Getting a shot in the doctor's office. Skinning a knee. Suffering from a headache. In these and other encounters with pain, girls and boys may differ in how they behave, express their pain, and perhaps even how they perceive pain, according to Patricia McGrath, Ph.D., professor of paediatrics and director, Paediatric Pain Program, Child Health Research Institute, University of Western Ontario, London, Ontario.
Girls and boys have different pain responses
A child's age, past experience with pain, and family and cultural styles, McGrath said, influences his or her response to new, painful situations. Parents serve as models. Young children often fall down, she observed, and then look at a parent for cues on how to react. In general, the younger the child, the greater his or her overt distress, and the more the child has to be physically restrained, she said, the more painful the experience will be.
Sex differences in pain responses may be apparent but are not always explainable. Boys rate having braces tightened as more severe than do girls, for example, while girls rate having a broken arm as more painful than do boys. Even so, girls, in general, grade many procedures as more painful than boys do. In comparable situations, she said, girls are more likely to be fearful and anxious, and boys to be angry.
It sometimes is hard for health professionals, and even parents, to avoid causing children pain when attending to their health. But some strategies, she said, can lessen pain. These include giving children as much control as possible over what is being done to their bodies. A child who needs to provide a blood sample, for example, can chose the finger, and perhaps even stick it, and smear the blood on a slide without help. At home, a child could wash his or her own cuts with soap and water, and put on a bandage.
With age, children inevitably encounter a variety of pains that differ in quality and intensity. Their perspective on pain changes, and they generally become more adept at dealing with pain.
Those who think of childhood as largely a care-free time, however, may be dismayed to learn that in a typical month, a normal, otherwise-healthy child averages about 4 acute pains related to injuries and diseases--falls, sore throats, sprains-- plus one achy pain, such as a headache or stomachache. Pain diaries kept by children show a diverse list of pain-causing experiences: being hit on the head with a golf club, stung by a bee, bitten by a dog, stepping on broken glass.
Many otherwise healthy and pain-free children, more often girls than boys, McGrath said, experience recurrent pain syndromes. These consist of episodes of headaches, abdominal pains, and limb pains as often as 3 or 4 times a week. In such instances, the pain usually does not reflect an underlying disease needing medical treatment, she said. The pain by itself is the problem.
Persistent pain problems in childhood may be predisposing factors for more debilitating pain in adulthood. "If we were able to better recognize and manage children's pain problems," McGrath said, "we might be able to prevent some disability in adults."
"In our clinic," she said, "we teach children that what they know, do, and feel, can influence their perception of pain." She and her colleagues try to improve children's understanding and control by giving them age-appropriate information, telling them, for example, that an injection will sting. They explain the rationale for what is happening, and they teach children simple pain-reducing coping strategies, such as active distraction.
|Chronic persistent pain is less common in children than adults, and disability also is less common in children, according to another conference speaker, Charles Berde, M.D., Ph.D., associate professor of anesthesia and pediatrics at Harvard University Medical School, and director of the Pain Treatment Service at Childrens Hospital, both in Boston, Massachusetts. "Distraction, relaxation, and other cognitive and behavioral strategies, as well as physical therapy," Berde said, "are particularly helpful for children with chronic pain syndromes."||
Distraction and relaxation can ease pain
|He and his colleagues have studied a complex regional pain syndrome known as reflex sympathetic dystrophy (RSD). This disorder involves pain with burning or coldness and other altered sensations, typically in one foot, ankle, and lower leg, but sometimes on both sides of the body. The cause is unknown.|
|"The incidence of RSD," Berde said, "rises dramatically at puberty." Adolescent girls outnumber adolescent boys by a ratio of 6 to 1 in the Boston Pain Clinics experience of 450 teenagers with this disorder.||RSD and puberty may be linked|
appears to be more common in female athletes, dancers, and gymnasts, leading some experts
to blame overuse injuries, along with nutritional and endocrine factors, psychological
stress, and pressure to succeed. "But these observations," Berde said, "are
merely correlational and say nothing about causation."
Many of the children referred to his clinic come on crutches or in wheelchairs with severe pain. A major part of treatment involves patient education and desensitization to the pain. He and his colleagues tell children, he said, "The pain is real. We believe in it, but it is not protective. It is not telling them about tissue injury, and it is not necessary for them to avoid moving or standing on the affected leg."
More than half of a group of 70 children with RSD given such treatment reported that they were pain free 2 to 5 years later. A small group, however, said they still had severe pain. "These children," Berde said, "may benefit from injections of pain-relieving medications to block nerve pathways."