Dr.

Connelly and his colleagues have developed a brief multidimensional pain assessment tool for pediatric rheumatology called Super-KIDZ that assesses pain features and impact on functioning, coping, and mood. When tested among 24 children aged 4-7 years and 77 youth, aged 8-18 years, completing the measure online took about 5 minutes, just slightly longer compared with a paper version. Most children preferred the computer version, as did a test group of rheumatologists and pain experts, who said they would recommend the computer summary to their colleagues (Pediatr. Rheumatol. Online J. 2012 Apr 10;10:7. [Epub ahead of print]). SuperKIDZ is still undergoing additional validation testing as well as translation. Eventually, the Child Arthritis and Research Rheumatology Alliance site may host the tool online, making it available to providers to use, Dr. Connelly said in an interview. Among other top 10 tips Dr. Connelly offered for why kids are not just "little adults" when it comes to pain were: Pain behaviors vary from child to child; some kids react to pain by sleeping or eating more, other by doing so less. Some children may curl up and become inactive or cling to their parents, while others may actually run around the room to distract themselves from pain, he said. Minor pains are not so minor. Clinicians need to be proactive in treating kids pain because even pain from minor procedures can set up a child for more pain in the future, he said. Long-term consequences of undertreated pain include hypersensitivity, hyperinnervation, wind-up of pain pathways, and avoidance of health care. Chronic pain can be disabling. It is the minority of children that are disabled by persistent pain, but for those who are, there can be increased direct and indirect costs totaling about $12,000 per year, resulting from social and school difficulties, increased depression and anxiety, and loss of activity and disability into adulthood. When Dr. Connelly and his colleagues asked nine school-age children with juvenile idiopathic arthritis and their parents to use electronic diaries thrice daily to assess their pain, the children reported reducing up to 82% of total activities at any given assessment (J. Pain Symptom Manage. 2010;39:579-90). Kids live with their parents. Parents responses to a childs pain can facilitate or hinder functioning. Natural protective behaviors, catastrophizing, personal distress, and modeling of disability are just some of the factors that come into play. The key here is to make parents an essential partner in lessening pediatric pain and disability.

 Childrens pain is plastic. Regardless of disease presentation, a variety of continually changing biological, social, and psychological factors can influence how children experience and express pain. They can include repeated experiences of pain in infancy, hospital experiences, understanding of health care, school or social failures, emotional lability and social isolation. Thus, pain assessment and treatment should always be based on a biopsychosocial understanding of pain. Kids go to school, except when they dont. Having children medical homebound is generally contraindicated for treatment of persistent pain in children because of a growing body of evidence showing that regular exercise and maintenance of routines is beneficial, Dr. Connelly said. Providers can help facilitate regular school attendance by writing an accommodations plan that may include a modified physical education curriculum, additional time or rest breaks in a quiet area, extra time for tests/assignments, or a modified school day. Interdisciplinary treatment is recommended for pediatric pain whenever possible. Such teamwork can pull together experts in medication support and interventional pain procedures as well as such nonpharmacologic methods as pain education, pain coping skills training, family counseling, physical therapy, acupuncture, and massage. Dr. Connelly reported research grants from the National Institute of Neurological Disorders and Stroke, National Institute of Arthritis and Musculoskeletal and Skin Diseases, and the Arthritis Foundation and Mayday Foundation.