Pain and JIA

Managing Pain

JIA (juvenile idiopathic arthritis) is the most common type of arthritis in children and young people under the age of 16.

Pain is the most common and distressing symptom of JIA.  Living with pain can be really difficult. Pain has been found to negatively impact all aspects of functioning, including physical activity, it may reduce their participation in school, being involved with social and family activities may be impacted, and may have an effect on them emotionally.

It can also result in sleep disruption and poor sleep quality, which in turn can cause daytime fatigue, reduced mood and increased sensitivity to pain, essentially creating an ongoing pain cycle. See our Rest and Sleep tips, on how to give your child the best chance of a good refreshing sleep.

A range of interventions, including medicines, use of hot and cold treatments, relaxation and distraction techniques, deep breathing, massage, gentle stretching and exercise can assist in relieving pain. See the information on Practical tips when having a painful or unpleasant procedure, these suggestions can also help when your child is experiencing a flare, and is in pain.

Please discuss pain management with your child’s medical professional.

There are many positive tools and strategics to assist you and your child with their pain

Types of Pain

There are two types of pain

Acute pain begins suddenly and doesn’t last for too long.

Chronic pain, sometimes called persistent or long-term, is pain that last longer than three months.

Chronic pain in a JIA child

Sometimes a child with JIA may require a multidisciplinary approach in managing chronic pain. The specialized team will provide you and your child with techniques and skills aimed at limiting the impact of pain on your child’s physical, psychological health and their social and educational development.

 

There is many as 20 to 30% of children and teenagers have pain that keeps going for longer than 3 months. This is called chronic pain. The NZ Starship Complex Pain Team sees about 100 to 120 new patients each year with chronic pain.

What causes chronic pain?

Pain is part of the body’s alarm system. When it happens following an injury or as part of an illness, the pain will usually go away as the body heals. When pain keeps going for a long time, it doesn’t mean the area is still being damaged. In fact, doctors often can’t find any reason for why the area is still sore. So why does it keep hurting? When pain has been there for a while, our body can get better and better at sending a warning (alarm bells) to the brain. This confuses our brain (like a false alarm) and it keeps telling us we have pain. This can mean just a touch to the skin, or a change in temperature can cause pain from a “false alarm”, so things that didn’t feel sore before, now do and things that only hurt a little bit now HURT A LOT! Chronic pain does not respond to the same treatments as acute pain (like rest and the usual pain medicines).

 

As pain becomes chronic, changes occur in the nervous system, including in the brain. New pathways are formed and chemicals involved in pain signalling increase. This means that pain can continue to be experienced even after the initial trigger has gone. These changes need not be permanent. The process can be reversed and the pain can improve by learning pain management strategies and accessing agencies that will provide support.

What will happen to my child?

Chronic pain may sometimes be associated with changes in temperature, colour, sweating and sensitivity of the skin, but not always. Pain is an unpleasant experience and therefore frequently results in feelings of sadness, anger, irritability and frustration. Chronic pain can stop a young person doing the things they enjoy. When the young person stops doing those enjoyable activities, their mood can get worse, and in turn so can the pain. This can be a vicious cycle.

What can be done to help my child?

Helping young people with chronic pain requires multidisciplinary care. A team of health care professionals may be involved in their care and in working with their school.  

 These may include:

  • Family doctor
  • Rheumatologist
  • Pain specialist doctor
  • Physiotherapist/exercise physiologist/osteopath
  • Occupational therapist
  • Psychologist/counsellor/psychiatrist
  • Specialty nurse
  • Music and art therapist

The team may help your child in some of the following areas:

  • Physical Management
    • Graded activity including exercise and stretches
    • Relaxation therapy
  • Mood and sleep
    • Good quality sleep
    • Healthy thinking habits
    • Socializing with friends and loved ones
  • Medicines
    • A number of medications may have a role under the supervision of a specialized team
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What will happen in the future?

For some young people, chronic pain will disappear with time. For others, it may last a very long time or re-occur from time to time. There will be no damage to the body and the body will continue to work normally. Understanding the chronic pain condition, what causes it to flare up for an individual, and how to manage those flares, will enable the young person to lead a full life.

Pain Resources

Pain Toolkit – The pain toolkit is a simple guide that gives you some handy tips and skills to help you to understand and manage pain better. (For young people and teenagers living with pain).

 

Starship’s Paediatric Complex Pain Team has a useful resource explaining pain. Download it here.