Chronic pain in kids can be tough to treat, particularly if the pain stems from nerve damage (neuropathic pain) or is longstanding. Standard pain medications are often ineffective against neuropathic pain; in some such cases, clinicians have had better luck with drugs originally developed for depression or epilepsy. These are prescribed off-label because they haven't been proven to work against pain in children. Non-drug treatments such as physical therapy and meditation may also be prescribed, along with alternative therapies including acupuncture. In some cases pain specialists may recommend individual or family therapy to help patients and their families cope with pain.
Some of the mainstay treatments include:
Tricyclic antidepressants such as nortriptyline (Pamelor) and amitriptyline (Elavil). Many pediatric pain doctors turn to these drugs first, since they're often thought to ease pain in lower doses [than those used to treat depression]. Even at these doses, though, tricyclics can cause fatigue, dizziness, dry mouth and, sometimes, blurred vision.
Anticonvulsants. The most widely used is gabapentin (Neurontin), approved for use in adults with certain types of nerve pain, though others may also be tried. Anticonvulsants can cause some of the same side effects as tricyclic antidepressants, including fatigue and dizziness; some patients also experience difficulty concentrating, clumsiness and memory problems.
Lidocaine patches (Lidoderm). Patches that diffuse the local anesthetic lidocaine into the skin are often favored by pediatricians because they're easy to use and have few side effects. The patches are applied to the skin where there's pain, and can be kept on for up to 12 hours at a time.
Anti-inflammatory drugs. Drugs like ibuprofen and naproxen can be useful for juvenile arthritis and other inflammatory pain.
Narcotics and narcotic-like drugs. In select cases, pain specialists may recommend drugs like hydrocodone (Vicodin) and tramadol (Ultram).
Physical Therapy Many pediatric pain programs recommend intensive physical therapy, sometimes including swimming pool therapy.
Behavioral and Cognitive Therapies Some patients have reported relief from such techniques as relaxation strategies, meditation, self-hypnosis and visualization. Evidence is largely anecdotal, though some techniques are beginning to be tested in clinical trials.
Alternative Therapies Some patients and practitioners have also reported good results from alternative practices such as acupuncture, massage, yoga and herbs, though many have not been tested in pediatric pain trials. Acupuncture studies suggest the treatment can help pain, and studies in kids are ongoing.
Psychotherapy and Family Therapy Can be useful to help cope emotionally with pain and to manage stress.
-- Jennifer Couzin