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Managing pediatric pain Children learn how through a special Western Psych program Tuesday, November 14, 2000 By Sally Kalson, Post-Gazette Staff Writer
Lauren Anderson is neither a mother nor a hypnotist, but the sound of her voice leads children to a place where the bogeyman can't easily follow.
Anderson is a biofeedback clinician and social worker. Her job is to help children suffering from chronic pain -- recurring migraine or tension headaches, abdominal, back or limb pain -- ease their symptoms by controlling their hand temperature, muscle tension and breathing.
Anderson's office is at Western Psychiatric Institute and Clinic in Oakland, home of the Pediatric Pain Management Program. The program has treated 60 children in the past two years -- 15 during the pilot stage as part of the Behavioral Medicine Program at WPIC, and another 45 since March when it created its own staff and budget.
Results have been so positive, the program just opened a second site in Monroeville and is planning a third in Wexford.
In her Oakland office, Anderson hooks young patients up to a computer loaded with special biofeedback programs that allow children to view the concrete measurement of their progress as she talks them through relaxation exercises.
"These are mostly kids who weren't being helped by prescription medication," Anderson said. "The pain was interfering with their function, they were missing school or couldn't socialize. Using biofeedback, we've helped the vast majority to get a significant reduction in frequency and intensity, so they can get back to a more normal life."
"We're seeing kids as young as 6 and 7, depending on whether they are developmentally ready for this kind of approach," said director Linda Ewing, a psychologist, registered nurse and faculty member at the University of Pittsburgh Medical School.
The children are brought in by their parents or referred by their doctors -- family practitioners, neurologists, psychiatrists or psychologists. Some have straightforward cases of pain that respond well to short-term treatment; others have more complicated physical and psychological difficulties that require medication.
"Each patient gets an individual plan," said Anna Marsland, also a psychologist and registered nurse who is co-director of the program.
When anxiety is a factor, for example, the clinic would recommend biofeedback, counseling and perhaps family therapy as well.
In most cases, the young patients show marked improvement in a matter of weeks or months.
After taping a thermometer to the children's hands or electrodes to their muscles, Anderson speaks to her patients in soft, soothing tones. She helps them breathe from the diaphragm, relax their shoulders, picture their favorite place and themselves in the midst of it, listening to the waves of the ocean or the breeze in the trees.
The more they follow her advice, the more they witness the positive response on the computer screen, with the hand temperature rising and electrical activity dropping. As the stress and tension dissipate, and so does the pain -- not always entirely, but most often significantly.
Most people think stress is a symptom of pain, but it's really the other way around, Anderson said. Manage the stress and you manage the pain.
"We teach children how the body reacts physiologically to stress," she said. "You breathe faster, your heart pounds, blood pressure goes up, digestion stops. All the blood is pumping to the major organs, so the hands and feet get cold. It's the fight-or-flight reaction."
But releasing that stress can be tricky for adults and children alike. People may think their muscles are relaxed, for example, until a biofeedback readout shows the opposite.
"It gives you information about your body you otherwise wouldn't have."
"Children are really good at this," she continued. "They get the hang of it pretty quickly."
Once they master the skills at the clinic, the young patients practice them at home, without the computer hookup, until they're able to use the techniques anywhere.
Krystle Parme, 17, and one of the clinic's star patients, has gotten so good at recognizing her body's stress signs, she ducks into the girl's room at the first sign of symptoms and takes control of her breathing before the pain gains a foothold.
"It helped get my life back," she said.
The Ingram teen first visited the pain clinic two years ago with debilitating symptoms -- three to four crippling headaches a week lasting from three to 40 hours; lost vision, shaky hands and exhaustion.
One headache, she reported, lasted four days. An array of medications was not helping, and sometimes caused debilitating side effects. The fear of pain, as well as the pain itself, was so bad that Krystle had stopped attending school a few years earlier and was being tutored at home. That led to social isolation and dependency on her parents, who were very protective and frightened for their daughter.
"She fully expected to be disabled for the rest of her life," said Marsland.
The cause of all of this is not entirely clear. Krystle contracted viral encephalitis at age12, and soon after began what she calls "seizures" and Marsland calls "blackouts."
"Neurology felt strongly they were not seizures," Marsland said, because there was no brain activity indicating them.
"My guess is that there was a large anxiety component as a consequence of that initial encephalitis," she said. "The fear and anxiety caused the ongoing symptoms."
Dr. Pam Murray, director of adolescent medicine at Children's Hospital, recommended biofeedback.
Krystle quickly learned to change her body and make it more relaxed. Soon she was increasing her hand temperature by 10 to 15 degrees and decreasing her muscle tension significantly as well.
Within six weeks, her headaches were occurring less than once a week; within nine weeks, watery eyes were her only symptom.
"My base hand temperature is 76 degrees," Krystle said. "I can get it up to 94 degrees in three minutes just by belly breathing. It feels great having control over that."
Her mother, Rebecca Parme, said Krystle still has to pace herself, especially when she gets a cold or the flu. But overall, she said of her daughter, "She's become a very strong person."
Krystle is now in high school full time and working 20 hours a week. She visits the clinic every three months for a therapy session, and once in while Anderson hooks her up to the biofeedback equipment for old time's sake. And although she still takes 11 pills a day, she also has high hopes for a future she once feared was impossible.
That includes thinking about what line of work she might like to enter.
"Maybe something in the medical profession," she mused.
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