Psychiatric Considerations in Pediatric Chronic Pain

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience,” which recognizes both the physiological and psychological aspects of pain. According to the Biobehavioral Model of Pediatric Pain (Varni 1989), biological factors (e.g., temperament, age, gender, cognitive development), family factors, cognitive perceptions, coping styles, and perception of social support work together to influence the experience of pain. Each of these cognitive, emotional, and physiological variables can have an exacerbating or ameliorating effect on pain management; therefore, each is a potential target for intervention. The psychological aspects of chronic pain have received increased attention due to concerns about the many potentially negative consequences related to pediatric chronic pain such as missed school, restrictions in daily activities and emotional and behavioral problems (Varni 1989). In pediatric populations, the impact of chronic pain is not limited to the patient, but also affects, and is affected by, the family as well. Parents, especially, play an important role in how children and adolescents cope with pain. The purpose of this chapter is to provide an overview of psychiatric considerations in pediatric chronic pain including the psychological factors that influence perceptions and management of chronic pain in children and adolescents, and associated psychiatric problems. In particular, there will be an exploration of the cognitive and behavioral aspects that mediate the pain experience and coping, review of psychiatric problems such as anxiety, depression, and somatoform disorders as they relate to pediatric pain, and the impact of chronic pain on school functioning.