How To Understand and Address Chronic Pain In Children

Episode Transcript

Dr. Nicole Beurkens: 

Hi everyone, welcome to the show. I am Dr. Nicole and today, we’re going to talk about children and teens who experience chronic pain. This is more common than many people realize. Kids can experience everything from chronic headaches, persistent stomach pain, joint pain, lots of other kinds of pain-related issues and one of the challenges is that pain issues in children often go unrecognized, especially in younger kids because they don’t have more sophisticated communication skills, but pain issues can definitely impact a child’s learning, their mood, their anxiety level and their behavior, so it’s an important topic for us to be aware of. So there’s a lot to delve into with this and I’m excited to have my good friend and colleague, Dr. Joe Tatta on the show today to talk with us about it. Let me tell you a little bit about him.

Dr. Joe is one of the pioneering experts in lifestyle interventions for treating persistent pain. A unique combination of physical therapist, nutritionist, and ACT trainer, he has 25 years of experience in physical therapy, integrative models of pain care, leadership and private practice innovation. He holds a Doctorate in Physical Therapy, is a Board-Certified Nutrition Specialist and has trained extensively in Acceptance and Commitment Therapy. Dr. Tatta is the Founder of the Integrative Pain Science Institute, a company dedicated to reinventing pain care through education, research, and professional training. In 2017, he was a key member of the APTA task force expanding nutrition as part of the scope of practice for physical therapists. He also is chair of the Physiotherapy Special Interest Group at the Association for Contextual Behavioral Sciences, volunteers his time on the New York Physical Therapy Opioid Speakers Bureau and the New York Physical Therapy Association Opioid Alternative Task Force. Dr. Tatta is the author of the bestselling book, Heal Your Pain Now and host of The Healing Pain Podcast, featuring interviews and free training from respected pain experts. It’s such a pleasure to have you with us today, Joe, thanks for being here. 

Dr. Joe Tatta:

Hi Nicole, it’s great to be here to talk about this important topic, thanks for having me on. 

Dr. Nicole Beurkens: 

Yeah, I think this is something that doesn’t get talked about enough for kids and I think that the issue of particularly chronic pain is something that impacts a lot of children, especially when we get overlap with kids that are experiencing anxiety issues, learning issues, developmental issues, those kinds of things. So I’m really excited to put this on the radar of our listeners. Pain is a huge topic and pain can be acute, it can be chronic. Let’s start out by having you explain the difference between acute pain and chronic pain and why this is so important for us to understand. 

Dr. Joe Tatta:

Yeah, it’s a great place to start, and like you’ve mentioned, pain is a huge topic. So just this one question that you’re proposing to start our podcast off can help literally thousands of people — not only help them understand what pain is, but it can actually help decrease their pain. So pain broadly falls into acute pain and chronic pain. Acute pain is the pain that all of us know well and we’re aware of. So let’s say you’re outside, you’re playing, your kids are playing in the backyard and one of them falls and scrapes their knee, they have a little cut on their knee. That’s a tissue injury. Your body has an incredible immune system that is going to send cells to the area, it’s going to create a little scab there, healing is going to happen and with a little cut on your knee, it may be, let’s say 10 days to 14 days and that’s going to clear up and no problem.

If there is something like a broken bone or a torn ligament, that’s a little bit longer. Anywhere between 8 weeks to 3 months. When pain continues beyond the point of 3 months, we look less to the actual site of where the pain is coming from and our attention is drawn more to what’s happening in the brain specifically, and on a larger topic, the nervous system in general. But the take-home point there, the difference between acute pain and chronic pain is that acute pain is an injury to tissue, where chronic pain is actually a condition of the nervous system, where the nervous system and the brain continue to kind of be stuck in almost a fight or flight response or stuck in the warning phase where the brain continually produces pain, even though there is no injury there.

And what’s really important about that for both parents and kids with pain is to realize that chronic pain does not mean that you’re damaged. It doesn’t mean you’re broken, it doesn’t mean that you have an injury that hasn’t healed. And it’s not that we don’t look to the joint or to the tissue in the area, but we look to other things in the brain and nervous system to try to help heal and overcome what’s happened. 

Dr. Nicole Beurkens: 

I do think that’s so important because often for children and adults, where our mind goes when we are continuing to experience pain is there is something wrong here in my body, there is something that still hasn’t healed or there is something that someone hasn’t uncovered or figured out and that keeps us really in that sort of anxious phase of thinking there’s something wrong and nobody knows what it is, which actually makes our pain worse. 

Dr. Joe Tatta:

That’s right, and if you look at this — to talk to the clinicians for a minute, as well as parents on this podcast. The clinicians know this as there is a biomedical model to look at things, and there is a biopsychosocial model. So the biomedical model would say something hasn’t healed, we need to either prescribe medication or potentially do an interventional surgery to treat the actual tissue. And that’s gotten us into a lot of trouble with regards to treating chronic pain in this country both in adults and especially in children.

If you look at the studies, there was a 2016 study done in the Journal of Pain that surveyed adults with chronic pain and 80% of adults reported that their chronic pain started in childhood and was either under-treated or not treated at all, and now you’re 10, 20, 30, potentially even 40 years into adulthood and these things can be more challenging to treat. What’s interesting about — one of the key points that are just going to help parents right here is that if you look at the stats for chronic pain for adults, it can be challenging to treat and sometimes, doesn’t go away fully. But when children receive adequate biopsychosocial care that either a psychologist or other types of rehabilitation professionals are involved in, upwards of 85% of children and adolescents can live a completely pain-free life.

And that number right there, as a parent, I can imagine if you have been struggling and you have only been relying on, let’s say, passive treatments or on medication to alleviate pain — just knowing that the proper care can reverse the pain in 85% of the cases in children with chronic pain.

So when we’re talking about chronic pain in children, we’re talking about primary pain disorders. So those are the ones you mentioned in the introduction. Headaches, both tension headaches as well as migraines are some of the most common types of pain that children report. The next are functional disorders of the GI or the gut, where they have abdominal pain and IBS that persists. And then the third, more common type of chronic pain that children experience is lower back pain.

Once you get beyond those 3, then we’re looking at either kind of just widespread chronic pain, which makes people think about fibromyalgia, but fibromyalgia is not a diagnosis that children should be provided with or received. We look at it as just more chronic widespread pain. The only one that’s really common in children is chronic regional pain syndrome. So this happens typically when there is a trauma, specifically, usually it’s either a fracture or blunt injury that a child sustains and they don’t receive the kind of care that they should receive and there is a wide range of symptoms that developed from that. So those are the three — now, there are of course things like pain related to childhood cancers and pain related to sickle-cell anemia, types of diseases, but for the most part, children with chronic pain, we’re talking about the 3 big ones of headaches, abdominal pain, and chronic widespread musculoskeletal pain.

Dr. Nicole Beurkens: 

Yeah. So helpful, because I know there are so many parents listening who are like “Yeah, my kid falls in one of those categories.” And I think the important thing to understand is that there can be a lot of overlap with these things, right? Like often I’ll have parents bring their children into the clinic and they’re here for maybe anxiety or a mood issue or behavior issues, and then as we’re learning more about the child and doing a thorough intake, we discover that there are chronic pain issues there and those intersect with all of these other things, so it’s really important to make sure that we know what we’re dealing with so we can get the right kind of treatments in place, which I guess leads me to the question of: It seems like there are children, teens more likely to develop some of these chronic pain issues than others. Do you find that to be true?

Dr. Joe Tatta:

Yeah, I mean we’re really kind of delving into the research right now and figuring out: Okay, who is most likely to develop a chronic pain syndrome in childhood or adolescence? We have a couple of really good clues. The information is not there 100%, but there are a couple of really good clues. The first one you mentioned in your introduction is that children that are diagnosed with anxiety and/or depression are more likely to develop chronic pain syndromes, either in childhood, adolescence and as I mentioned before, into adulthood.

The interesting thing about chronic pain is a lot of overlap with many of the mental health conditions that mental health providers are seeing, and in a way, what’s interesting as a practitioner to treat these things is that it requires you to really fall back on all your skills that have to do with how do I help this person on a psychosocial level and how do I help them on a physical level. So there are significant ways to help people with improving their mental health as well as their physical health and they’re bidirectional. When you have anxiety, you’re more likely to develop pain. When you have persistent pain, you’re more likely to develop anxiety. So they’re bidirectional in nature.

An interesting one that I know you talk about a lot in your podcast is screen time. There is significant research that shows that children who watch television more than 2 hours a day are likely to develop persistent pain, and I don’t think it’s just television, I actually think it’s screen time in general. So that’s really fascinating and those are some things that parents and practitioners who are counseling people with chronic pain can start to talk about right away. 

The third one, which is interesting and a lot of parents have a hard time just wrapping their heads around this one, and this is where I think a mental health provider can really help out is  that a parent’s understanding of what chronic pain is and how they relate to their child in chronic pain is a predictor of pain persisting in their child, more so than pain intensity. So as we kind of talked about that first question, what’s the difference between acute pain and chronic pain, as you start to realize that chronic pain is a disorder of the nervous system and not necessarily the musculoskeletal system, the kind of mantra that people start to pick up from that after a while, and that mantra has to be carried through with the practitioner who is treating the person with pain, the child as well as the parents is simply that hurt doesn’t equal harm. So just because you feel a little bit hurt or you feel a little bit sore, or you wake up in the morning and you don’t feel 100% doesn’t mean that you’re damaged, it doesn’t mean that you can’t start your day as a normal, functioning child. 

Dr. Nicole Beurkens: 

That’s so important and I think what we see across the board, whether we’re talking about pain or anxiety or whatever we’re talking about with children — the parent’s response to that and how the parent engages the child around that is so critical for them what the child’s experience of that is. So that’s great, I want to come back to that in a minute, but it occurs to me, because some parents might be thinking: “Well, I don’t know, my child is really young, but my child hasn’t necessarily communicated this.” What are some ways that parents can know or what are some of the red flags, or things for parents to be aware of to maybe recognize that chronic pain might be an issue for their child? 

Dr. Joe Tatta:

The first one we mentioned, the first one is a diagnosis of anxiety and/or depression in children. The second one really revolves more about what’s happening in the child’s life. So if you notice that they are refusing or objecting to going to school, that’s really a big red flag when it comes to chronic pain. And it relates to, of course, they’re uncomfortable and they’re struggling with pain, so they don’t obviously feel like going to school, but there are also other things that are aligned within the “I don’t want to go to school” in the morning. Some of it is actually around fatigue. There are lots of similarities between chronic pain and fatigue.

So even if the child is able to, let’s say, tolerate some pain in their life, they just maybe fatigued and they find they can’t make it through the day at school. What’s connected to that, often, or the root of that are challenges with sleep. They either have problems falling asleep at night or they wake up throughout the night and once your sleep is disturbed, you can pretty much guarantee that pain intensity is going to be worse and your fatigue is going to be worse. Withdrawing from social activities — so school is part of that umbrella of social activities, but then just playing with friends or going to sports or going to the movies or the mall — so when they kind of start to pull back from those social activities — that’s really a big sign.

And then, last but not least, when you look at things at school and social activities like bullying, like the stigma that’s attached to chronic. Let’s face it, kids can sometimes be mean, especially in their adolescents and look at kids like they’re weak or they have a persistent problem or a condition — so those are things that, as a parent, you know you’re aware of, but a lot of kids need support on that, especially as they start to reintegrate into school. 

Dr. Nicole Beurkens: 

Yeah, and I think that school avoidance and the physical complaints or the pain complaints around that are one of the biggest issues that we see with kids and there is that major overlap then with anxiety. Sometimes what will happen is parents will bring the physical complaint to the attention of the pediatrician or the primary care provider. “My child is complaining every morning of headaches or as having this persistent stomach pain in the mornings or while they’re at school” and so often, that gets approached from the physical standpoint initially.

Seeing what can be done about headaches or things, but then in the end, when that really doesn’t resolve with those kinds of interventions, then they end up in my office or a mental health practitioner’s office because there is recognition then at that point that the child is experiencing these physical symptoms. They are having headaches or migraines, they are having persistent gut pain, IBS, whatever it is. But now there is a focus on okay — well let’s look at it from more of the psychosocial standpoint and really, to me, ideally, especially with children, those things should be looked at jointly right from the get-go. I find so many parents spend months or even years pursuing the physiological or the medical model of that, and their child gets put on all kinds of medications or various things. And really, what needed to happen was the parent and the child needed an understanding from the big picture of what was going on, and to develop some coping skills and some skills to manage the anxiety, the stress, the bullying, whatever was going on that was intersecting with that. 

Dr. Joe Tatta:

Yeah, the big point you bring up, and this is kind of the biggest challenge that we face in our healthcare system is that the entryway into healthcare of most people, whether you’re a child with chronic pain or an adult with chronic pain is through primary care, is through a physician. And physicians definitely have a place in the world of pain care. The biggest challenge we have with that is that in medical school, physicians learn about 4 hours of what’s called pain science or pain education. And the vast majority — so that’s over a 4-year medical training, just 4 hours for probably one of the largest problems that we face in society today. The biggest problem with that is that those 4 hours are pretty much dedicated to the prescribing of pain. So what pain medication works for treating pain.

Now, this is a tricky topic in general because the studies we have on pain medication are only done on adults. We don’t have one study. There’s not one evidence-based, randomized, controlled trial out there that shows that medication is effective for pain relief in children and adolescents with primary musculoskeletal type pain. There’s that one opioid study that shows that it’s effective. So if your child is being prescribed opioids for their headaches, for their persistent abdominal pain, for their chronic musculoskeletal pain, we’re setting them up for things like addiction, harm, abuse, overdose — the other thing, and I’m sure that you see this in your practice, is that the message is getting out there that these types of pain medications are not effective for chronic pain.

Then there’s kind of the second class of medications that people fall back on — which are the SSRIs. And again, there is no good randomized, controlled trial out there that shows that these are effective for treating primary and musculoskeletal pain. In a lot of ways, this starts to kind of peck at the beliefs of children as well as their parents as to, okay, what does really work? And the average parent brings their child to at least 5-10 medical providers before they find someone like yourself, Dr. Nicole, who knows how to treat these conditions effectively. 

Dr. Nicole Beurkens: 

Yeah. And it’s such a frustrating path. I think we’re trained to — oh, my child’s having this pain or this physical issue, bring them to the physician and we’ll get something that will treat that and what so many families find is they just go round and round with different specialists, different medications, you mentioned the SSRIs, so things like Prozac, Zolax, Paxil, and in fact we don’t have good studies on those even for the things that they’re typically provided for like depression and anxiety, we just don’t have good medication studies in children, period, and you’re saying too for the chronic pain stuff, so, often I’ll see kids who haven’t prescribed many different types of medications and they’re still having these persistent pain issues because we haven’t really gotten to the root of that.

So it’s a real frustration for families for sure because nothing’s worse than being a mom or a dad and seeing your child so distressed every morning before school or whenever the symptoms are coming up for them and feeling like you don’t know what to do about that, right? My child is having these terrible headaches or feeling like they can’t get out of bed or having this chronic diarrhea, these stomach cramps — and as a parent, the worst feeling in the world is the feeling of helplessness of “I can’t figure out what to do to help my child with this. My child needs to go to school.” You just see kid’s lives can really unravel. I mean these pain issues can really affect kids in every domain of their life and it’s tough as a parent to watch. 

Dr. Joe Tatta:

It’s true. This is why podcasts like this and episodes like this are really so important, because, within a matter of 30-40 minutes, we’re going to give people — if they listen to this once or twice, they’ll have a laundry list of at least 10 things that they can start doing at home on their own or they can bring to their primary medical physical or other types of practitioners and just say, okay, how do I start to implement this into my kid’s life.

Dr. Nicole Beurkens: 

That’s right. So critical for that. So you spoke a little bit ago about that intersection between how parents are understanding and responding to their child’s pain or symptoms and then how the child experiences that. So pain really is sort of a family affair, right? Can you talk more about that?

Dr. Joe Tatta:

Yeah, there are definitely lifestyle habits that strongly influence pain on many different levels. We can spend a whole podcast on that in general, but one is nutrition, one is obviously the food you eat has an effect on how you feel both physically in your joints, in your stomach, obviously, we talked about stomach pain before and IBS. It also affects your cognition, it also affects your mood. So just the food that you put on your plate at breakfast, lunch, and dinner, that you’re eating as a parent as well as of course as your children are eating can have a dramatic effect on pain sensitivity levels.

It can have a dramatic effect on how your brain responds to pain, how the opioids are produced, the natural opioids are produced in your brain that actually trickle down from your brain into the rest of your nervous system throughout your body and that make you feel well. The other aspect of it as far as the entire family approach goes is that as you mentioned before, pain can be really confusing to children. They don’t really know exactly what’s going on. As parents start to learn that this is not a problem, that they’re not damaged, is to take some time and to validate that I see that you have pain, I see that you’re struggling, but to know that I know your pain is real, you’re not making this up, you’re not just making up an issues that are not there — because pain is something that you can’t see, you have to just —

Dr. Nicole Beurkens: 

You’re not just trying to get out of going to school or —

Dr. Joe Tatta:

That’s right. So we have to believe what everybody is saying about their pain, it’s a really subjective experience. So having the whole family validate the child in pain is really, really important. And then there are the responses that everyone in the family has towards someone who is in pain. So after the validation period, it’s trying to help them with the behavior change that they need to start to re-engage with their life again. The rule with chronic pain for both children and adolescents is that you return to your life first, and then your pain goes away, not the opposite. Not that the pain has to go away first and then we turn back to life. We actually find that when people engage with the activities they love, whether they’re at school, social functions, play, sporting activities, healthy distraction, when they engage those types of activities first, that their pain will go away faster, rather than targeting the pain specifically. 

Dr. Nicole Beurkens: 

Such an important thing to understand because so often, we just think well — I have to wait until I feel good in order to be able to do things and what you’re saying is actually, it’s important to get moving, to engage in meaningful activities and then we start to feel better. 

Dr. Joe Tatta:

That’s right, so on the typical scale of 1-10, with 10 being severe pain that would drive you into a hospital and one being just a gentle ache, let’s say, having children engage in activities where they’re maybe like a 1 or a 2 is perfectly normal. They’re not going to hurt themselves, they’re not going to make their pain worse. Yes, if we move into activities that are at a 5, a 6, a 7, then you do run a risk of flaring pain up and that’s not healthy for a child. But staying in that 1 range is very, very helpful to start to retrain that nervous system and start to decrease the sensitivity to many different types of activities in their life. 

Dr. Nicole Beurkens: 

Yeah, because often what I see happens with kids and adults, for that matter, is when they’re experiencing the chronic pain, their world tends to get smaller and smaller and they avoid doing anything that they think might even slightly increase the pain or where they might experience that, and so their world really does get smaller and even from an anxiety standpoint, it’s like we have to have some exposure to some things that make us uncomfortable in order to get more comfortable with it. You can’t get comfortable or improve those kinds of symptoms by living in a bubble and not doing anything out of fear.

So I think you’re really saying the same thing, that as parents, we need to encourage kids to do some things that may make them slightly uncomfortable and to help them feel good about that and kind of rally behind that. I know that you can do this. I’m going to help you. Yet, you’re having a little bit of discomfort — that’s okay, that means your muscles are moving. I think how we talk about that in our own affect with how we’re engaging with the child as the adult is so important. Because if we come at that with a lot of fearful language or a lot of, “Oh, are you hurting? Is it hurting? Are you okay?” That really just exacerbates the anxiety for the kid, right?

Dr. Joe Tatta:

That’s right, the one word you mentioned there, which is probably the most pivotal word for parents and families is fear. If you have a response of fear and your child sees that in your face and in your manners, and like you mentioned, in your language, then they’re going to adopt similar behaviors. In every clinical study, fear or increase in fear is linked to worse pain intensity and the persistence of pain. So normalizing, kind of naming it and normalizing it is really important for children in pain. The technical words for that, for the practitioners that are listening to the podcast, is ‘pain catastrophizing’. So if the child, as well as the parent,  are ruminating, or they’re extremely pessimistic about pain and the responses or the trajectory that the child is on, if that catastrophizing continues in the home, then children are likely to develop that, to take that on and to carry it into the rest of their social life. 

Dr. Nicole Beurkens: 

Absolutely. So our response as parents is so critical to helping normalize this for kids and helping them to comfortably move through it. You talked about nutrition. There is a food component to it. And you touched on the importance of engaging with meaningful activities and activities that the child enjoys. I know that movement, just that physical activity and movement is important and I’m wondering if you could talk a little bit about how would a parent know if maybe something like physical therapy could be a helpful component of treatment for their child who is having chronic pain?

Dr. Joe Tatta:

Sure. Physical therapy definitely has a place for children and adolescents with chronic pain. It typically comes up most if you see a child that is persistently avoiding gym class or they find gym class to be so uncomfortable that they can’t even imagine going to gym class, then that’s a key sign that physical therapy would be a helpful intervention for the child. Often times, schools have a physical therapist on staff, if not, there are often physical therapists that consult with schools or you’ll find the physical therapists in the community that can help out and can obviously help them with a return to gym activity in a way that’s healthy. Oftentimes, when children have injuries, let’s see they have a sports injury, they’re sent back to physical activity without anyone screening them or checking them.

So a physical therapist can be a good bridge between that return to sport or return to gym activity. So gym is the first one. The second one, as I mentioned just now is sports. If they’re having a problem returning to sports, that’s a clear sign that a physical therapist can help them with that return. And then, as a parent, if you notice that there is weakness that continues or they have a limp that continues, or they have some kind of odd movement pattern when they lift things or when they put their clothes on, or when they’re doing normal activities, that’s a clear sign that physical therapy can be helpful for them. And then, as another general term, which is called ‘kinesiophobia’, which is just in general fear of movement and physical activity. If you find that your child has that, then it’s another really good indicator that a physical therapist can help your child or adolescent return to their normal activities. 

Dr. Nicole Beurkens: 

Awesome. So you’re talking quite a bit about movement and the importance of movement, and even if there is some slight discomfort with it, that movement is important whether we’re talking about a kid who maybe had a broken bone that resolved but now they’re continuing to have chronic pain as a result of that experience, or we’re talking about a child with persistent headaches or things — what are some suggestions that you would give to parents around how they can help get their child moving, maybe even as a whole family, how they can just move more. Because that’s a big issue and the sedentary stuff with screen time plays into that a lot, so I’m curious as to your suggestions for that.

Dr. Joe Tatta:

Yeah, it’s such an important message. I mean movement is medicine. No matter how you look at movement, and we’ll talk about some of the various ways that movement is medicine, but movement really is a part of every single rehabilitation approach to chronic pain in children as well as adults. So from the family perspective, because I really think that families that play together stay together and they’re healthier. So when you look at family activities. I have to reflect back to my own family on this. I have cousins in Italy, I visit them in Italy every once in a while, and they have this word in Italian, which literally means ‘a walk after dinner’. The word in Italian is ‘passeggiata’. So it actually means a stroll after dinner.

So if you look at communities in the Mediterranean, after dinner, instead of sitting down on the couch and watching television for 2 hours, they eat, the whole family chips in to help with clean up, which right there is actually a physical activity. And then they actually walk around the community or up and down the street, they visit other kids and families, and just that little bit of activity after dinner, not only will help digest your food, but it’s really good for that parasympathetic response, that relaxation response. Activity helps your digestion. Activity also helps elevate your mood. So when you look at things like anxiety and depression, some of the best interventions we have along with CBT or physical activity intertwined in them. So getting the whole family involved in an activity.

Now, of course, this can be a little bit challenging when your kid is hurting, but there’s a lot of healthy distraction that happens when the entire family engages in an activity, and that healthy distractions, it oftentimes is what helps quiet that nervous systems so that pain response doesn’t turn on. We’re recording this episode during summer, so things like walks on the beach, going to the park, even engaging in an activity like a fundraising walk can be really helpful for families.

I had a patient a while ago whose dad was an avid golfer. And I actually called the dad up and said, “Hey, take him down to the driving range on Saturday and before you golf, hit some balls at the driving range, or take him on 3 holes of golf instead of the whole 9, so he gets some sport activity as well as physical activity of walking, which is involved with gold. Now if you have children who are not very physically active, let’s say you have kids who are, let’s say maybe involved in things like art and things like that — a walk in a museum for an entire Saturday afternoon is a really good way to get some physical activity. 

The other thing that I find that’s lacking from our culture in general is dance. And if you look at dance, I mean there are whole parts of your brain that are dedicated to movement and dance. And when you dance, not only are you getting the physical activity part of it and the movement part of it, but music helps with the reward center in the brain. So just listening to music, that healthy distraction that you tie in with dance is really important. And then there’s the encouraging of the child or the kid themselves to do some more healthy activities. So those could be things like if your kid takes the bus home from school, getting off from the bus one or two stops before so they can walk home. Instead of just letting the dog out in the backyard, have your kid take the leash and take the kid for a couple of blocks walk, and then finally finding some physical activity that they can engage in that they can enjoy. If physical activity and exercise is not enjoyable for kids, they’re probably not going to engage in it. But it is important for parents to understand that the average child should have 60 minutes of activity, 5 days a week. And the two days that I think are most important to start are Saturday and Sunday. There should be a solid hour if not more on Saturdays and Sundays where your kid is finding some kind of activity to engage in that they really enjoy. 

Dr. Nicole Beurkens: 

Yeah, and it needs to be movement, more than just their fingers on the buttons of the video game controller, because really, that’s what we are seeing across the board is kids, in general, having such sedentary lifestyles as a result of sitting with screens and that type of thing, and particularly if your child is struggling with any type of chronic pain issue, anxiety, depression — those types of things. They need to get moving as part of their treatment plan for helping them get better. And so, I love what you’re suggesting, it’s just trying to work movement into normal activities and to really do that as a family.

You can’t say as the parent, you need to go out and go for a walk, you need to get more physical activity when we’re modeling sitting down and not doing anything. So I love that idea of even something as simple as — maybe you have to start with just 5 minutes of walking down the street and back together after dinner. Okay, start wherever you need to start but get your child and your family moving, that’s such a big piece. 

Dr. Joe Tatta:

Yeah. There are two, and I’ll call them very strong recommendations that I give kids and families with regards to the video games, and I’m wondering if you can chime in on this as well, Dr. Nicole. First is, there are video games that you have to sit down for, which we know that sedentary behavior is not good, it leads to things like obesity and diabetes, which are linked to chronic pain type syndromes. Choose a video game, and they have them out there where you have to be active. Where you’re actually up, mimicking a tennis player or a golf player, or some type — they even have yoga video type games that your child can engage in.

The other that I’m strong with, when we’re talking about the nervous system and wanting to quiet down that nervous system and get your child into that parasympathetic response — having a child engage with activity games, specifically video games that are violent is a really detrimental and probably adding to sensitizing their nervous system and turning on that sympathetic response.

So much of our television and so many of our video games are violent. So moving them away from the violent TV and violent video games is a great way to help them quiet down, calm down. Especially when you look at evening time, finding that hour or two to power down, not only the games, but also power themselves down. Where they learn some deep breathing, some gentle stretching, some progressive muscle relaxation — those are really key important tools and techniques that kids can implement, as well as their parents. 

Dr. Nicole Beurkens: 

That’s right. I couldn’t agree with you more about those strategies because so much of what kids are doing with screen time is so overstimulating, whether they realize it or not, even if they are enjoying it, it is very overstimulating to their nervous system. And when you have a child who is already experiencing chronic pain, which is an over-sensitized nervous system, we need to be doing what we can to quiet that down. So those are really great practical suggestions. We could certainly talk about this all day, there are so many things around this, but you have given listeners some really helpful strategies and ways of thinking about this. I want to end by maybe just giving an overall message, because chronic pain can just be really challenging, not only for children, but for parents and even siblings, the entire family, and really does require a whole family approach to that. What would you say is the silver lining for parents who are concerned about this. They feel like, “These are symptoms that my child is dealing with, what’s going to happen as they get older?” What would you say to those families? 

Dr. Joe Tatta:

Yeah, it can be stressful for a family, I mean the silver lining is, one — when you find a practitioner like yourself who understands pain as it takes instantly a lot of stress off the child and a lot of stress off the family. So if you’re stressed out from this chronic pain syndrome that has been a part of your family, reach out to your practitioner because it’s going to alleviate and take the pressure off everyone. The second thing is when I’ve had many patients and clients come back to me in college and later on in life. And the tools that they learned as a child and adolescent to deal with and cope with their chronic pain, believe it or not, come in very, very handy as an adult later on in life. So when you learn how to buffer stress effectively, when you learn healthy eating habits, when you learn how to stay away from medication as a primary source to relieve your stress or to relieve your pain and your anxiety. I’ve had many patients come back and say, “You know, I really appreciate this because now I’m in my first semester of college and the workload is maybe increasing, but I have the skills and tools and I see a lot of my other schoolmates not able to negotiate this effectively.”

So there is a little bit of a silver lining here, is that yes, it may take a little bit of time, the average kid who has chronic pain can take anywhere between, let’s say 8 weeks to 6 months to really get a handle on that, but these are solid, healthy behavior skills that many adults don’t have. So the silver lining is: In a lot of ways, you’re going to make your kid healthier for the long term. You may even increase their lifespan and have a healthier lifespan or healthspan, so there are many, many different benefits to that, but I think as a parent, we want to set our kids up for success, and health is a big part of that. Helping your child overcome chronic pain is a great way to set them up for that. 

Dr. Nicole Beurkens: 

That’s a great way to think about that, that even in the most challenging circumstances, there can be positive things that come from that, so I think that’s a really helpful way for parents to think about it. I want to make sure that people know where to find out more about you and what you’re doing online. You’ve got tons of articles and resources and things available, so where is the best place for people to find you?

Dr. Joe Tatta:

The best place is to go to the integrativepainscienceinstitute.com that’s a website. I have a great podcast there, it’s called ‘The Healing Pain Podcast’ where we talk about all types of issues related to chronic pain, and a great blog post there and some programs for both clients as well as practitioners who are interested in treating chronic pain more effectively. 

Dr. Nicole Beurkens: 

Awesome. I highly recommend that people who are interested in this topic go there to learn more, just lots of great education and resources available, so definitely check that out. Dr. Joe, thank you so much for being here with us today, this was really helpful. 

Dr. Joe Tatta:

Thanks, Nicole, thanks for letting me chat on this important topic. 

Dr. Nicole Beurkens: 

Alright, everybody, that’s it for this episode of The Better Behavior Show! We will see you back here next time.