Report calls for more awareness, better treatment of children's pain

When Laurelle Connolly was 14 years old, surgeons at the Alberta Children’s Hospital performed spinal fusion surgery on her, screwing rods into both sides of her spine.

Connolly went to see a doctor when her dance teacher noticed that her rib cage and shoulder blade were protruding. She was diagnosed with scoliosis, a condition that causes the spine to curve. The Calgary teen was sent to the Alberta Children’s Hospital (ACH) where she had spinal fusion surgery to correct it — surgeons screwed rods into both sides of her spine. She then had a second surgery to adjust a screw.

“The post-operative pain was the most pain I’ve ever had in my life," says Connolly, who was missing school and spent most of her time in bed resting. "It was excruciating. It took me around six months to recover and I never felt fully back to my old self as I was constantly in low-level pain.” 

The team at the Vi Riddell Children’s Pain and Rehabilitation Program at ACH met with Connolly, offering her treatments for her pain. “I got my life back through all the different therapies that made me so much stronger and helped me understand how to live with chronic pain. I am so grateful,” she says.

Lancet commission calls for immediate action

Dr. Kathryn Birnie, PhD, met Connolly while she was in rehabilitation and says the teen’s experience of pain is frequently the norm in Canada. Birnie, an assistant professor in the Department of Anesthesiology, Perioperative and Pain Medicine, and a member of the Alberta Children’s Hospital Research Institute (ACHRI) at the Cumming School of Medicine, is co-author of a new report calling for immediate action to help children with pain.

The findings of the Lancet Child and Adolescent Health Commission, from the University of Bath in the United Kingdom, highlight that paediatric pain is poorly recognized, assessed and treated around the world. The commission was led by an international group of paediatric pain experts and young people and families who live with pain.

“It’s time the medical community recognize the seriousness of this problem,” says Birnie. “Paediatric pain should matter to everyone, and cross-sector collaboration is needed to make a quick and effective progress.”

“We are calling for four key goals — to make childhood pain matter, to make it understood, to make it visible and to make it better,” say the report's authors.

There must be widespread recognition that too many children live with pain and that not enough is being done to support them from diagnosis through to management of long-term conditions.

The report suggests that changes to childhood pain recognition, diagnosis, assessment and management over the past 40 years have been slow. The last major intervention in the field came in the 1980s when, for the first time, it was recognized that babies experience pain. Up until that point, several routine and major operations, including heart surgery, were carried out without anesthetics.

Among its recommendations, the commission calls for an end to children experiencing pain when receiving routine vaccinations — an area where there's a great deal of science about how to do it well, but that isn't regularly put into practice. The commission authors write that chronic pain experienced in childhood is likely to continue through to adulthood and has long-term health, mental health, and economic costs. The report calls on funders, researchers and policymakers to recognize that too many young people are in pain and need help.

Pain is different for everyone

Connolly, now 20, completed the pain management therapies at ACH. These allowed her to finish high school, travel, and attend university — something she never thought she’d do. The pain she now describes as a dull ache is usually small enough that she doesn’t even notice it and she feels positive about the future.

“I’m hoping that research gives us a better understanding of the complexity of pain. Pain is never the same in two people. I want the information on new therapies available to kids in pain, the sooner in their journey the better.”

Kathryn Birnie is an assistant professor in the Department of Anesthesiology, Perioperative and Pain Medicine at the Cumming School of Medicine (CSM), and a member of the CSM’s Alberta Children’s Hospital Research Institute and The Mathison Centre for Mental Health Research & Education at the Hotchkiss Brain Institute. She is the assistant scientific director of Solutions for Kids in Pain a national mobilization knowledge network working to improve children’s pain. For more information, visit Partnering for Pain, a patient-oriented research program.

Led by the Hotchkiss Brain Institute, Brain and Mental Health is one of six research strategies guiding the University of Calgary in its Eyes High strategic direction. The strategy provides a unifying direction for brain and mental health research at the university and positions researchers to unlock new discoveries and treatments for brain health in our community.