Chronic pain: the impact on children and adolescents

The Bath Centre for Pain Services is a national centre of excellence providing treatment for people of all ages (children to older adults) from across the UK and internationally, with all types of complex chronic pain. The service offers residential interventions to groups and individuals, to children and families and offer consultations to professionals. The treatment model is based on Acceptance and Commitment Therapy, which gives a foundation for the interdisciplinary team to deliver creative and innovative rehabilitation. We have been working at the Bath Centre for Pain Services as part of our undergraduate degree for over nine months. During our time on placement, as the third year of a four-year degree, our roles have been to support the team and observe group and individual programmes.

Having no experience and limited understanding of chronic pain before joining the service, this placement experience has opened our eyes to the wider impacts of chronic pain in adolescent lives. We only left school a few years ago ourselves – being a similar age to some of the patients at the service, we were able to relate to being a young person and the pressures that arise at this age. However, adolescents who come into this service also carry the pressures of having a chronic pain condition, making the journey into adolescence and young-adult life significantly more challenging.

However, whilst this therapy is applied to both adults and adolescents, at Bath Centre for Pain Services we have observed how the programmes are adapted for young people to focus on the specific areas of life that can be impacted when experiencing chronic pain. Young people and their parents can often, understandably, feel distressed and stuck, unsure how to move forward. They may find it difficult to complete activities that are developmentally appropriate for their age, such as education, going out with friends or participating in sport. Further, these tasks may also promote anxiety in the adolescents' caregivers, as such activities may induce a pain flare. Therefore, the programme seeks to support young people in pursuing their goals in the presence of negative emotions and physical sensations to move closer towards their values in life, such as independence or creativity.

Our role during treatment was to support adults, adolescents and parents to achieve goals they had set. With adolescent patients, this might include supporting them on trips to town or to a public gym. Understandably many of these challenges can cause anxiety and distress. We would often encourage adolescents to approach tasks independently, whilst remaining nearby, in order to encourage the use of developmentally appropriate skills such as assertive communication and problem solving; for example, asking for assistance in shops. In this role, it was a pleasure to support patients and to see their confidence grow throughout the course of treatment.

Collecting research data is an important part of the work done at BCPS. We were responsible for distributing and recording patient questionnaires. Patients at the service complete pre-, post- and follow up outcome measures which allow clinicians to understand the physical and emotional impacts of chronic pain for each patient. Patients could also contribute their questionnaires to the Bath Centre for Pain research database, allowing researchers at BCPS to produce clinically relevant life-span research on chronic pain. For instance, exploring the mechanisms and relationships between chronic pain, physical disability, and distress. Throughout placement, we were required to enter collected data, keeping the databases up-to-date and professionally organised. We also had the opportunity to contribute to research projects on placement such as service audits and research posters. One poster was presented at the British Pain Society Annual Scientific Meeting 2022. It was also our responsibility to create weekly timetables for staff and patients. We would coordinate staff and allocate specific timings for sessions to ensure the treatment day ran efficiently. 

We had regular educational opportunities to enhance our understanding of chronic pain. We would attend weekly in service training sessions where different topics within the field of chronic pain were taught, weekly team clinical development meetings, and attending the quarterly Bath Pain Forum – international researchers and clinicians are invited to present. Working in an interdisciplinary team meant that we had daily discussions with different clinicians (physiotherapists, occupational therapists, psychologists, doctors and nurses) at the service who would share their knowledge and answer any questions we had. We found this hugely beneficial to supporting our placement and education, as chronic pain is broad and complex field to understand. Having this deeper knowledge then allowed more insight with regards to what patients at the service might be dealing with on a daily basis.

When we began our placement, we both had times when we felt anxious and overwhelmed. This helped us to relate to patients arriving here. The new experiences that we have had have helped to build our confidence and independence. People with chronic pain can find it hard to seek out new experiences and often feel too distressed about how they might manage this. Experience helps to prepare a young person for adulthood and to identify career goals and aspirations, which is challenging enough without chronic pain.

By observing how the different programmes work, assisting on outdoor activities and sessions involving adolescents, we have come closer to understanding the wider impacts that chronic pain has on adolescents, other than just physical experience. Therefore, we thought it was important to create a visual poster that captivates some of the wider implications of chronic pain [see main picture]. We wanted to raise awareness and make sure both adolescents and parents did not feel alone in their experience, by combining the observations we have made whilst on placement and current research in the chronic pain literature.

Comment from BCPS: "Thank you so much Carlie and Cerys. It has been wonderful to be a part of your journey. For others considering a professional placement, it can be very challenging and a very rewarding experience."

If you would like to find out more about the programmes at the Bath Centre for Pain Services please visit: www.bathcentreforpainservices.nhs.uk