Excerpt: 'Conquering Your Child's Chronic Pain'

May 10, 2005 — -- A nationally recognized leader in the field of pediatric pain management, Dr. Lonnie K. Zeltzer's book, "Conquering Your Child's Chronic Pain," offers an invaluable guide to control the pain that plagues your child, from headaches to arthritis, irritable bowel syndrome, fibromyalgia, and more.

Drawing on more than 30 years of study and combining modern medicine with complementary methods such as hypnotherapy, yoga, acupuncture, and biofeedback, Zeltzer explains how to soothe the nervous system, find the most effective medications, use relaxation techniques and more.

You can read an excerpt from the book below.

Chapter One: What Is Pain?

That which hurts, also instructs.

-- Benjamin Franklin

Mark is a 14-year-old whose gastroenterologist could not find a cause for the chronic esophageal pain he had had for four months, during which he was unable to eat, sleep, attend school, or engage in other normal activities. Mark initially had developed significant pain when swallowing, which continued until a yeast infection was diagnosed and treated. By that time, however, he had had the pain for six weeks and had missed the first month of school. After the infection was gone, his pain remained, despite a normal-appearing esophagus. Mark began spending hours during the day crying, moaning, and scratching at his chest. Instead of getting better, his pain was getting worse.

• • •

It can start quite suddenly.

Your daughter complains about a stomachache, which you attribute to the fast food she gobbled down at dinner the night before. Soon you notice she is complaining of similar aches in her stomach every few days. A couple of days later, you notice her limping and rubbing her leg. When you ask her about it, she says her leg feels hot and prickly. The complaints seem unconnected, but you take her to the pediatrician for the stomach problems. The doctor attributes the stomachaches to nerves. "After all," he says, "the new school year is approaching." The leg pain, he attributes to normal "growing pains." "All children get them," he assures you. Fast forward: It is one year and dozens of doctors later. Your daughter is still in pain. In fact, the pain is much worse and has traveled to other areas of her body. She is attending school sporadically, and she shows little interest in the things she once loved, such as her friends and gymnastics. What's more, you are still no closer to knowing what is causing the pain. Your nerves are frazzled; you are missing work, are fighting with your husband, and feel guilty all the time. "How did this happen?" you ask yourself.

Pain is much more than an uncomfortable sensation that we all would like to keep our children from experiencing. It can affect a child's ability to breathe easily, perform everyday tasks and activities, and eat normally. It also interferes with sleep and energy, and it alters mood and disrupts relationships.

You may be just beginning the journey to understanding your child's pain, or you may have been struggling with it for years. You may be feeling many of the symptoms of what I call the "parent pain burnout syndrome" -- fear, confusion, frustration, anger, and helplessness. You are not alone. One in five children in the United States suffers from some form of chronic pain. That means that at least the same number or more parents are suffering right along with those children.

Pain, in one form or another, is a part of every child's life experience. Some children are fortunate to experience only common cuts and bruises, whereas others experience more serious injury, illness, or disease. Some types of pain can be useful, because they teach children what is dangerous (e.g., touching a hot stove) or alert parents to a condition that needs immediate attention (e.g., acute pain in the right lower belly associated with appendicitis). However, chronic pain never serves a useful purpose. It is the most misunderstood of all childhood conditions for which parents seek pediatric help.

Chronic Versus Acute Pain

Teresa, nine years old, had the flu and developed abdominal pain. Two different doctors told her that it was just the flu and not to worry. However, her belly pain got worse. It turned out that she had a ruptured appendix; she spent two weeks in the hospital. (Parents: Most cases of appendicitis are readily diagnosed not only by belly pain but also by physical examination and the child's white blood cell count, so please don't worry every time your child has a stomachache.)

Teresa had a five-inch incision from her navel to her pelvic bone that had to remain open to allow the wound to drain. She experienced severe postoperative and daily procedural pain when the surgeons cleaned her wound. After Teresa came home from the hospital, her mother, Deana, had to clean the wound so that it would continue to drain. This daily process caused Teresa excruciating pain. For Deana, performing this task while her child screamed in pain was torture. The wound eventually drained and healed, but Teresa's belly pain persisted.

Teresa started to fear going to the bathroom because of the pain and began having trouble sleeping at night. The director of pediatric surgery at the hospital and two specialists told Deana that Teresa's pain was "all in her head" and that she "was going to have to live with it." They also believed that Teresa must have "a low pain tolerance" -- rather ironic, considering what she had already endured.

Finally, a gastroenterologist was consulted. He was appalled and told Deana, "No child should have to experience or live with this kind of pain." A simple statement, but it was a tremendous relief to both Teresa and her mom because they had begun to feel that they were crazy. Despite his empathy, however, the gastroenterologist did not know how to help Teresa.

Today, nearly five years later, Teresa still suffers from some pain, although she has found many ways to alleviate much of it -- including massage, Iyengar yoga, biofeedback, and low doses of the antidepressant Elavil and the antianxiety drug Effexor.

• • •

Pain generally has two basic forms -- acute and chronic. Although most people think of all pain as pretty much the same and so approach it the same way, there are important differences between the two. Approaching them with the same mind-set may result in prolonging a child's chronic pain. Also, inadequate treatment of acute pain or pain associated with medical procedures or injuries may actually worsen chronic pain or lead to the development of chronic pain.

The foregoing is excerpted from "Conquering Your Child's Chronic Pain" by Lonnie Zeltzer and Christina Blackett Schlank. Copyright © 2005 by Lonnie Zeltzer and Christian Blackett. All rights reserved. No part of this book may be used or reproduced without written permission from HarperCollins Publishers.