Pain Assessment and Management, 2nd Edition _ _________________________________________________
Recovery is unusual for those with fibromyalgia, so the focus of treatment tends to be management of the symptoms (Kwiatek, 2017). Juhlin et al. (2024) found individuals who developed strategies for improved health and contextual factors that sup- ported improvement experienced less pain. The participants identified choosing to act to improve their health, developing a positive mental approach to the illness, and changing their view of themselves and their life. Contextual factors focus on the support from others including healthcare providers, social supports, and assistance in managing their day-to-day tasks. Treatment approaches include psychological support, exercise and physical activity, and pharmaceutical approaches. Psychological support is found to be essential for coping with the illness (Climent-Sanz et al., 2024). These authors report that cognitive behavioral treatment (CBT) in combination with exercise is most effective when compared to the two methods used alone. Helpful exercise activities include aerobic exercise, muscle strength training, stretching, and aerobic exercise (Maf- fei, 2020; Sosa-Reina et al., 2017). In addition, exercise-based complementary and alternative medicine (CAM) interven- tions—including tai chi, qigong, and yoga—have been found to help some patients with fibromyalgia, others find the relief to be short lived and expensive (Climent-Sanz et al., 2024; Lauche et al., 2015). In addition, the use of mind-body CAM interventions such as meditation, mindfulness-based stress reduction, and guided imagery all have a positive effect on the symptoms of fibromyalgia (Lauche et al., 2015). The use of CAM in pain management will be discussed in a later section. According to Maffei (2020), between 10% and 25% of indi- viduals treated with medications receive 50% reduction in pain intensity. Currently, there are three types of FDA-approved drugs for fibromyalgia, and medical management is found to be only partially successful (Climent-Sanz et al., 2024; Macfar- lane et al., 2016). These include an antiepileptic drug (prega- balin) and two serotonin-norepinephrine reuptake inhibitors (SNRIs; Forte et al., 2015). Antidepressants, analgesics, opioid analgesics, anti-inflammatories, and muscle relaxants are used off-label for the treatment of fibromyalgia in the United States (Forte et al., 2015). Maffei (2020) reports that only 25% to 40% of pain reduction occurs due in part to dose-limiting adverse effects and incomplete drug efficacy. According to Climent- Sanz et al. (2024), many reject medications due to the side effects, lack of effectiveness, and fear of addiction. CONSIDERATIONS FOR PAIN ACROSS THE LIFESPAN Pediatric chronic pain is a widespread public health concern (Silveira Bianchim et al., 2024). The prevalence of pediatric pain is relatively high, 20.8% or one in five children worldwide (Chambers et al., 2024). It however continues to be underrec- ognized and undertreated (Pico et al., 2023). In a systematic review, Pico et al. (2023) found that many healthcare profes- sionals are not knowledgeable on the assessment or manage- ment of pediatric chronic pain. The treatment focus is often
behavioral in nature or directed at the symptoms only. Many will recommend complementary therapies without consider- ing the benefits of rehabilitation to improve function for the individuals. The ability to report pain improves for most chil- dren as they develop the ability to communicate. However, for those who experience cognitive or communication limitations or are otherwise restricted in the ability to express themselves, reporting pain becomes unreliable (Sekhon et al., 2017). When reviewing the evidence for children’s experiences of postopera- tive pain management, Sng et al. (2017) found that children are able to communicate to their parents that they are in pain and provide accurate information on the intensity of the pain. Children do need the parent to advocate for pain management, as the child is less likely to share this information with nurs- ing or other staff. Silveira Bianchim et al. (2024) found that moderate to severe chronic pain has significant impacts on the well-being of the child and family as well as autonomy, identity, family dynamics, socialization and relationships, and education and work opportunities. Norton and Southon (2021) found that children with chronic pain are on average absent for over 13 days in a 60-day period from school. The pain can be caused by a chronic condition, an injury, or surgery and it can occur without a definitive cause or expla- nation. Depending on the condition, there are indicators for specific interventions. Nerve blocks are often used for children who experience cancer pain, phantom limb pain, and CRPS. Pain caused by spasticity may be treated with baclofen (Ostojic et al., 2019). In a review of the literature, Birnie et al. (2020) found that most research focused on headaches or migraines and abdominal pain. Interventions for pediatric migraines were focused on prevention and management of acute pain flares. These authors identified significant gaps in the literature with regards to pediatric chronic pain management. It is noted that the majority of research available for this population focused on reduction in pain intensity. Birnie et al. (2020) found few studies focused on outcomes related to physical and emo- tional aspects, role function, or quality of life and even fewer that addressed the outcomes of participation in meaningful activities, social roles and relationships, vocational planning, or concentration. Fisher et al. (2022) report that pharmacological, psychological, and rehabilitation therapies demonstrate some ability to reduce pain in children and youth. Rehabilitation and psychological therapies were the only interventions that were effective in improving physical functioning. These authors found none of the interventions provided significant changes in health-related quality of life, role participation, emotional functioning, or sleep. The evidence that supports these interventions, however, is focused on the pharmacological methods, and the outcomes for all interventions are of low certainty. Older adults experience higher rates of injury and disease as well as increased risk of developing chronic pain. This pain can have a significant impact on an individual’s physical and psychological health (Domenichiello & Ramsden, 2019).
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