Complex Pain
Treatment Guide
by John S. Jones, MD; Jeffrey Weiss, MD;
Alison Perkins, PT; Jeanette Smith, PhD;
Kiran Aurora, MEd;
and Anica Herrera, CTRS, CCLS
#1044
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Simple and Complex Pain
by John S. Jones, MD
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Simple and Complex Pain
Everybody feels pain sometime. Pain can be useful. It protects us from hurting our
bodies. When we have an injury, pain keeps us from hurting ourselves more.
Pain changes the way we think, feel and act. Pain that lasts a long time hurts our
relationships with our family and friends. Pain can keep us from going to school
and having fun. Pain that lasts a long time can hurt our minds as well as our
bodies. Pain can make us sad, anxious, or depressed.
Two types of pain
There are two types of pain, simple pain and complex pain.
Simple pain is also called acute pain or nociceptive pain. Medical tests can usually
find the cause of simple pain. If you break a leg, an x ray shows the broken bone.
We feel pain because our nerves act like little electric wires and send pain messages
from the injured part of our body to our brain. The pain keeps us from using the
injured area and allows time for it to heal. The main treatments for simple pain are
pain medicine and rest.
There is another type of pain that happens even when all the medical tests and Xrays are normal. This is called complex pain. Because complex pain can last a long
time, it is also called chronic pain. In complex pain, the nerves continue to send
pain signals even after the injury has healed or the illness is over. The pain can be
just as bad as when there is an injury. Complex pain is real pain!
Simple pain and complex pain have different treatments
To understand pain treatment, you need to know a little bit about the nervous
system. Nerve receptors in our skin, muscles and body can sense pressure,
temperature, and pain. The receptors use chemicals called transmitters to send
messages (called signals) along nerves. The signals go through many nerve paths
in the spinal cord up to the brain. Nerves send different signals and use different
spinal cord pathways for different things. A tickle or itch message travels on a
different pathway than a pain signal. Simple and complex pain signals travel on
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different nerve pathways.
We usually treat simple pain with medicines that keep the pain signals from
getting to the brain. Some examples of medicines for simple pain are:
acetaminophen (Tylenol), ibuprofen (Advil), narcotics (morphine and codeine), local
anesthetics, and nerve blocks.
The medicines used for simple pain don’t work on complex pain.
Complex pain signals travel to the brain with different transmitters on different
nerve and spinal cord paths. Medicines for simple pain usually don’t work for
complex pain. They may even cause addiction or make complex pain worse.
Treatment of complex pain often includes using medicines that are not usually
called pain medicines. Complex pain signals are sometimes sent through the
same pathways that affect mood, so some medicine that is used to treat depression
(antidepressants) may be used to treat complex pain. Using an antidepressant does
not mean the person imagines the pain or that the person is “crazy.” Complex pain
is real pain. Medicine used for other medical problems treat complex pain
because they target the specific transmitters and nerve pathways that send the
complex pain signals. Medicines that may be used are those that treat depression
(antidepressants), seizures (anticonvulsants), or high blood pressure
(antihypertensives).
Exercise is an important treatment for complex pain, but not for simple pain.
If you break your leg, simple pain actually helps you. Because it hurts, you stop
walking on your broken leg and give it a chance to heal. After the bone is all healed,
the nerves stop sending pain signals. The pain goes away and you can walk on the
leg again. Complex pain is different. In complex pain, the nerves continue to send
pain signals when they’re not supposed to, even after the injury has healed or the
illness is over. The nerves send signals telling us to rest the part of our body that
hurts, but these signals are wrong because rest is bad for complex pain. The right
treatment for complex pain is to be more active and get more exercise. Vigorous
exercise works by increasing brain chemicals called endorphins. Endorphins block
pain signals so you don’t feel the pain.
In complex pain, the painful areas become very sensitive. Even a very light touch
can cause bad pain. This is called sensitization. By frequently using and touching
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Pain pathways and where treatments work
pain
brain
cognitive
behavioral
therapy
antidepressants
anticonvulsants
opioids
acetaminophen
injury
local
anesthetics
NSAIDs
When the hand is injured,
it sends a message to the brain using chemical transmitters.
This picture shows where on the pathway
each of the treatments works to treat the pain.
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the painful part of the body, the nerves heal and return to normal. This is called
desensitization.
Treating complex pain
Treating complex pain based on the rehabilitative model of pain management.
1. The goal of treatment is not to take away all the pain. The goal is to learn how
to cope, return to school and normal activities, and go on with life, even if there
is some pain.
2. Medicine is only a small part of treating complex pain. Good nutrition, exercise
and physical therapy, distraction, breathing techniques, psychological counseling,
and even acupuncture can help.
3. Opioids (narcotics) are bad medicines for complex pain. Medicines like
morphine and codeine don’t take the pain away, they interfere with restful sleep
and they are addictive. Opioids decrease brain endorphins and make pain worse.
Doctors try to stop opioids in patients with complex pain. If opioids have been
used for a long time, they need to be stopped slowly to avoid withdrawal symptoms.
4. The behavior of family toward a patient with complex pain influences the
patient’s recovery and return to a normal life. Family counseling can help the family
understand complex pain, the treatment plan, and how to help the patient learn to
cope and go on with life, even if there is pain.
The health care team
Complex pain is treated with the support of a team of health care providers,
including pediatricians, pain specialists, psychiatrists, psychologists, physical
therapists, child life specialists, nutritionists, nurses, and others. Together, they
work with the patient and family to build coping skills, support healthy behaviors
and habits, and help the patient live a normal, independent life.
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Now that you’ve read this:
1. When we can tell what causes the pain with a medical test, that pain is called
___________________ pain.
2. When medical tests don’t show the cause for the pain, this pain is called _______
____________ pain.
3. Describe in your own words the difference between the treatment for simple pain
and complex pain.
4. What is the goal of treatment for complex pain?
5. Why is exercise part of the treatment plan for complex pain?
The answers are on page 41.
Written by John S. Jones, MD • Illustrated by Rebekka Takamizu
© 2009, 2010, Phoenix Children’s Hospital
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A Chronic Pain Crossword Puzzle
Across
1 Antidepressants, anticonvulsants, and antihypertensives are types of ___
4 When a very light touch causes pain, it is called ____
8 We call the group of people that treat complex pain the health care ___
Down
2 The part of the treatment plan that includes healthy food
3 The type of medicine that doesn’t work on complex pain
5 The active treatment that increases endorphins
6 The type of pain that comes with a broken leg
7 Tests don’t show a cause for this type of pain
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Answers to the Chronic Pain Crossword Puzzle
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Complex Pain and Medicine
by John S. Jones, MD
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Complex Pain and Medicine
We use many methods to treat complex pain. No single treatment cures it. We use
a team of specialists who are all experts in some aspect of pain control. Your pain
management team will teach you coping strategies, healthy behaviors, and good
habits that will help you live a normal life.
Medicine can help reduce pain, but there is no one medicine that cures complex
pain. For that reason, we use many other treatments to achieve the goal: to have a
normal daily life, even if you still have some pain.
We use many medicines to treat complex pain. Many of these medicines were
developed to treat other medical problems, such as high blood pressure, seizures,
depression, and even a stuffy nose. But these medicines reduce pain too.
Patients with complex pain have usually had pain for a long time. Often, because
their pain was severe, these patients were treated with opioids (also called
narcotics). Some common opioid medicines are morphine, hydromorphone
(Dilaudid), fentanyl, hydrocodone (Vicodin, Lortab), oxycodone (Percocet),
methadone, and codeine (Tylenol #3). Opioids work on opioid receptors in the
brain and spinal cord to block specific pain pathways. Opioids are safe and work
well for simple pain, but they are not good for complex pain.
Opioids have many side effects. These include itching, nausea, constipation, and
trouble urinating. Opioids can have complications like bad allergic reactions and
breathing problems. When patients take opioids for a long time, they need bigger
and bigger doses and can become addicted.
Besides being risky, opioids just don’t work that well for complex pain. Patients
usually say that opioids “take the edge off ” their pain, but they do not get rid of the
pain enough to let the patient have a normal life. Opioids make patients drowsy,
but they can prevent good, restful sleep. Not getting enough restful sleep is a big
problem for patients with complex pain. If they are too tired, patients won’t get the
exercise they need to get better.
With complex pain, it is important to remove opioids from the patient’s treatment
plan. If a patient with complex pain is taking opioids, doctors will try to lower the
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dose slowly until the opioids can be stopped completely.
We sometimes treat complex pain with antidepressants such as amitriptylline
(Elavil), nortriptylline (Pamelor) and duloxetine (Cymbalta). This works because
the same chemical transmitters in the nervous system that cause depression can also
send pain signals. Depression may also be a part of having complex pain, so an
antidepressant medicine may help with both the pain and the depression. Using an
antidepressant does not mean the person imagines the pain, or the person is “crazy.”
Complex pain is real pain.
Seizure medicines (anticonvulsants) treat complex pain by calming overactive
nerves. Anticonvulsants are especially useful if the pain has a sharp, shooting, or
stabbing quality. The anticonvulsants that we use the most to treat complex pain
are gabapentin (Neurontin) and pregabalin (Lyrica).
Clonidine was developed originally for stuffy noses, but doctors have found it also
works for both high blood pressure and pain. Clonidine can be given by mouth,
by IV (intravenously), or absorbed through the skin. It is good for both simple and
complex pain.
Antidepressants, anticonvulsants, and clonidine are used to treat complex pain,
but the pain management team may prescribe other medicines too. Remember,
medicine is just one tool used to achieve the goal of having a normal life and
returning to school and normal activities. Medicines work best when they are just
one part of a complete pain management plan.
Now that you’ve read this:
1. Is there any one medicine that can cure complex pain?
2. What is the goal of complex pain treatment?
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3. What type of pain do opioids treat best?
4. Name the reasons why opioids should not be used to treat complex pain.
5. Name three types of medicine that help control complex pain.
Written by John S. Jones, MD
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A Complex Pain Word Scramble
Change the order of the letters of each of these words to spell a word from this
workbook.
XCMPELO
GOINPC
IEECXRSE
LEPSE
IDSENOPRSE
LIAYMF
NINTRUIOT
CDENIMEI
The answers are on page 41.
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Lifestyle to Treat Complex Pain
by Jeffrey Weiss, MD
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Lifestyle to Treat Complex Pain
It can be hard to overcome complex pain, but there are some things that can help:
• Sleep about 9 hours each night
• Exercise every day
• Eat good foods and maintain a healthy weight
• Have fun with friends
Get a good night’s sleep
Many children with pain, especially teens, don’t get enough sleep at night. That
makes them tired during the day, which keeps them from doing the exercise they
need to do to stop their pain.
Go to bed at the same time every night. A half hour before bedtime, do things that
are calm and relaxing. Before bedtime, read, meditate, write in a journal or listen to
soft music. Remove clocks and all distracting lights from the room. The goal is to
sleep about 9 hours at night.
Watching TV, exercising, and eating will make it hard to fall asleep. Do not nap in
the afternoon and evening. Don’t have any drinks that contain caffeine.
Exercise every day
Some children with complex pain think exercise will make the pain worse. It may
hurt some, but regular exercise will improve your mood and eventually decrease
the pain. Doctors think this is due to brain chemicals called endorphins that are
stimulated by exercise. Endorphins work by giving you a “natural high” and by
blocking pain signals from getting into the brain.
Ask your doctor or physical therapist what exercises might work for you. Think
about things you like to do. Start slowly. Every day, do a little bit more. After a
few weeks, work up to at least daily 45 minutes of exercise to strengthen the parts
of your body that hurt, and 45 minutes more of hard exercise that makes your
heart rate and breathing faster.
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Healthy Food
Good food gives you the energy to exercise, and the nutrients to heal. This will also
help you stay at a healthy weight. Extra weight on your body can make pain worse.
Drinking enough water all day long is especially important in Arizona. Having too
little water in your body (dehydration) can make pain worse.
Ask your nutritionist for a balanced meal plan that will work for you. Eat the right
amount of food, not super sized portions. Eat a good breakfast every day. Make
your meals colorful, with vegetables and fruits. Fried food and drinks with lots of
sugar and caffeine can put on weight and make the pain worse.
Fun with friends
It’s hard to have fun when you’re in pain, but you can. Like the sneaker ad says, just
do it! Get out of bed, get out of your room, get out of the house and do something!
You’ll be surprised at how just doing something will distract your mind from the
pain. Staying connected with your friends will boost your mood and will also take
your mind off the pain. Make a list of all the activities you like to do. Do one
activity every day and you’ll begin to feel like you’re conquering your pain. Have
fun! Laughter is great medicine!
Now that you’ve read this:
Fill in the blanks:
1. A child or teen should sleep about _______ hours every night.
2. The brain chemical that improves mood and blocks pain is _________.
3. I need to exercise for at least __________ minutes every day.
4. Make a list of ways you like to exercise. Show the list to your nurse, doctor, or
physical therapist.
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5. Read the handout “Foods Your Child Likes to Eat” #1027. Check all the foods
you really like. Show the list to your nurse, doctor, or nutritionist.
6. Make a list of all the things you like to do with friends. Show the list to your
nurse, doctor, or physical therapist.
The answers are on page 42.
Written by Jeffrey Weiss, MD
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A Lifestyle and Chronic Pain Word Search
Words to look for
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Answers to the Lifestyle and Chronic Pain Word Search
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Physical Therapy
and Complex Pain
by Alison Perkins, PT
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Physical Therapy and Complex Pain
Exercise and physical activity is an important part of dealing with pain. Physical
therapy will help you do the activities that you could do before your pain started.
What will I do in Physical Therapy?
While you are in the hospital, you’ll have physical therapy twice a day, an hour
session in the morning and an hour session in the afternoon. During those sessions,
you will do activities that are meant to make you work hard and make your heart
beat fast. Each day, you’ll try to do these exercises faster and faster. The therapist
will push you to go as fast as you can. Usually the timed activities will not take up
the whole session and other exercises will be used to help with your complex pain.
The therapist will give you your own exercise program that will get you to use the
parts of your body that hurt. Physical therapy will also improve your overall health
and fitness level.
Will Physical Therapy make me hurt more?
In the beginning, it probably will hurt more. The goal of physical therapy is to
increase blood flow to the area that hurts. This stops nerves from sending pain
signals when they’re not supposed to. Exercise also raises the amount of endorphins
in your brain. Remember endorphins block pain. It may seem crazy but it works!
Some muscles may feel sore because you have not exercised much recently. After a
few days of therapy, the pain will begin to go down and the exercises will get easier
and easier.
Will I be completely pain free when I leave the hospital?
No, most kids go home with some pain. But when you go home, you’ll know how
to use exercise and activity to control your pain.
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What if I have pain while I’m in the hospital and I don’t think
I can do physical therapy?
When you don’t think you can do physical therapy, start doing it anyway. Then
keep doing it, to treat the pain. Complex pain is why you are getting physical
therapy. One of the most important treatments for complex pain is to get moving.
We know it is not easy to move when you hurt, but you will see, in the end, it will
lessen your pain.
If you think you may have injured a muscle, a doctor will check you. If you have a
muscle injury you may need rest, but if the muscle isn’t injured, you need to keep
treating the complex pain with physical therapy.
When you go home you will need to continue this exercise treatment. There may
be times at home when you don’t want to exercise. While you are in the hospital it
is good to learn how to get moving, even if you don’t want to. Practice ways to tell
yourself to exercise, even when you hurt.
How will I keep doing activity without physical therapy at
home?
The physical therapist will give you a home exercise program that is designed
just for you and your pain. Every day you need to get at least 45 minutes of pain
exercises for the body parts that hurt and also 45 minutes of heavy exercise that
will make you breathe fast and raise your heart rate. Strenuous activity every day
will raise your brain endorphins. There are lots of ways to get strenuous exercise,
like taking your dog for a fast walk or playing basketball with friends or family. By
the end of your stay in the hospital, you will understand how activity can help you
conquer your pain.
Will my pain come back and will it always feel the same?
Your pain may come back and it may feel different. Ask yourself, “Did I hurt myself
enough to have this much pain?” If the answer to that question is “no,” it may be
your complex pain returning. Start exercising and moving again. Don’t let the pain
start all over again.
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Now that you’ve read this:
1. True or False:
I woke up this morning and my pain has gotten worse. The doctor looked at me
and couldn’t find anything wrong (no breaks, sprains, strains). I’m going to talk to
my physical therapist and cancel therapy for today.
2. How long should your home exercise program take when you leave the hospital?
a. 10 minutes
b. 45 minutes of exercise for the parts that hurt plus 45 minutes to get my
heart rate up and to make me breathe fast.
c. 2 hours
d. 4 hours
3. An example of strenuous activity is:
a. sitting on the couch watching television
b. reading a book quietly
c. taking a 45 minute nap
d. taking a fast walk with my friends for 30 minutes
4. I successfully completed the program a few months ago but I woke up this
morning with bad back pain. I haven’t done anything different and I can’t
remember injuring my back. I should:
a. lie down and not move for a week. I really just need rest.
b. check with my doctor and then do the exercises my physical therapist
gave me.
c. immediately ask my mom to take me to the emergency room for some
pain meds.
The answers are on page 42.
Written by Alison Perkins, PT
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Coping with Complex Pain
by Jeanette Smith, PhD
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Coping with Complex Pain
So you have some kind of complex pain disorder. What does that mean? Why aren’t
the doctors just fixing it? Why can’t they just make the pain disappear?
How frustrating!
When we’re dealing with any kind of pain, we hope there is something to make it go
away fast. With strep throat, medicine makes the pain go away in a few days. With
appendicitis, a surgeon can take out the appendix and make the pain go away. But
with complex pain there is no quick fix.
There is no quick fix for diabetes either. People with diabetes have to deal with
their illness every day. Their behaviors and thoughts can help control the diabetes,
or make it worse. The goal is to manage the diabetes and learn to cope with it so
they can go on with every day activities and meet their goals. Just as we can’t make
diabetes simply go away, the same is true for complex pain. You didn’t want this
pain, but there are ways you can gain control over it.
What do we do to help day to day life with complex pain?
With complex pain, we need to do the opposite of what we do for simple pain.
When we have simple pain, we rest the part that hurts. But with complex pain, rest
often makes the pain worse. We treat complex pain by making the painful parts of
the body stronger. Resting too much only makes the pain worse.
Short term effort for long term gain
Patients with complex illnesses must focus on the long term benefits of treatment.
For instance, if patients with diabetes only thought about what makes them feel best
now, they’d never give themselves insulin shots or eat a good diet. To stay healthy,
diabetics have to think ahead about what treatments they can do now that will help
them feel better in the future. Patients with complex pain who choose to use opioid
medicines are risking addiction, which creates more problems in the long term.
Patients with complex pain who choose to rest and remain inactive, are hurting
themselves physically and emotionally in the future. It is similar to the diabetics
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who choose not to take their insulin or to eat lots of sugar because it helps them feel
better for the moment. If you don’t get the proper treatment now, you’ll end up
with long term problems, whether it’s for diabetes or complex pain.
How do we help our thoughts?
You may notice that there are times when you choose not to be active, because
you feel tired, sore, or stressed. At those times you are probably thinking thoughts
that stop you from making healthy choices. They may be thoughts like, “I’ll hurt
too much if I go to the movies with my friends.” These are negative and “self
defeating” thoughts that keep us from choosing behaviors which will help our
bodies become stronger in the future.
Many patients who do well even with complex pain say that they hurt when they
exercise, but they hurt even more when they don’t exercise. These patients know
they have to push themselves to stay involved with friends and activities.
You should try to notice when you have thoughts that stop you from making
healthy choices. Then change that thought! Instead of the negative thought, say
to yourself, “Going out to the movies will get me moving and help my body get
stronger. Being with friends will help me forget my pain for a while.” You may also
use relaxation techniques to help manage any pain or discomfort.
Another kind of thought that can hurt a person with complex pain is to expect too
much. Some people who don’t get all A’s or don’t excel in sports worry that they
are disappointing their parents or worry that they aren’t a very good person. These
types of self defeating thoughts make it more difficult to make it through the day.
These negative thoughts make pain worse. Everyone makes mistakes, and it is
impossible to be perfect at everything all the time. To help your mind and body
work in a healthier way, your psychologist can help you become aware of your
negative thoughts and help you change them to positive thoughts.
How do we help our behaviors?
With complex pain, people often stay away from friends and activities. You can
feel left out if your friends make plans without you. You might have told them
you didn’t want to go places or do things with them because of your pain. Now,
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you want to get back into living your life. You are accepting that your body may
feel sore or more tired than other people, but that won’t stop you any more. You’re
accepting that you may not “do your best” in everything, and that is OK. You’re
going to learn relaxation, problem solving and pain management skills to help you
manage your pain. You’ll then be making choices that show you can manage the
complex pain and make the most of your life.
Conclusion
You may realize that you are going to need to do a lot of work to manage your
complex pain. You may need to work to strengthen old friendships and make new
friends. You need to slowly increase your amount of exercise and strength. Sitting
at home on the couch all day hasn’t helped you physically, socially, or emotionally.
You see that now, and you know you have complex pain, but you’re not going to
let that change your life anymore. When you’re stressed, you’ll challenge your
self defeating thoughts, go for a walk, go to the gym, use relaxation and pain
management techniques, and talk with a friend.
You know stress increases your pain. Now that you’re learning how to manage
stress, you’ll be able to lead a better balanced life. You’re probably already learned
how to manage stress better than a lot of your friends. Keep working on learning
how to solve problems. Practice keeping self defeating thoughts from taking over
you mind. This will get you back on the path to living your happy life again.
Summary
• You can gain control over your complex pain.
• You can live a full life while managing the complex pain.
• Your psychologist will help you learn:
— Relaxation techniques
— How to change negative self defeating thoughts
— Problem solving
— Coping skills
• Lead a balanced life with physical activity, intellectual, spiritual, social, and
emotional support.
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Now that you’ve read this:
1. Complex pain:
a) may start from diseases or injury
b) may continue after the original injury or disease is over
c) may come from some unrecognized reason
d) all of the above
2. The best treatment for complex pain is:
a) medicine
b) cognitive behavioral psychology
c) physical therapy
d) a combination of all of the above
3. When you have complex pain, it is best to:
a) rest until you feel better
b) avoid friends until you can be more social
c) interact with friends and family
d) avoid school
4. Managing the complex pain means:
a) learning how to live a fulfilling life while managing the pain
b) learning how to accept not doing pleasurable activities
c) learning how to get others to leave you alone
d) learning how to get more medicines to make the pain go away
5. Tell your psychologist, nurse, or doctor 3 tools for choosing healthier behaviors.
6. Tell your psychologist, nurse, or doctor an example of a thought you may have
that keeps you from making a healthy choice, and how you might change it.
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7. Tell your psychologist, nurse, or doctor how spending more time with friends can
help you feel less pain.
The answers are on page 42.
Written by Jeanette Smith, PhD
© 2009, 2010, Phoenix Children’s Hospital
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Going Back to School
by Kiran Aurora, MEd
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Going Back to School
School is important in a teen or child’s life. When kids are hospitalized, they need
to continue the normal routine of school participation. The Phoenix Children’s
Hospital school, 1 Darn Cool School, lets patients continue their schooling while in
the hospital. This helps lower their anxiety levels so they feel better, physically and
mentally.
Going back to school can be scary for kids, especially if they’ve been absent for a
long time. It may be hard if their illness or injury caused medical or emotional
problems that they didn’t have before they came to the hospital. When a patient
is ready to return to school, our school re entry specialist talks with the staff at the
patient’s school to help plan for the educational and emotional needs of the child.
People with complex pain feel better when they’re going to school. Of course it can
be tough to concentrate in school if you’re tired or have pain, but going to school is
part of the treatment for complex pain.
People who have sleep problems, changing meal schedules and activity levels have
less energy and more pain and fatigue. Going to school provides a regular daily
schedule, and this can help a lot with complex pain. Get up at the same time every
morning and eat at the same time every day. Spend some time with your friends
every day.
Plan ahead before you go back to school. Meet with the school staff to work out
the details. Decide if you’ll go back part time or full time. Talk to your teacher or
counselor about your class load. Figure out how you’ll make up missed work. Ask
about taking medicine in school.
Talk to your teachers about what you will do if you have some pain at school. It’s
not good to have the nurse send you home right away. Arrange a place where you
can go to use the pain control techniques you’ve learned. Ask the teacher to let
you out of class for a few minutes to do some exercises to stretch your muscles and
decrease the pain. Take some pain medicine if you need to. Think about something
other than the pain.
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What will you tell people when you go back to school? You don’t have to give them
lots of details about your illness. Just tell them you had some pain, but are happy to
be back at school. Try practicing what you will say with a parent or a good friend.
Some people might tease you or make hurtful comments. Forget about it and work
to build friendships with people you like. Reconnect with old friends and making
new friends.
Once you’re back at school, take it easy at first. Make sure to get about 9 hours of
sleep each night. Don’t try to do too many extra activities. And ask for help if you
need it! Don’t worry if your grades aren’t as good as they used to be. Do your best.
The goal is to stay in school. School is a great treatment for pain!
Now that you’ve read this:
1. Tell your teacher, nurse, or doctor why you think it is important to go to school
every day.
2. Tell your teacher, nurse, or doctor 3 of the hardest things you may have to learn
to cope with when returning to school.
3. List 3 things you can do to make going back to school easier.
Written by Kiran Aurora, MEd
© 2009, 2010, Phoenix Children’s Hospital
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© 2009, 2010, Phoenix Children’s Hospital
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Things I Enjoy Doing
by Anica Herrera, CTRS, CCLS
© 2009, 2010, Phoenix Children’s Hospital
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© 2009, 2010, Phoenix Children’s Hospital
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Things I Enjoy Doing
Part of managing complex pain is learning how to use your free time well. The
word recreation means to refresh your health or spirits by relaxing and having fun.
You may find such activities can help get you moving, help you relax when you’re
stressed, or just distract you from your pain. These activities also help you get
together with friends and give you a chance to make new friends.
While you are in the hospital, you will be involved in activities through the Teen
Room, school assignments, and maybe the Playroom. This will help you practice
using your free time to get involved in rewarding experiences.
Every person has different interests and abilities. It is helpful for you to find out
what you enjoy doing. You may want to make a list of activities you enjoy. If you
have trouble thinking of things, on the next page is a list of fun things to do. Check
the things you like to do, and things you might want to try. It may have been a
while since you’ve felt like doing some of these activities.
Most community recreation centers offer activities for all ages and levels of skill.
This is great when trying a new sport or activity. For example, if you want to learn
to paint, a teacher can help you learn what type of painting you like best.
Learning a new activity can be fun. Don’t be afraid to try something new. You
might find a new activity that you’ll enjoy for a long time.
Now that you’ve read this:
1. List 3 new activities you would like to try.
2. List 3 challenges that may keep you from enjoying activities.
3. Decide what you will do to distract yourself from your pain. Write a plan, with a
list of things you could do. Call it: My Plan — What to do when my ____ hurts.
4. Write a plan for how you will spend your days when you get home. Call it:
My Daily Schedule.
© 2009, 2010, Phoenix Children’s Hospital
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Check all the things you like to do.
Games
p Cards
p Dominoes
p Checkers
p Chess
p Backgammon
p Puzzles
p Monopoly
p Life
p Risk
p Yahtzee
p Video Games
p Computer Games
p Other ____________
Doing Sports
p Swimming
p Bowling
p Tennis
p Jogging, Running
p Dancing
p Ping Pong
p Bicycling
p Volleyball
p Basketball
p Football
p Soccer
p Baseball
p Golf
p Billiards, Pool
p Yoga
p Other ____________
Outings
p Movies
p Shopping
p Restaurants
p Sporting Events
p Parties
p Plays
p Concerts
p Parks
p Zoo
p Museums
Other ______________
Hobbies
p Cooking
p Gardening
p Sewing
p Knitting, Crocheting
p Home Decorating
p Photography
p Woodworking
p Leather Crafts
p Auto Mechanics
p Fishing, Hunting
p Service Groups, Volunteer
p Church Groups
p Playing Instrument
p Singing
p Exercising
p Other _______________
Arts and Crafts
p Painting
p Drawing
p Ceramics
p Candle Making
p Holiday Crafts
p Clay Art
p Decorating cookies, cupcakes
p Jewelry Making
p Other ____________
Quiet Activities
p Television
p Listening to music
p Crosswords, word find
p Computer email, chatting
p Reading
p Hanging out with family
p Hanging out with friends
p Other _______________
Written by Anica Herrera, CTRS, CCLS
© 2009, 2010, Phoenix Children’s Hospital
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Outdoor
p Hiking
p Camping
p Barbecues
p Picnics
p Horseback Riding
p Backpacking
p River Rafting
p Canoeing
p Traveling
p Watching sports
p Skiing
p Snowboarding
p Games like tag
p Trampoline
p Other __________
Answers
Simple and Complex Pain - page 8
1. simple, acute, or nociceptive pain
2. complex or chronic pain
3. Treatment:
simple pain = medicine and rest;
complex pain = nutrition, sleep, exercise, physical therapy, distraction,
breathing techniques, psychological counseling, acupuncture
4. to learn how to cope, return to school, and normal activities, and go on with life,
even with some pain
5. to increase brain endorphins that block pain
Complex Pain and Medicine - page 13 - 15
1. No
2. learn coping strategies, healthy behaviors, & good habits that will help you live a
normal life
3. simple pain
4. many side effects, makes you sleepy, causes addiction, they don’t work well
5. antidepressants, seizure medicines, clonidine
Word Scramble
COMPLEX
COPING
EXERCISE
SLEEP
DEPRESSION
FAMILY
NUTRITION
MEDICINE
© 2009, 2010, Phoenix Children’s Hospital
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Lifestyle to Treat Comnplex Pain - page 19
1. 9 hours
2. endorphins
3. 90 minutes (45 minutes for the body parts that hurt and 45 minutes of hard
exercise)
Physical Therapy and Complex Pain - page 26
1. False
2. B
3. D
4. B
Coping with Complex Pain - page 31
1.
2.
3.
4.
D
D
C
A
If you want to learn more:
The Complex Pain Service. (2003). Complex pain: What to do when pain won’t
go away. Video. Vancouver: BC Children’s Hospital.
Krane, E. J. & Mitchell, D. (2005). Relieve your child’s chronic pain. New York:
Simon & Schuster.
Zeltzer, L. K., & Schlank, C. B. (2005). Conquering your child’s chronic pain: A
pediatrician’s guide for reclaiming a normal childhood. New York: HarperCollins.
© 2009, 2010, Phoenix Children’s Hospital
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If you have any questions or concerns,
p call your child’s doctor or p call ______________________
If you want to know more about child health and illness,
visit our library at The Emily Center at Phoenix Children’s Hospital
1919 East Thomas Road
Phoenix, AZ 85016
602-546-1400
866-933-6459
www.phoenixchildrens.com
Disclaimer
The information provided at this site is intended to be general information, and is provided for educational purposes only. It is
not intended to take the place of examination, treatment, or consultation with a physician. Phoenix Children’s Hospital urges
you to contact your physician with any questions you may have about a medical condition.
Tuesday, January 19, 2010 • DRAFT to family review
#1044
© 2009, 2010, Phoenix Children’s Hospital
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The Emily Center
A Guide for Treating Complex Pain
Procedure/Treatment/Home Care
Si usted desea esta información en español,
por favor pídasela a su enfermero o doctor.
Name of Health Care Provider: _______________________________ Number: 1044
For office use: Date returned: ____________ p db p nb
Family Review of Handout
Health care providers: Please teach families with this handout.
Families: Please let us know what you think of this handout.
Would you say this handout is hard to read?
easy to read?
p Yes
p No
p Yes
p No
Please circle the parts of the handout that were hard to understand.
Would you say this handout is interesting to read?
p Yes
p No
p Yes
p No
p Yes
p No
Why or why not?
Would you do anything differently after reading
this handout?
If yes, what?
After reading this handout, do you have any
questions about the subject?
If yes, what?
© 2009, 2010, Phoenix Children’s Hospital
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Is there anything you don’t like about the drawings?
p Yes
If yes, what?
What changes would you make in this handout to make it better or
easier to understand?
Please return your review of this handout to your nurse or doctor
or send it to the address below.
Fran London, MS, RN
Health Education Specialist
The Emily Center
Phoenix Children’s Hospital
1919 East Thomas Road
Phoenix, AZ 85016-7710
602-546-1395
fl[email protected]
Thank you for helping us!
© 2009, 2010, Phoenix Children’s Hospital
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p No