When we think of chronic pain, many of us picture adults—perhaps someone older or carrying years of physical or emotional stress. But the reality is that children can experience chronic pain too, and often, it’s even harder for them to explain what they’re feeling.
Kids may complain of daily stomachaches, tension headaches, joint or limb pain, or simply say, “I just don’t feel good,” without any clear explanation. Sometimes, they avoid school, sports, or play—not necessarily because they don’t want to participate, but because their body is signaling pain that doesn’t seem to go away. And unlike adults, kids often don’t have the language to describe what’s happening or the tools to cope with it.
“You’re braver than you believe, smarter than you think, and stronger than you seem.” ~ Christopher Robin
A Hidden Struggle for Many Families
Research estimates that 20% to 35% of children and adolescents are affected by chronic pain worldwide. While most aren’t severely disabled by it, it still takes a toll on school attendance, emotional health, family life, and day-to-day joy.
Even more concerning: if chronic pain isn’t addressed early, it can persist into adulthood and raise the risk of anxiety, depression, and long-term disability. One study found that up to 80% of adults with chronic pain had symptoms that began in childhood.
Palermo T., Eccleston C., Goldschneider K., McGinn K.L., Sethna N., Schechter N., Turner H. Assessment and Management of Children with Chronic Pain. A Position Statement from the American Pain Society. [(accessed on 13 July 2018)]; Available online: http://americanpainsociety.org/uploads/about/position-statements/Pediatric%20Pain%20Policy.pdf
Research
Functional pain syndrome is known as primary pain—where pain is the primary problem, not secondary to an injury or structural disorder. This is common, but underdiagnosed and undertreated in children and teens.
Acute nociceptive pain may exist from tissue injury, whereas the pathophysiology of chronic pain often turns to nociplastic (from a sensitized nervous system) or psycho-social-spiritual-emotional pain. In this case, medication is not the first-line treatment. Rather, the correct approach combines integrative mind-body techniques, psychology, and “getting back to life”, or reintegrating to school, sports, and social life.
Naturally, kids are afraid of pain—but that fear can actually make pain feel worse. Research shows that when children or parents catastrophize the pain experience, symptoms increase and patients have a harder time coping. When parents focus too much on the pain, this will even shape how kids remember and think about that pain later on!
Fear of pain impacts both physical and mental health. The good news is that helping kids feel less afraid of pain is linked to better outcomes. There is a strong connection between being afraid of pain and being more disabled by it. Psychological intervention involving psychoeducation and evidence gathering is key to reducing fear and helping kids function better and feel less stuck in their pain.
Mind-body techniques like guided imagery, mindfulness, breathing strategies, hypnosis, biofeedback, and yoga can aid recovery by tapping into the body’s natural pain control systems. For example, guided imagery can trigger the release of endogenous opioids (natural painkillers) in the brain. These help activate pathways that tell the body to dial down pain signals before they even reach the brain—like flipping a switch to quiet the pain at its source.
Friedrichsdorf SJ, Giordano J, Desai Dakoji K, Warmuth A, Daughtry C, Schulz CA. Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints. Children (Basel). 2016 Dec 10;3(4):42. doi: 10.3390/children3040042. PMID: 27973405; PMCID: PMC5184817.
What Parents Should Know
If your child seems to be in pain frequently without a clear diagnosis, you’re not imagining things—and they’re not making it up. Their pain is real. And more importantly, they can recover.
Common chronic pain presentations in kids include:
– Stomachaches, IBS, or other abdominal pain
– Headaches or migraines
– Musculoskeletal/joint pain or unexplained fatigue
– Complex regional pain syndrome
– Numbness, paralysis, inability to speak, or other neurologic symptoms not explained by medical evaluation or diagnostic testing
– Recurrent flare-ups that don’t respond to traditional treatment
Often, these symptoms are tied to a sensitive or overactive nervous system which can send danger signals even with no physical damage. This is known as primary pain disorder or neuroplastic pain.
So What Can Help?
Pain Reprocessing Therapy (PRT) is an evidence-based approach to treating chronic pain by helping the brain and nervous system relearn what is truly dangerous, and what isn’t. This is especially important for kids, who are still developing cognitively, physically and emotionally.
PRT helps children:
– Understand their pain is real and reversible
– Learn simple, age-appropriate tools to regulate stress and nervous system responses
– Develop confidence in their body again
– Step in for themselves, take breaks, and ask for what they need so that pain does not have to do it for them
– Re-engage with normal life (school, play, friendships) without fear
A Note of Hope
Even when your child’s pain has persisted for months (or years), healing is possible. We’ve seen it happen, and research supports it. Kids are incredibly resilient when given the right support, understanding, and tools. Just as the brain can learn pain, it can also unlearn it. The brains of kids and teens are more plastic and flexible than those of adults, making it even easier and faster to unlearn their pain.
Later this year, we’ll be sharing more resources around PRT for teens, including a new workbook to help providers, families, and teenagers navigate complex chronic symptoms.
If you’re a parent, caregiver, or practitioner working with kids in pain, stay with us—we’ll keep sharing tools and hope.