Lessons about pediatric pain and JRA






You can file this blog post under "Things you might not know unless someone tells you, so I am telling you."

I am not an expert in pain by any means, but I learned a simple lesson once that I wanted to express.  It is so simple to remember and I am disappointed that I learned it a little too late.

Anyway, for a real expert on pain I refer you to Bronnie Thompson's blog at http://healthskills.wordpress.com/  Her blog is my final destination when I want to learn more about pain issues.

On to when I learned my first real lesson about pain.

Today I was reading an interesting article about the Numerical Rating Scale that you can find here.  The scale is imperfect, and it really doesn't work for children all the time.  For kids we use things like the Faces scale that seems easier for them to understand.  Still, degree of pain is an elusive thing to measure in kids - and Lacey taught me that better than anyone.  I remembered her today when I read that article because the author talks about the limitations of pain scales.

Lacey was a nine year old little girl who has juvenile rheumatoid arthritis.  I saw her for therapy many years ago; I am sure she must be in her thirties by now.  I like to think that I was a good (albeit new and inexperienced) occupational therapist and I knew just about everything out of the book that there was to know about JRA.  I studied the disease process. I read all my textbooks. I talked to the rheumatologist and got all the information I needed to have. I studied the effects of different medications she was on.  I took her range of motion measurements diligently.  I made her the exact splints that the MD ordered.  I worked on the exact kinds of activities and goals that the MD and family wanted.  And I was gentle when I did range of motion.

I think that is why I was kind of shocked when I saw little tears welling up in Lacey's eyes.  I didn't understand.  I was moving her fingers so slowly and so gently.  I was watching her closely to make sure I would have noticed the slightest change in her respiration or any other sign that would have indicated any discomfort.  And then I made one of the most uninformed statements that I ever made in my therapy career that still rings in my ears all these years later:

"Oh Lacey, I am so sorry.  I thought I told you to let me know if I did anything to hurt your fingers when we were doing therapy."

And then a little nine year old child gave me the lesson about JRA and pain that I will never forget.  She said back to me through too many tears, "It's really OK.  But my fingers always hurt.  What am I going to say?"

That is why I know that pain scales don't always work with kids.

Comments

Your Therapy Source Inc said…
I always find it amazing as to what the children teach us!!!! Great post. I just wrote a post suggesting that children create a list of tips and suggestions for other children. Wouldn't it be great to have an ongoing list of suggestions such as ways to decrease pain based on their own experiences.
8:30 PM
Post a Comment

Popular posts from this blog

On retained primitive reflexes

Each year I receive several emails from colleagues about 'retained primitive reflexes.'  I am also seeing an increased number of reports from local 'health care' providers who are documenting these alleged problems so I thought I would write a summary of my opinion on this topic.   Predatory 'health care' providers including some OTs, PTs, chiropractors, and behavioral optometrists are creating a new 'market' for treating this alleged 'problem.'  Parents should be very wary of these practitioners and other professionals should challenge these practices whenever they are seen. The following is the kind of information that causes concern and was provided to me by a colleague as a sample from a student's IEP: The student continues to demonstrate the following retained primitive reflexes that at times interfere with his ability to demonstrate appropriate adaptive responses: Fear Paralysis Reflex, Moro Reflex, Palmer Reflex, Tonic Labyri
Read more

Deconstructing the myth of clothing sensitivity as a 'sensory processing disorder'

Please note first that there is no formally recognized clinical designation of  'sensory processing disorder.'   It is a term constructed by occupational therapists that has not been formally recognized by the larger medical community. In our clinic we receive many referrals from local pediatricians when parents have concerns about children being overly sensitive to their clothing.  Most often the children referred are from four to seven years old and the families are severely disrupted by the children's behaviors and responses to clothing issues.  Commonly, children will have severely constricted tolerance for certain outfits, want to wear the same clothes repeatedly, complain that clothing is itchy/scratch/bumpy/wiggly/ouchie, and this all leads to disruption of daily dressing routines.  There is no doubt that the behavioral concerns are very real. The pediatricians tend to be appropriately conservative and provide families with good behavioral management suggestions
Read more

A Critical Appraisal of Therapeutic Listening

Image
History: According to Frick (2002, p. 358), auditory training has been used in Europe since the mid-1900s to address sensory processing disorders and these techniques have been recently popularized in the United States. Frick has based her Therapeutic Listening program on the work of Dr. Alfred Tomatis and Dr. Guy Berard, both of whom are French physicians. Both the Tomatis and Berard programs are delivered by specific machines using earphones but these devices do not have FDA approval and have been banned in the United States (Barrett, 2003). Frick (2001) states “With the advent of new technology, similar altered music has become available on compact disc. The discs do not replace either the Tomatis Method or the Berard Method. The compact discs do provide a less intense way to access both the auditory and vestibular systems to impact neural function and integration and are easily available to clinicians in a variety of practice arenas.” The CDs referenced on Frick’s webpages are ass
Read more