Managing pain caused by juvenile rheumatoid arthritis

Most children who have juvenile rheumatoid arthritis (JRA) will have some pain and discomfort from the disease. The pain of JRA is related to the type and severity of the disease, the child’s pain threshold, and emotional and psychological factors. Pain limits a child's ability to function. With attentive care and good communication with your child’s health professional, it is possible to provide some, if not total, relief.

Pain can be difficult for a child to describe. In addition, a child is not always able to recognize a sensation as pain. An older child may be able to describe tingling, cramping, or sharp sensations and may be able to tell where and when the sensation occurs. When a young child is in pain, the signs can be hard to recognize. Signs that may mean your child is in pain include:

  • Changes in usual behavior. Your child may eat less or become fussy or restless.
  • Crying, grunting, or breath-holding.
  • Crying that can't be comforted.
  • Facial expressions, such as a furrowed brow, a wrinkled forehead, closed eyes, or an angry appearance.
  • Sleep changes, such as waking often or sleeping more or less than usual. Even children in severe pain may take short naps because they are tired.
  • Body movements, such as making fists, guarding a part of the body (especially while walking), kicking, clinging, or not moving.

Your child's JRA treatment plan should include regular assessments of pain and what to do to relieve it, starting with medicines such as nonsteroidal anti-inflammatory drugs (NSAIDs). Because pain, stiffness, and swelling can change in intensity from day to day, it is important to learn how to assess your child's condition, which often requires being sensitive on a daily basis to nonverbal signals, such as irritable behavior or an unwillingness to rise from a seat. Pain is not a visible symptom, and so you and your child's treatment team will need to rely on your child as the primary source of information on the status of his or her pain. Only your child knows if pain is present, and experts say that children rarely fabricate pain.

Some children may deny that they are in pain because they are afraid of medical procedures. Admitting they are in pain might mean a trip to the medical laboratory for more blood tests, which are often painful themselves. Some children may try to ignore their pain rather than take medicines, which often have discomforting side effects.

A child may not respond to treatment for pain because of emotional or psychological factors. A child's ability to cope with pain depends in part on age, temperament, health status, and other factors, such as family situation. Therapists can teach your child techniques to deal with pain or pain-causing times. These techniques include distraction, humor, relaxation exercises, and allowing the child to have some control over what is happening to him or her. Cognitive-behavioral therapy is another way for your child to learn positive techniques for dealing with pain. Progressive muscle relaxation, guided imagery, and hypnotic suggestion are examples of strategies that can help your child learn to manage pain.1

Heat can be a great reliever of pain for your child. Taking baths can provide soothing moist heat, and hot packs set on a low-to-medium setting can be applied off and on throughout the day and night. If you have access to a swimming pool, you may want to try pool therapy, which provides an inviting environment for exercises.

The rule with JRA with respect to physical activity is exercise but not overexertion. Encourage your child to attend school, even at times of discomfort, but work with the school to make your child's special needs an accepted part of the routine.

Your child's pain may be more manageable if he or she is in good general health. Children with JRA need more rest, such as frequent naps or quiet periods, than most other children do. This increased time devoted to rest, coupled with the side effects of some medicines, can lead to a weight problem. Offer a balanced diet to your child, and don't neglect your health and that of your other family members. You are all in this together.

Citations

  1. Simon L, et al. (2002). Treatment of pain in children and older adults with arthritis. In Guideline for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis, 2nd ed., chap. 5, pp. 119–129. Glenview, IL: American Pain Society.

Last Updated: June 25, 2008

Author: Shannon Erstad, MBA/MPH

Medical Review: Michael J. Sexton, MD - Pediatrics & Stanford M. Shoor, MD - Rheumatology

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