Pain management

Abstract

Pain constitutes a complex multi-dimensional phenomena comprising of sensory, affective, cognitive, and behavioral components. It is broadly classified as acute or chronic pain based on duration. Chronic pain, particularly pertaining to headache and abdominal pain, is highly prevalent in adolescents. It affects various aspects of an adolescent’s life including physical, psychological, and emotional states as well as academic and interpersonal aspects. The cognitive behavioral conceptualization highlights the predisposing, precipitating, and maintaining factors associated with pain. An adolescent with presenting complaints of pain can be assessed through various assessment tools including interview, self-report measures, pain diary/ABC charts, and observation. This chapter elucidates the concept of pain through the cognitive behavioral lens. It highlights the process of assessment followed by planning and conducting cognitive behavioral sessions for the adolescent. Cognitive behavioral management of pain involves three phases, namely, initial, middle, and termination. The initial sessions involve establishing a rapport with the adolescent, explaining the relationship between thoughts, feelings, and pain behavior as well as establishing goals of therapy. Middle sessions focus on teaching the adolescent cognitive behavioral techniques and giving homework assignments. These include relaxation techniques, distraction techniques, structured activity scheduling, and cognitive restructuring. The adolescent is encouraged to take more responsibility while terminating therapy and the progress with possibility of set back post-therapy are discussed. Termination is followed by additional follow-up sessions. The process of therapy may involve certain barriers which may be overcome through timely intervention.