Cognitive Behavioral Approaches

Cognitive-behavioral techniques not only have direct effects on symptoms but also promote self-efficacy by increasing the child's ability to self-manage symptoms. Although parents may need an initial explanation so as to understand how the techniques can alter physiological function to provide symptom relief, parents are often pleased to have their children learn skills that can work synergistically with

Table 9-4. Clinical interview topics


Description of pain: Location, quality, intensity, duration, variability, predictability, exacerbating and alleviating factors, types of pain under differing circumstances

Impact of pain: School attendance, school performance, homework, social activities, family, parents, siblings, chores, physical ability, eating, sleep

Pain beliefs: Etiology, prognosis, dangerousness, treatment approaches that will be helpful or unhelpful

Pain coping: Child's response to pain, child's ability to self-manage pain, parents' responses to child's pain, others' responses to child's pain, child's typical coping strategies and temperament

Pain history: Past hospitalizations (including premature birth), medical procedures, injuries, trauma, other significant illnesses, sensory overload, opioid use, other past treatments for pain (home remedies, alternative/ complementary therapies)

Comorbid symptoms and stressors

Other physical symptoms: Other pain, sensory sensitivity, fatigue, nausea, tachycardia, sweating, shaking, shortness of breath, choking, lump in throat, chest pain, dizziness, numbness or tingling, chills, hot flashes

Psychopathology: Anxiety disorders (including separation, generalized anxiety, panic, obsessive-compulsive, phobias, posttraumatic stress), depression, complicated grief, pervasive developmental disorders

Family functioning: Parental or sibling illness, disability, psychopathology, substance abuse, chronic pain, poor coping, conflict, discipline styles

Other stressors: Academic, social, athletic, extracurricular, developmental milestones, familial, health of self or others medications. Sometimes such techniques allow children to avoid medications and their possible side effects completely. Strategies include parent training, family interventions, psychotherapy, cognitive-behavioral therapy, relaxation, distraction, guided imagery and hypnotherapy, and biofeedback. Expertise with the techniques requires training and practice. Randomized trials provide evidence of efficacy for children and adolescents with functional abdominal pain, irritable bowel syndrome, headaches, procedural pain, and burn pain (Damen et al. 2006; Duarte et al. 2006; Hicks et al. 2006; Hoffman et al. 2008; Humphreys and Gevirtz 2000; Robins et al. 2005; Sanders et al. 1994; Stinson et al. 2008; Trautmann et al. 2006; Uman et al. 2006; Vlieger et al. 2007; Weydert et al. 2006). Preliminary research results are promising for children and adolescents with pain related to cancer, sickle cell anemia, complex regional pain syndrome, and arthritis (Lee et al. 2002; Walco et al. 1999; Wilder 2006). Following are brief descriptions of these somewhat overlapping interventions.

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