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Pain 2: Strategies to manage pain for children with arthritis

Pain is subjective and will affect different people in different ways. Coping with pain is more demanding if you are very tired, depressed, or under a lot of stress. Pain from arthritis changes hourly and is caused by a combination of the following factors:

1. Inflammation in the joint may cause swelling, redness, localised heat, and loss of movement Damaged structures within the joint
2. Weakness and reduced stamina of muscles around the joint can lead to sudden muscle spasms or muscle strain from the protective tensing of muscles
3. Periods of immobility can exacerbate pain because the joints are more easily jarred (conversely slow gradual constant movement seems to help relax the joint structures)
4. Compensating action by the body can strain other muscles and joints. For example if a knee is very painful and stiff, a person may adjust their hips and spine in order to avoid bearing weight on the troubled knee. In time this will lead to other aches and pains because the body is unbalanced and working unevenly.

Strategies to manage pain

• hot packs wrapped around the joints (splash water evenly throughout a cotton towel, fold and put in centre of microwave oven, heat for approximately 1 minute - check the temperature on your cheek before administering on the child. You may need to experiment carefully about the heating time). Some commercial hot packs can be bought from high street chemists but these can be heavy for children and require more time to reset. Contents include herb and corn fillings while others contain crystallising gel. Follow the manufactures' instructions.
• Some children prefer to use a cold pack - the home version is a 1 Kg bag of frozen peas wrapped up in a soft thick towel, and then wrapped around the joint. Do not put any frozen or very cold item directly onto the skin as this could stick to and damage the child's skin.
• Ask your therapist to show you how to gently massage the child's neck or troublesome joint. This can bring effective pain relief because it relaxes the muscle and tendons around the joint. You can use baby oil or hand lotion on your hands to smooth the movement of your hands over the painful area.
• Get into a warm bath, keep moving gently, and read a story or play a relaxing tape. Favourite books or story tapes and nursery rhymes are relaxing/fun and distracting.
• Transcutaneous nerve stimulation (TeNS) is a non-invasive method of pain relief that uses electrical impulses to block pain pathways. More effective if used on particular joints, but children may find keeping still for long enough difficult. Elsewhere TeNs machines are commonly used to ease pains during pregnancy, and machines can be purchased in high street chemists. Follow manufacturers' instructions.
• Use any splints that have been prescribed for your child as these rest the joints while keeping them in a correct position.