washingtonpost.com  > Health > Children & Youth
Correction to This Article
A March 15 Health article about chronic pain in children misidentified the institution that has begun enrolling youngsters in an acupuncture study. It is the Medical College of Wisconsin, not the University of Wisconsin.

Pain on a Smaller Scale

Support and Treatment Often Lag for Children With Chronic Pain

By Jennifer Couzin
Special to The Washington Post
Tuesday, March 15, 2005; Page HE01

At 13, I teamed up with my best friend Jill on Halloween: She was a nurse, and I dressed as an injured person. Though we wrapped my body in white gauze and Ace bandages, some of my outfit was not part of the costume. I was in my second month on crutches then, for a painful knee problem that had lingered since August, a case of bone outpacing muscle as it grew.

By spring doctors could explain why my knees had taken so long to improve: My legs didn't harbor the only bones growing astray. In May 1990, the month of my 14th birthday, I was diagnosed with scoliosis, a curvature of the spine. The development, my doctor believed, had further unbalanced my knees. Most cases of scoliosis are mild but a minority are not, and I stumbled headfirst into that category.


The Oucher Scale (www.oucher.org) helps young children gauge their pain so doctors can know if a prescribed treatment is working. Caucasian and Hispanic versions also exist. (Photo ) Mary J. Denyes And Antonia M. Villaruel)

_____Live Discussion_____
Children Living With Chronic Pain: Ken Goldschneider, head of pain management at Childrens Hospital Medical Center in Cincinnati, and Susmita Kashikar-Zuck, Associate Professor of Pediatrics at the Cincinnati Children's Hospital Medical Center, will be online at 11 a.m.
_____Graphic_____
How Pain Develops
_____From The Post_____
Sources on Relief
Treatments for Children

Within months the condition worsened. Pain radiated through my back, my ribs, my hips, my chest. Its demands for attention intruded at the most inopportune times: during French class, a Halloween party, gossip about boys.

What I didn't know then was that kids like me were everywhere.

"Most people don't think of kids as having chronic pain, but there are tragically thousands and thousands of kids who are eligible," said Laura Tosi, an orthopedic surgeon at Children's Hospital in the District.

A Dutch survey published in 2000 in the journal Pain found that 25 percent of youngsters experience chronic pain. Roughly three-quarters of such children experience headaches, abdominal pain or musculoskeletal problems, say pain experts. The rest usually have an underlying condition like cancer, sickle cell anemia or cerebral palsy.

Years of research have changed how specialists view children in pain; as recently as the 1980s, many doctors believed babies didn't feel pain, said Neil Schechter, head of the pain relief program at Connecticut Children's Medical Center, and some were operated on without anesthesia.

Today, many children and adolescents with chronic pain are thought to harbor hyperactive nerves relentlessly firing pain signals, said Lonnie Zeltzer, head of the pediatric pain program at the University of California, Los Angeles (UCLA). Pain might start from something as simple as a bout of stomach flu.

"Everybody [in the family] gets better except for one child" who's left with persistent abdominal pain for reasons doctors don't understand, said Zeltzer. "It really becomes a neurologic problem."

It can become a psychological problem as well if a child has trouble convincing doctors that the pain he's feeling is real. Doctors are often uncertain about what causes pain in kids -- and what relieves it -- and treatment is often delayed.


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