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.


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.

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