Guest writer, Rebecca Fechner, is exploring chronic pain/persistent pain in children through her PhD: how pain is communicated, modelled, and experienced in schools; the projection of pain concepts within the teacher/student relationship; and the potential impact of introducing pain science education into the school curriculum.
When we think about the social implications of experiencing long-term pain, it’s likely that ‘stigma’ comes to mind. Pain sufferers often report feeling alone, unheard and unseen. Young people certainly have similar experiences of stigma (Wakefield et al., 2021). They hide their pain, fearing they’ll be accused of faking it. They often present as hurt, defensive and angry – and are often very difficult to engage.
Have you ever heard someone say ‘they just want attention’ when a child expresses pain? It’s such a common expression – I’ve certainly heard it a lot – and I do have to admit that I’ve also thought it! (We’re all human, right?)
But what happens if we substitute the word attention with connection?
Whether it’s a broken bone or a broken heart, connection with others can help us heal. Young people look to adult role models to support, protect and help them make sense of the world. This connection with a trusted adult can provide safety at a time when they are vulnerable – such as when they’re in pain. But how can adults meet the needs of young people if they don’t understand the complexity of their biopsychosocial experience?
They probably can’t.
Before I was lucky enough to learn about the mysterious science of pain, I believed that showing pain was for weaklings. When I was a child, I thought that some people had pain that was all in the head. Learning about pain was such a relief… and a revelation!
But not everyone has been as lucky as I have been.
One in five adults in Australia live with chronic pain and are consequently also living with stigma and isolation. Those adults could be a child’s parent, teacher or best friend’s mum. Evidence suggests that adults with chronic pain are less likely to conceptualise pain as biopsychosocial (Pate et al., 2021). How do these adults respond to and talk about pain with kids?
Even adults without chronic pain are subject to societal beliefs that don’t support our modern scientific view of pain. These adults may be unintentionally projecting these beliefs onto children. ‘Don’t sit like that, you’ll get arthritis!’ or ‘You’re just anxious – chin up and get on with it!’.
Who sees a young person’s pain, and how do they see it? What sort of connection is made? What message is passed on? Is it based on fear of damage, stoicism and pushing through pain, or dismissal of pain and the idea that it’s all in the head? How do these interactions shape young people’s trajectories?
Did you know that kids spend up to 40% of their awake time at school? That’s a significant amount of time with teachers as their adult role models. What would our world be like if pain science was part of the school curriculum? What if kids got to learn about pain and the way the body and mind link in this everyday human experience? What if teachers as adult role models understood the biopsychosocial nature of pain? Teachers may not be in a position to treat pain – but could their connection with their students be different? What if teachers knew that everything matters when it comes to pain?
In my PhD, I am starting to tackle these questions. I am particularly interested in how pain is communicated, modelled, and experienced in schools. In the coming years, I am working on a tool to assess a teacher’s concept of their student’s pain. I’ll then investigate how pain science learning in a classroom may influence classroom culture, a teacher’s responsiveness to pain, and young people’s pain experiences.
I would absolutely love to hear what clinicians think about these ideas. Please email me if you’d like to connect!
Images from Zoe and Zak’s Pain Hacks, Book 3: Zoe and Zak’s Brainy Adventure! © Joshua W. Pate, Noigroup Publications (In press 2022)
Pate, J. W., Simons, L. E., Rush, G., Hancock, M. J., Hush, J. M., Verhagen, A., & Pacey, V. (2021). The Concept of Pain Inventory for Adults (COPI-Adult): Assessing Knowledge and Beliefs Regarding Pain Science Education. The Clinical journal of pain, 38(1), 32-40. https://doi.org/10.1097/AJP.0000000000000990
Wakefield, E. O., Belamkar, V., Litt, M. D., Puhl, R. M., & Zempsky, W. T. (2021). “There’s Nothing Wrong With You”: Pain-Related Stigma in Adolescents With Chronic Pain. J Pediatr Psychol. https://doi.org/10.1093/jpepsy/jsab122