication will target, along with an understanding of how it works, will complement non-pharmacological strategies.

Clients at Holland Bloorview generally have stays that are long enough to trial different techniques and master skills, however, patients experiencing shorter stays can quickly learn certain pain management techniques. Simpler strategies like therapeutic touch, deep breathing and management of physical space can be implemented with little instruction. In all cases, patients should be encouraged to have a dialogue about pain management rather than simply accepting pharmacological strategies as the total plan.

Ideas for a patient distraction box:

• Party blowers and pinwheels that encourage deep breathing
• Bubbles for deep-breathing and therapeutic popping
• Squishy items like stressballs for therapeutic touch and massage
• Toys like dinky cars can bring attention to or away from pain area
• CDs with calming music
• Joke book or other items that employ humour
• Hot or cold packs