Carl Maronich (Host): There are a few things more difficult for a parent than seeing their child in pain. Today we are going to be talking about chronic pain in children, just how to navigate this very challenging issue. Welcome to UK HealthCast, a podcast presented by UK Healthcare. I'm Carl Maronich, your host. And joining us in this conversation on chronic pain in children is Dr. Tanesha Johnson. Doctor, welcome.

Tanesha Johnson, PhD: Hi.

Host: Let's start perhaps by talking a little bit about your background and kind of what led you to this specialty.

Tanesha Johnson, PhD: Yeah, so I did grad school at St. Louis University and while I was there, I got the opportunity to work at St. Louis Children's Hospital in their chronic pain clinic. And it was so amazing and I got to learn a lot about how we can like support children as they're navigating their chronic pain.

And so since then I've been like searching and trying to integrate that into my practice here at UK.

Host: So you're a Pediatric Clinical Psychologist.

Tanesha Johnson, PhD: Yup.

Host: And obviously been studying chronic pain in children for some time.

Tanesha Johnson, PhD: Yeah, I feel like there's been lots of new treatment modalities. I feel like psychology and pain teams have really come together and have a really great collaboration now of like how to do both of like supporting the chronic pain from the mental health side and the physical health side.

Host: Well, maybe we should start by defining, if you will, chronic pain, particularly in children and how that kind of presents and all that around that issue.

Tanesha Johnson, PhD: Yeah, so chronic pain I like to think about is sort of like a seatbelt. And so when you're in your car, you put on your seatbelt, the pinging stops, right? Like when you don't have your seatbelt in, it pings, you put the seatbelt on. It stops pinging. Chronic pain is like you put the seatbelt in the buckle, but your body is still pinging.

It's still saying there's lots and lots of pain. Chronic pain is something that we would think is above and beyond what would be like a normal amount of pain for a significant amount of time. So we're thinking like 3, 6, 9 months past when we would expect the pain to sort of start to decrease for a child.

Host: Yeah. And children especially difficult. How does a parent really determine if it's chronic pain or just other discomfort that the child may be going through?

Tanesha Johnson, PhD: Yeah, so parents can always talk with their pediatrician if they're feeling like the pain is above and beyond what we would expect. Like if a child falls off the monkey bars, we would expect them to be injured for maybe a couple of weeks and maybe start to get better, start to get back to their lives.

But if the pain is still significantly impacting their lives where they're unable to school, they're not able to spend time with friends or do the activities that they want to do; that's when we start to move into the chronic pain sort of space.

Host: Regionally, is there anything about where folks are? And does that play a part in any of this?

Tanesha Johnson, PhD: Yeah. I feel like in the Midwest, especially, we have a lot of kids with chronic pain conditions like pancreatitis, like sickle cell disease, like CPRS, complex regional pain syndrome. I think that it's just maybe because our kids are outside more and they're playing more and our bodies are used to like being more active.

And then when our bodies have a hard time or get like stuck in that pain loop, I feel like our kids come here and we are able to like help them a little bit more. I think it's just maybe a Midwest kind of thing, but we do see it other places. But I feel like here in the Midwest we have a lot of kids experiencing chronic pain.

Host: Yeah. Around this issue, what are some of the things that patients and their parents probably more so, are worried about when they hear this diagnosis?

Tanesha Johnson, PhD: I think what parents are most worried about is how is this going to impact their lives? How are they going to have to adjust to a child's chronic pain? What does this mean for like their life and what they're going to be able to do? Like some kids are really active in sports, and so when kids are diagnosed with chronic pain, sometimes there's like this upheaval of their lives of like, we have to stop doing all of these things. Where I think that for kids it's more like, how am I going to get to school when I'm in this much pain? Am I going to be able to see my friends? I think for some families it's a lot of going back and forth to the hospital, which is really complex because you have to have resources to be able to come to the hospital and see your providers. And so I think, those are some of the bigger things that come up of just like, how is this going to be a drop in a bucket and on the ripple effects into our lives?

Host: And you help navigate that obviously when a parent comes to you with that concern.

Tanesha Johnson, PhD: Yeah. So what I like to do is I try to teach parents and kids how to be in the driver's seat of their lives versus letting pain be the driver of their lives. And so I talk with parents about, sometimes this feels very counterintuitive to try to keep your kid in the normal activities of going to school, playing their sports with modifications, being social as they were before they had this chronic pain diagnosis; because we really want our kids to have fulfilled and happy lives. And sometimes chronic pain interrupts their ability to do that. And so what I like to do is teach kids we can hold onto chronic pain like in our back pocket, but we really want you to be the driving force of your life.

Host: Now certainly, medication and things that kids could put on to moderate this and to and to help with it. But there are also non medical, non medicine treatments and such. Maybe you can speak a little bit to that.

Tanesha Johnson, PhD: Yeah, so some of the things that I teach kids are like behavioral strategies, like how do we relax our body? Because when we're in pain, our body tends to tense up. Our muscles are tight, we shallow breathe, and so I teach kids really how to intentionally relax their body because our bodies can't be tense and relax at the same time.

And so as we're teaching kids to relax their bodies in the face of pain, we will also teach them, okay, like this pain is a drop in our bucket, but we can adjust the things that we want to do in our lives. Maybe this is like attending school regularly. Maybe this is being able to go to their sporting events.

Maybe not necessarily playing the whole game, but adjusting and pacing themselves so that they are able to return to the things that they really love. Sometimes it looks like just moving their bodies in a different way. Maybe that's like with stretching or yoga or with physical therapy or with some of the like alternative medicines like aromatherapy, acupuncture, massage therapy, and so trying to find ways to modify what the kids are wanting to do and what important to their families, and just moving pain to the side so that we can get to those other things.

Carl Maronich (Host): We are very much a fix things now society, so I'm sure when this comes up, parents are often let's, you know, give me the pill I can give to my child to make it better. And as you're saying, that isn't always going to work. So I'm sure one of the challenges for you is to convincing the parent that you've gotta look at some of these alternatives.

Tanesha Johnson, PhD: Yeah, and sometimes I think I try to preface it with families of like, this is the long game, right? Chronic pain is going to be there and it's chronic because it lasts a long time. The same way some of our like non-pharm pain management strategies like these are going to take time to build the skills, to practice them, and to integrate them into your lives. It's not like a quick fix, but it will fix it eventually.

Host: Are there children that are better candidates for some of these kind of treatments than others?

Tanesha Johnson, PhD: I think kids who are ready to go back to their lives, I think are really good candidates. I don't know that there's a specific like diagnosis that this works best for. I think really it matters if like the kid and the parents are like, okay, we have this diagnosis and we're really motivated to start moving the ball forward as the medical team is figuring out like the pharmacological part of their pain and like what's causing it and how to treat it.

If parents are also like, okay, what do we do in the meantime? Those are really great candidates for starting to teach them non-pharm pain management strategies because they're motivated. They're like, what else can I do to help my kid?

Host: And, kind of in that vein, what are some resources that you might direct parents to, to get more information? I mean, the world's full of information now via the internet. What reputable sources might you send parents to, to get some information?

Tanesha Johnson, PhD: Yeah, so I would always recommend talking to the person who is like your pain management specialist. So maybe that's your physician, whoever that is, talking to them first to see if they have any resources. The other thing is looking at some of the bigger hospital systems, they have chronic pain summer camps.

The one that I always recommend to families is the MEG Foundation, M-E-G Foundation. They have a wonderful, wonderful, free website that has chronic pain management worksheets, teaching resources for parents, how to navigate like the hospital system when you have chronic pain. It is a wonderful, wonderful resource that I always send parents, not just for chronic pain, but for like acute pain.

And even when your kid has just some needle phobia or struggling with getting pokes, the website has so many, so many, so many free resources. That is my favorite one to recommend to parents.

Host: I'm guessing at some point this becomes a family issue, not just the parent and child, but siblings need to have some input or certainly they experience all this as well. Does that come up in your practice?

Tanesha Johnson, PhD: Yeah, so I often talk about pain as a drop in the bucket, and then there's all these ripple effects. And the ripple effects include your entire family. So sometimes parents will stop doing fun activities because they're like, oh, little Johnny has pain. We don't want to make the pain worse.

And so then other kids start to miss out too. But I think getting the whole family on board of like pain is there and we might have to adjust what we do as a family, but like holding it in our pockets. And so sometimes that's having siblings come in and talk about the impact that their sibling's pain is having on them and talking about how we can adjust to make the whole family adjust or be cognizant of pain, but not let it impact and influence what they do as a family.

Host: Well, chronic pain, certainly a challenging issue for parents and children and the entire family, as you've said. Dr. Tanesha Johnson, a Pediatric Clinical Psychologist. Anything we didn't address that you want to mention or reinforce?

Tanesha Johnson, PhD: I just want to reinforce that just because you meet with the pediatric psychologist for pain does not mean that your pain is not real or that we don't believe that your child is in pain. It really is like a partnership with their physical health. We know that mental health and physical health are really partners and they like coincide with one another. And so we really want to strategize as like as the medical team is doing their part, how can we support the mental health to do that part?

Host: Absolutely. Well, Dr. Johnson, thanks so much. A lot of great information, hopefully helping parents navigate these challenging waters, as we said. And for more information, you can go to UKhealthcare.uky.edu. Thanks for listening to the UK HealthCast, the podcast from UK Healthcare.