Pain on a Smaller Scale

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)

Instead, Schwartz determined that surgery had aggravated nerves in Casey's leg, causing neuropathic pain -- pain that is caused by damaged nerves. Skin patches embedded with the local anesthetic lidocaine and the drug amitriptyline, a tricyclic antidepressant, eliminated his pain within a month. Even after he stopped the drugs, Casey's pain stayed away.

That Casey's pain ebbed after one drug but not another is no surprise, because pain comes in many flavors. Acute pain -- the kind people think of most often -- usually signals a tissue injury. Nerve endings called nocioceptors -- there are millions in the body -- sense that something is awry and send a signal to the brain, which interprets the message as pain. Acute pain acts as a crucial warning system, alerting us when something goes wrong.

But when it comes to chronic pain, normally defined as lasting longer than three months, pain may no longer serve a useful purpose. Bruised nerves can send pain signals even when there's no obvious injury or disease. Other types of long-term pain can come from chronic diseases, like sickle cell anemia, that aggravate tissues over time. Certain pain, like abdominal pain, is more common in children than adults, but mostly the biology of pain in children is not known to be distinct.

When relief is slow to arrive, sometimes children and teenagers teach themselves ways to cope.

Maggie Chesnut, from Putnam Valley, N.Y., was 7 years old when she began experiencing vicious bouts of stomach pain several times a week. It took seven years for doctors to diagnose her with celiac disease, an inability to tolerate foods containing gluten, like wheat and other grain products. Meanwhile, Maggie found she could deflect attention from pain by taking baths. Beginning when she was around 9, she said, "I would feel the water and learn to separate my mind from the pain, concentrate on the water, separate my body from my mind."

Maggie didn't know it, but she was on to something: Her use of distraction mirrors some of the best pediatric pain treatments. Other UCLA "golden rules" include exercising, improving sleep and easing anxiety.

Now 17, Maggie also has a golden rule of her own: reaching out to others with chronic pain. Last summer, she launched a teen discussion group tied to the American Chronic Pain Association.

"I don't want other kids to feel ashamed about something that is in no way their fault," she said.

Head Images

In college, my attention swings from literature to chest pain from a twisted rib cage. My clothes hang loose because pain is shaving away my appetite. Friends prompt me in the dining hall: "One more tater tot! One more mouthful of tomato soup!"

As pain becomes more disabling, I make the decision I've resisted for years. Two weeks after my 20th birthday I undergo nine hours of surgery in which my spine is straightened and 11 vertebrae fused with donor bone and steel. The operation, at Boston Children's Hospital, erases about half my pain by easing inflammation.