presented by Susan Stralka
Children with persistent pain beyond the time frame of acute injury are often not diagnosed immediately and research has reported at times it is as long as one year before diagnosis is made. Persistent pain shows a female preponderance and this incidents of pain increases during puberty. This lecture will discuss pain types and mechanisms to identify the symptoms. A review of scientific advances in identifying brain changes or reorganization that occur with persistent pain will be presented. In children with persistent pain there are similar patterns of symptoms, behaviors, and cognitive changes which must be addressed for an effective treatment. Because persistent pain is complex an interaction of physical, affective, sociocultural, behavioral and cognitive factors are involved. Due to the above interaction recent studies strongly support using a biopsychosocial approach for treatment so that the components involved can all be addressed.
Susan W. Stralka, PT, DPT, MS, is a licensed physical therapist with many years of experience treating both musculoskeletal and neurovascular consequences of injury. She earned her bachelor's degree, master's degree, and Doctorate in Physical Therapy from The University of Tennessee Health Sciences Center in Memphis, Tennessee (UTHSC). She has a strong clinical background in treating neurological and musculoskeletal consequences of injury. Susan has presented nationally and internationally in upper and lower extremity dysfunctions as well as pain management. Susan has written articles on a wide variety of topics related to physical therapy for many national publications and health journals. Her most recent publications are “Graded Motor Imagery” in the Journal of Hand Therapy 2011 and a chapter on "Thoracic Outlet Syndrome" in the book entitled Neck and Arm Pain Syndromes by Elsevier in 2011. In 2009, Susan was recognized by the Arthritis Association as Volunteer of the Year. With the goal of providing the best rehabilitative care to patients, Stralka continually recruits and supports innovative clinical programs to benefit future patients.
This chapter will discuss the impact that pain has on children as well as the misconceptions about pain in this population. The developmental differences and age related pain expressions will be reviewed.
Understanding and differentiating musculoskeletal and neuropathic symptoms in children will be discussed. Children with persistent pain are often not diagnosed early on and then central nervous system changes or central sensitization develop. The importance of addressing the biopsychosocial side of pain will be emphasized.
The similarities and differences of amplified musculoskeletal pain and idiopathic musculoskeletal pain compared to CRPS will be presented. Understanding the guidelines for treatment of children with CRPS and the importance of early identification of brain changes to improve outcomes will be reviewed.
Research has shown that training the brain and the use of multidisciplinary service produce the best outcomes. The role of mirror therapy and graded motor imagery will be presented. Advancement in using Ketamine (medication) to shut down receptors will be discussed. A summary of treating children and the importance of educating for discharge will be included.