Juvenile Idiopathic Arthritis: Pain Management

Topic Overview

Most children who have juvenile idiopathic arthritis (JIA) will have some pain and discomfort from the disease. The pain of JIA is related to the type and severity of the disease, the child's pain threshold, and emotional and psychological factors. Pain limits a child's ability to function. With care and good communication with your child's doctor, it is possible to provide some, if not total, relief.

How to know if your child is in pain

Pain can be difficult for a child to describe. Also, a child isn't always able to recognize a sensation as pain. An older child may be able to describe tingling, cramping, or sharp sensations and may be able to tell where and when the sensation occurs. When a young child is in pain, the signs can be hard to recognize.

Signs that may mean your child is in pain include:

• Changes in usual behavior. Your child may eat less or become fussy or restless.
• Crying, grunting, or breath-holding.
• Crying that can't be comforted.
• Facial expressions, such as a furrowed brow, a wrinkled forehead, closed eyes, or an angry appearance.
• Sleep changes, such as waking often or sleeping more or less than usual. Even children in severe pain may take short naps because they are tired.
• Body movements, such as making fists, guarding a part of the body (especially while walking), kicking, clinging, or not moving.

Some children may deny that they are in pain because they are afraid of medical procedures. For example, admitting that they are in pain might mean blood tests, which may be painful themselves. Some children may try to ignore their pain rather than take medicines, which often have discomforting side effects. Pain isn't a visible symptom, so you and your child's treatment team will need to rely on your child as the primary source of information on the status of his or her pain. Only your child knows if pain is present. And experts say that children rarely pretend to have pain.

Managing your child's pain

Your child's JIA treatment plan should include regular assessments of pain and what to do to relieve it, starting with medicines such as nonsteroidal anti-inflammatory drugs (NSAIDs). Pain, stiffness, and swelling can change in intensity from day to day. So be sure to learn how to assess your child's condition, which often requires being sensitive to signs of pain on a daily basis.

The following may help relieve some pain:

• Therapists can teach your child techniques to deal with pain or pain-causing times. These techniques include distraction, humor, relaxation exercises, and allowing the child to have some control over what is happening to him or her. Cognitive-behavioral therapy is another way for your child to learn positive techniques for dealing with pain.
• Relaxation exercises, such as progressive muscle relaxation, guided imagery, and hypnotic suggestion, are examples of strategies that can help your child learn to manage pain. You may also want to try meditative breathing exercises, such as breathing exercises and belly-breathing.
• Heat can be a great reliever of pain for your child. Taking baths can provide soothing moist heat, and hot packs set on a low-to-medium setting can be applied off and on throughout the day and night. Do not use heat if your child's joint are red and warm. If you have access to a swimming pool, you may want to try pool therapy, which provides an inviting environment for exercises.
• Exercise can help with pain, but don't allow your child to overexert while exercising. Encourage your child to attend school, even at times of discomfort, but work with the school to make your child's special needs an accepted part of the routine.
• Distraction can take your child's mind off of the pain. Having conversations with or reading to your child can give your child something to focus on besides the pain. Doing fun activities with your child can also help.

Your child's pain may be more manageable if he or she is in good general health. Children with JIA need more rest, such as frequent naps or quiet periods, than most other children do. This increased time devoted to rest, coupled with the side effects of some medicines, can lead to a weight problem. Offer a balanced diet to your child, and don't neglect your health and that of your other family members. You are all in this together.