When It's A Child Who Is Hurting

By MICHAEL D. LEMONICK

Doctors have long believed that children experience pain differently than adults. Unfortunately, most doctors thought kids felt pain less than grownups do, and didn't retain any memory of it. As late as the 1970s, infants underwent major surgery without anesthetics while older kids were often denied powerful pain-killers, on the theory that narcotics were too addictive and dangerous to be administered to children.

This barbaric notion was finally put to rest in the 1980s, as research proved that kids, with their still developing nervous systems, actually experience pain more intensely than adults do. But only recently have doctors begun to get serious about the problem of chronic pain in kids--even though millions of children suffer from juvenile arthritis, cancer, fibromyalgia and other extremely painful disorders. Moreover, as many as 20% of kids who undergo surgery each year develop chronic pain that lasts long after the body has healed. According to Dr. Lonnie Zeltzer, founder and director of the Pediatric Pain Program at UCLA's Mattel Children's Hospital, an operation can jump-start a child's immature nervous system, stimulating pain-sensing neurons that will keep firing indefinitely.

The UCLA program uses an innovative mind-body approach that has typically not been used before to treat chronic pediatric pain. Team members begin by taking a detailed pain history and asking kids--even as young as 4 or 5--where it hurts and exactly how bad it feels. Says Zeltzer: "You have to be a detective and put all the pieces together." The resulting treatment plan may include pain-killers, but these often have side effects--and because they're usually only tested in adults, they sometimes act unpredictably in kids. Whenever possible, Zeltzer chooses from a broad range of therapies designed to retrain the nervous system.

Kate Dunitz, 16, was plagued by chronic pain following surgery in 2004, and was prescribed a mix of healing Iyengar yoga, craniosacral massage, art therapy and hypnotherapy. The clinic also uses acupuncture, meditation and relaxation exercises. "I thought they were hocus-pocus," says Dunitz, "but I did a complete turnaround." She will return to high school full time next fall as a senior.

According to Zeltzer, some 80% of kids under 17 treated in her pain clinic also suffer from anxiety and depression, and the clinic addresses those feelings as well (so do the handful of other programs around the country that focus on pediatric pain). "It's really sad that children were so undertreated in the past," says Dr. Catherine Skae, director of Pain Service at the Children's Hospital at Montefiore in New York. "I think we've come a long way, but we still have a long way to go." --By Michael D. Lemonick. Reported by David Bjerklie/New York and Jeanne McDowell/Los Angeles

With reporting by David Bjerklie/New York; Jeanne McDowell/Los Angeles