Chronic pain is characterized by low energy, an imbalance in brain hormones, reduced mental performance, and the development of mood disorders. It is also commonly associated with anxiety and depression, which can become aggravated when the body undergoes neurochemical changes that increase a person’s sensitivity to pain. Dealing with pain is especially difficult for teenagers who are going through simultaneous physical and emotional transformations. However, with technological devices permeating most aspects of an adolescent’s life, teens may already have the very tools they need to help them overcome the hurdles of chronic pain and manage it more effectively.
Teenagers and Pain
Diagnosing and treating chronic pain can be highly complex, given that individuals often can’t pinpoint the exact source of the pain. Even if the original injury or condition that triggered the pain has healed, the pain can persist. Young people struggle with communicating their experiences, which can sometimes make it easy for parents and health-care professionals to dismiss complaints of pain.
Communicating with young people can also be difficult for pediatricians. The Mayo Clinic in Rochester, Minnesota, has a special pain rehabilitation program specifically for pediatric patients who experience debilitating chronic pain. The objective of the program is to assist teens in learning how to relieve their emotional distress and live a more functional and active lifestyle. Achieving successful rehabilitation may be a challenge when it comes to adolescents, who often do not see any appeal in brochures or other non-interactive learning resources.
Dealing effectively with pain during the early years is paramount. If chronic pain is not addressed during the teen years, individuals will most likely struggle with it well into their adulthood. However, the number of young people hospitalized for chronic pain has been increasing. Between 2004 and 2010, the number grew ninefold. During an interview with CNN in 2015, pediatrician John Stork, M.D., said, “We tend not to think of children as having chronic pain, but it’s actually a relatively common problem. Sometimes, as many as 20 percent of children have been thought to have some degree of chronic pain.”
The teenage years are emotionally, socially, physically, and academically formative. Chronic pain can negatively affect a teenager’s mood and overall well-being, leading to missing school and reduced future employment opportunities if grades suffer. Pain can also interfere with a teenager’s functioning at home and in his or her social circles, which can be particularly damaging to self-esteem. “For teenagers, what matters is a group, not family,” says Zbigniew Kirkor, M.D., Ph.D., a consultant in anesthesia and pain medicine who heads the Pain Clinic at the Princess Royal Hospital in Telford, England. “It could be a group at school, a sports team, or hobby mates. They seek acceptance from their group; they want to belong. Suddenly, with chronic pain, they are no longer able to perform, belong, or find acceptance. That’s a real tragedy that adults might underestimate.”
Pain is an indication of a problem that needs attention, and this problem may not always be of a physical nature. Chronic pain could be the manifestation of a social, psychological, or family-related issue, says Kirkor. He shares a telling experience with a teen girl who came into his clinic complaining about severe and constant abdominal pains. The girl was performing well at school and in her ballet classes, and her family was proud of her accomplishments. “It took months of hard work to figure out that the girl hated doing ballet. The moment she stopped her classes, her pain vanished,” he says. “In situations such as this, it becomes vital to be able to talk to the patient alone, without parents or guardians present.”
Still, communicating with teenagers on a meaningful level is a tricky business. Teens think and feel differently from adults, and reaching out to them requires a different and more modern approach, which is where a digital connection can play a fundamental role.
Digitizing Pain Management
Mobile applications for pain management may uniquely be suited to providing a solution for teens living with chronic pain. Technological gadgets, apps, and web-based services are more in tune with how young people communicate and express themselves. “Apps are a great idea,” says Kirkor, “because mobile devices and the Internet are things that teenagers are so familiar with.”
Apps can be developed to provide pain education and pain management services, and learning about the condition can be made more appealing to young people, according to a recent paper in the Journal of Opioid Management. They also offer the benefit of reducing the amount of time taken away from school or social events, which often happens when teens need to attend clinical appointments. Control of their lifestyle and personal goals is placed back in their hands, which can be extremely empowering.
However, teens and their parents, caregivers, and pediatricians must also be cautious and selective when deciding which apps to use. A systematic review found that most pain apps lack input from health-care professionals or evidence-based pain management features. Part of the criteria for selection should be that some of the developers or visionaries of the app are practicing physicians to ensure that the services embedded in the app are evidence-based. Two examples of such apps are iBeatPain and Pain Squad.
Pediatricians at the Mayo Clinic’s Minnesota campus, together with the Mayo Clinic Center for Innovation, developed the iBeatPain app. Pediatric anesthesiologist Tracy Harrison, M.D., and pediatric psychologist Jennifer Fisher, Ph.D, L.P., were the visionaries of the project. In Harrison’s clinical experience, coming up with treatment and exercise recommendations for young people often takes a joint effort of experts from pediatric psychology, pain medicine, and physical medicine. Communicating instructions to the patient is another obstacle. Therefore, Harrison and Fisher started developing the app, knowing that health-care professionals needed a better tool to help young patients define their pain-related goals and daily tasks, which can quickly become overwhelming.
The app facilitates setting goals, which could be something as simple as waking up at the same time every day and later could progress to something as complicated as signing up for a sports event. Starting with small, realistic goals can help teens moderate their activities. Achieving minor goals helps teenagers stay focused and learn to hold themselves accountable.
iBeatPain also encourages self-care, and teens can personalize the features of the app to suit their needs, preferences, and rehabilitation objectives, as well as track their own progress. Some of the features include “Practice relaxation,” “Participate in school,” “Get regular sleep,” “Engage in self-care,” and “Exercise.” The app also has a unique feature called the “Inspiration box,” where users can attach images, videos, or quotes to keep them motivated.
Cynthia Harbeck-Weber, Ph.D., L.P., a pediatric psychologist at Mayo’s Minnesota campus who was part of the development team for iBeatPain, explained in an interview with PsychUpdate that the app was not intended to provide medical assessments about the cause of pain. Rather, it is a tool for young people to learn how to achieve holistic functional mobility. “Our goal is to help them learn to relax their bodies to take the focus off pain and instead move forward with the lives they want to have,” she explained.
Developed by the Improving Outcomes in Child Health through Technology (iOUCH) research team of the Hospital for Sick Children (SickKids) in Toronto, the Pain Squad app was designed for children ages 8-18 who live with cancer-related chronic pain.
Researchers at SickKids needed a consistent way of acquiring data from pediatric cancer patients, but after receiving various types of therapies, young patients often felt defeated and struggled to maintain a journal that chronicled their pain.
The app was packaged as a game in which the user could play the role of an enlisted officer to the special police group dedicated to hunting down pain. The group is called the Pain Squad. The patient is only required to enter his or her pain details once in the morning and once in the evening. In the app, however, this is referred to as their “mission” to report on pain twice daily, every day. With a user-friendly interface that is easy for children to understand and use, the app can monitor the general area where the pain is coming from, the intensity of the pain, and which medications or activities make the pain better or worse.
The app has an excellent motivation model as well, in which children who consistently use the app are “promoted” into higher-ranking positions in the squad. They also receive special messages directly from squad headquarters. Additionally, inspirational videos from the cast of the top two police television dramas in Canada, “Rookie Blue” and “Flashpoint,” are interwoven into the app to reinforce user behavior and ensure that children consistently report their daily condition.
In a promotional video for the app, one mother of a young girl with cancer said, “The app is an excellent tool. That’s her control over the pain because she is able to document it herself when she’s using the app. She just glides right through it, and it makes her feel that she is a part of this [treatment process].”
The results of the self-reported outcomes can be printed as a chart so patients, parents, and physicians can sit together and evaluate the child’s progress.
Getting Everyone on Board
Although they may not admit it, teens need all the support they can get when it comes to pain management. Using apps such as iBeatPain and Pain Squad may appeal to young people, but for them to be successful in the long-term, physicians, therapists, caregivers, parents, and other family members must collaborate closely.
Documenting and managing pain digitally also makes the physician’s job easier. Results can complement consultations with pediatricians and other health-care providers, making the use of apps (or other methods of consistent reporting) an important component in improvement of mental health. Working closely with physicians in the use of pain-management apps is also necessary to ensure that teens and parents are selecting the most appropriate and effective app available.
One of the most valuable benefits of social and mobile platforms is the creation of a community in which teenagers can find people like themselves. They can use the apps to find stories shared by other teenagers, while physicians can use them to bring young patients together in the same room. “Both social media and support groups may and should play a vital role in chronic pain management among teenagers,” Kirkor says. “I think it is very important for such patients to be able to belong to a group of similar young people with the same pain problems.”
Many options are offered to people who struggle with chronic pain: medication, meditation, counseling, hypnosis, and alternatives such as acupuncture and yoga. However, if the right approaches are not used, teens with chronic pain will continue to find pain management challenging, and doctors will continue to struggle to relay their treatment recommendations. Living with pain can be extremely difficult for anyone, but particularly for teens. Fortunately, overcoming the hurdles is not completely out of reach, especially with current technological innovations in pain management. Such innovations can go a long way in helping teens living with pain grow into adults with the self-management skills they need to function and live well.