Child Life Blog Banner (8)

Non-Pharmacological Pain Management for Children with Sickle Cell Disease and Other Sources of Pain

Jessica Westbrooks, MS, CCLS
Children’s Healthcare of Atlanta,
Atlanta, GA

Non-pharmacological pain management refers to any method of pain management used that does not involve medications (Geziry et al., 2018). As child life specialists, we use these techniques on a daily basis in providing coping strategies and opportunities for distraction from pain and discomfort. We aim to promote coping with acute and chronic pain by teaching children coping strategies such as guided imagery, deep breathing, and distraction techniques. While this article highlights the significant need for non-pharmacological pain management in children with sickle cell disease, these resources may also benefit the many children coping with acute and chronic pain associated with other illnesses, disabilities and hospital experiences.

Children with sickle cell disease (SCD) can often struggle with acute and chronic pain associated with vaso-occlusive events (VOE). VOE not only causes pain crisis for some patients with SCD, but also may can cause damage to bones, spleen, brain, liver, lungs, kidneys, and joints (Zouki et al., 2018). This organ damage can result in additional need for pain control.  VOE occurs when “sickled cells” stick together in a blood vessel blocking blood flow to a certain part of the body. VOE is the most common reason for hospital admission for children and teens with SCD (Zouki et al., 2018). Increased pain and suffering can escalate a patient’s vulnerability to psychiatric illnesses such as depressive disorders, anxiety disorders, and post-traumatic stress disorder (Geziry et al., 2018). It is vitally important that all pain is acknowledged and that non-pharmacological pain management techniques work in partnership with pain medications to provide better pain management for SCD patients and other children coping with pain.

Many families may not be aware of or have access to options for non-pharmacological pain management due to lack of insurance coverage, lack of availability in the community, or lack of education and referrals for services. Child Life Specialists, social workers, hospital psychologists, and health care providers are often the medical team members best positioned to provide education, information, and resources to encourage and equip patients with tools and ideas for non-pharmacological pain management. The resources below will provide a starting point for professionals seeking to support their patients as they are coping with pain. While many of these ideas are from clinical experience working with children with sickle cell disease, most all ideas are applicable for children coping with pain due to other sources. Some ideas include massage therapy, acupuncture, guided imagery, meditation, progressive muscle relaxation, music therapy, effective pain rating scales to identify pain accurately, and deep breathing exercises.

References

Geziry, A., Toble, Y., Al-Kadhi, F., Pervaiz, M. & Al-Nobani, M. (2018). Non-pharmacological pain management. In N. Shallik (Ed.), Pain management in special circumstances (pp. 1-14). IntechOpen.

Zouki, T., Haroutunian, A. & Malcom, T. (2018). Pain management for the sickle cell patient. In N. Shallik (Ed.), Pain management in special circumstances (pp. 15-32). IntechOpen. 

 

Articles & Informational Guides for Parents

  1. Kids Health. This website provides a basic overview of sickle cell pain crisis, what it is, how it is caused, what it feels like, how to respond during crisis, and how to try to prevent a crisis from occurring. This is a great teaching sheet available in English and Spanish for helping educate teenagers about their pain and for starting the conversation about pain management strategies. https://kidshealth.org/en/teens/sickle-crisis.html
  2. Centers for Disease Control (CDC). This organization offers multiple PDF fact sheets about sickle cell disease that can help promote understanding for parents, teens, school teachers, or other members involved in supporting a child with sickle cell disease. Through additional education and clear, concise teaching resources, patients and families can have a better understanding of pain, pain management, and how to partner with healthcare providers to manage pain. https://www.cdc.gov/ncbddd/sicklecell/materials/factsheets.html
  3. Practical Pain Management. This website provides an excellent article written by Rosemary Black that can be a helpful tool for parents as they care for a child with chronic pain or long-term frequent acute pain. It gives great tips for how to react when a child is in pain and how to help a child manage their pain.https://www.practicalpainmanagement.com/patient/resource-centers/chronic-pain-management-guide/when-your-child-living-chronic-pain
  4. About Kids Health. This website is a source of helpful information for parents who are parenting an older child with chronic pain. This specific article provides ideas for keeping regular routines, establishing good sleep patterns, supporting children through transitions in school, taking care of yourself as a parent, and advice for when to seek professional help for your child. https://www.aboutkidshealth.ca/article?contentid=3651&language=english
  5. Health Engine. It is so important for non-pharmacological methods of pain management to be used in combination with pain medications. Health Engine acknowledges how important this is in their article and provides a list of 10 examples of methods of non-pharmacological pain management. https://healthengine.com.au/info/control-of-pain-in-children-paediatric-pain-management
  6. Joint Commission, Division of Healthcare Improvement. (2018, August). Quick safety: Non-pharmacological and non-opioid solutions for pain management. https://www.jointcommission.org/-/media/tjc/documents/resources/pain-management/qs_nonopioid_pain_mgmt_8_15_18_final1.pdf. This article from the Joint Commission lists evidence-based, non-opioid options for treating pain. It provides a thorough list of non-pharmacological pain management ideas that are supported and validated by research.


Making a Personal Pain Scale

  1. Pain Doctor. This website provides a helpful article about 15 different pain scales and how to find the best pain scale. The “personalized pain scale” and “Randall pain scale” are the two scales that I have used with children in the hospital setting. It is so important for patients to have a way to describe and rate their pain for effective pain management to occur. https://paindoctor.com/pain-scales/
  2.  Functional Pain Scale. This is a link to a more thorough description of a “functional pain scale” and examples of how this type of pain scale could be created and used with a patient. https://www.caltcm.org/assets/Pain-file/functional%20pain%20scale%20u%20of%20iowa_2001.pdf
  3. Randall Chronic Pain Scale. This website provides additional information about the “Randall chronic pain scale”. This pain scale can help patients rate their pain with descriptions and personalized examples of when various levels of pain have been experienced previously. http://www.infomin.org/painscale.html#howto


Books 

  1. Culbert, T. & Kajander, R. (2007). Be the boss of your pain. Free Spirit Publishing.  This book is an excellent tool for providing education about non-pharmacological pain management and teaching tangible skills to children. Some skills discussed include acupressure, aromatherapy, biofeedback, the jettison technique, changing the image of your pain, and belly breathing.
  2. Arteaga, M. & Celej, Z. (2013). Inside my imagination. Cuento de Luz. This peaceful, calming story has beautiful illustrations that promote relaxation and encourage children to use their imagination. This book can also create the opportunity for a child to learn how to use imagination as a technique for distraction from pain. This book is available in both English and Spanish versions for purchase.
  3. Clarke, C. (2014). Imaginations 2: Relaxation stories and guided imagery for kids. Bambino Yoga. This book provides guided imagery stories for each season of the year and for specific environments in nature such as rainbows or waterfalls. Some stories are lengthy but are perfect for pain management moments when a longer reading is preferred.
  4. Clarke, C. (2016). Imaginations 3: Guided meditations and yoga for kids. Bambino Yoga. A wonderful children’s book that provides prompts for leading a child or teen through guided meditation. Additionally, this book provides information about the basics of yoga and yoga routines for kids of all ages to enjoy for relaxation and stretching.
  5. Hsu, L., Rodrigues, C., & Brandalise, S. (2019). Hope and destiny jr. workbook. Hilton Publishing.This is a workbook and learning guide designed specifically for adolescents with sickle cell disease. It provides education about types of pain and provides a place to track pain and symptoms. It also offers learning activities and journal pages to write about challenging experiences. 


Other Resources

  1. Sleep Talk Down Guided Meditation: Fall Asleep Faster with Sleep Music and Spoken Word Hypnosis. This YouTube video shows soothing images of outer space and guides the listener through soothing spoken word and guided meditation to help promote sleep and relaxation. https://www.youtube.com/watch?v=69o0P7s8GHE
  2. Moshi. This app has wonderful guided imagery and relaxation stories that are designed to help children fall asleep. Many of the stories are free and do not require additional payment within the app. There are also “sounds” available without words that could be used as background music for story time, guided imagery, or as a sound machine for relaxation. https://www.moshisleep.com/?gclid=Cj0KCQjw-af6BRC5ARIsAALPIlVnyLr2opB8imxOuIuw8YyzeyIRI4w8_D_RVro8wr8U3aSyuyQzsWgaAk_9EALw_wcB
  3. Breathe2Relax. This app provides guided deep breathing exercises which can help with relaxation and non-pharmacological pain management. The app helps remind the listener to create a calming environment before beginning each deep breathing exercise. It also provides reminders for best body posture and reminders to breathe intermittently throughout the exercises. https://apps.apple.com/us/app/breathe2relax/id425720246
  4. Calm. This App is free with the opportunity to purchase additional resources within the app. It provides 7-day educational sessions such as “how to meditate” or “7-days of calm” which could help introduce these concepts to patients and families. There are guided relaxation sessions catered to sleeping and in the “more” section of the app you can find “breathing exercises” which guide the user through deep breathing with a visual bubble. https://www.calm.com/
  5. Pain Scale. This app not only creates a place to document pain level and pain’s location on the body but it also helps document triggers and patterns as each person tracks their pain over time. It provides daily ideas for pain relief, videos for daily guided meditation, and additional articles and videos for education, encouragement, and building a base of non-pharmacological pain management strategies. https://www.painscale.com/
  6. Fully Loaded Electronics. This company offers virtual reality (VR) systems that are already pre-loaded with games. Their VR systems are user-friendly for child life specialists and they offer payment by invoice (which most hospitals need). They offer a wide array of games that can promote relaxation, diversion and pain management with multiple bundle options. https://fullyloadedelectronics.com/collections/virtual-reality-vr-therapy
  7. Childrens Healthcare of Atlanta Virtual Reality Case Study. This article provides an overview of a case study done at Children’s Healthcare of Atlanta to assess the benefit of virtual reality to patients while coping with procedures, pain, and/or anxiety. Overall, the article highlights games that were beneficial to promote patient coping, previous studies done showing the effectiveness of VR, and patient and staff quotes after the use of VR in this study. https://www.wsbtv.com/news/national/hot-topics/children-s-healthcare-of-atlanta-using-virtual-reality-to-help-young-cancer-patients/943030453/


Jessica Westbrooks has been a child life specialist for 6 years and has worked with patients and families in an outpatient hematology/oncology setting for 5 years. In her time working in this environment, she has created functional pain scales with patients to help with better pain rating and she has used techniques such as virtual reality, diversion, guided imagery, essential oils, and deep breathing to promote non-pharmacological pain management. Jessica is passionate about connecting patients with resources to support their coping in the hospital environment and at home. Jessica can be reached at jessica.westbrooks@choa.org.

Leave a comment

Leave a comment
  1. William Johnson | Jul 04, 2022
    You should on a huge level cerebrum blowing in like way solid course, which means notice:  2022 Tundra
  2. waqas | Jul 04, 2022
    This article gives the light in which we can observe the reality. This is very nice one and gives indepth information. Thanks for this nice article. sbobet wap
  3. qk | Jul 04, 2022
    i really like this article please keep it up. sbobet indonesia
  4. a course in miracles books | Jul 03, 2022
    This is a great post. I like this topic.This site has lots of advantage.I found many interesting things from this site. It helps me in many ways.Thanks for posting this again.a course in miracles books
  5. yoyo | Jul 02, 2022
    I am definitely enjoying your website. You definitely have some great insight and great stories. buy fentanyl patch
  6. ayan | Jul 02, 2022
    I recently came across your blog and have been reading along. I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often. quantum code
  7. yoyo | Jul 02, 2022
    I am definitely enjoying your website. You definitely have some great insight and great stories. ehm297
  8. asd | Jul 02, 2022
    i never know the use of adobe shadow until i saw this post. thank you for this! this is very helpful. คาสิโน ออนไลน์ เว็บตรง
  9. Anne Phoebe | Jul 02, 2022

    A strong essay outline is essential to writing a decent essay. A strong structure unites all the elements of an excellent piece. The majority of students use outlines created online. However, savvy students either complete the assignment themselves or engage specialists with a variety of experiences to write the essay for them.

    We are aware of how challenging it can be for you to tackle challenging arithmetic issues unless you put in a lot of effort or take some time out of your busy schedule. Due to our online maths coursework help, MyAssignmenthelp.com is here to put an end to all of your concerns once and for all.

    The phrase "do my dissertation” is frequently used by students in the USA. When students are given the assignment to write a dissertation, they may get a chill down their spine. It's really easy to understand why. A superb dissertation requires extensive study and takes a lot of time to write.

    To finish all of their assignments, students frequently face a tight deadline. Naturally, maintaining the quality of such tasks becomes tiresome. Use of the free spell checker tool is advantageous for this reason. With just a few clicks, the students can use this tool to quickly find all the mistakes and inconsistencies.

  10. asd | Jul 02, 2022
    Hey, this day is too much good for me, since this time I am reading this enormous informative article here at my home. Thanks a lot for massive hard work. Escort İzmir
  11. sa | Jun 30, 2022
    Pretty good post. I just stumbled upon your blog and wanted to say that I have really enjoyed reading your blog posts. Any way I'll be subscribing to your feed and I hope you post again soon. Big thanks for the useful info. bandar rolet
  12. sa | Jun 30, 2022
    I was surfing the Internet for information and came across your blog. I am impressed by the information you have on this blog. It shows how well you understand this subject. idn slot online
  13. sa | Jun 30, 2022
    This blog is so nice to me. I will keep on coming here again and again. Visit my link as well.. sbobet88 login
  14. sa | Jun 30, 2022
    This is my first time i visit here and I found so many interesting stuff in your blog especially it's discussion, thank you. game slot gacor
  15. sa | Jun 30, 2022
    This post is good enough to make somebody understand this amazing thing, and I’m sure everyone will appreciate this interesting things. judi tangkasnet
  16. ali | Jun 30, 2022
    The matter you we highlighted above is surely value able for anyone to workout. the concept of your article is very true and It will result in a positive way. Business Development Services
  17. SEO | Jun 30, 2022
    Positive site, where did u come up with the information on this posting?I have read a few of the articles on your website now, and I really like your style. Thanks a million and please keep up the effective work. Medyum
  18. qaseo | Jun 30, 2022
    I got what you mean , thanks for posting .Woh I am happy to find this website through google.KELTEC SUB 2000
  19. sasa | Jun 30, 2022
    What are the causes of high rates of unemployment? How it harms the society in a long run? ประกันตนเอง
  20. waqas | Jun 30, 2022
    Your article has piqued a lot of positive interest.  I can see why since you have done such a good job of making it interesting. https://kubslot99.com
  21. Shopify Store Development & Customization Experts | Jun 30, 2022
    Jarvis is the leading We have a team of certified Shopify experts who have helped thousands of businesses create and customize their online stores.Shopify Store Development & Customization Experts
  22. waqas | Jun 30, 2022
    Took me time to read all the comments, but I really enjoyed the article. It proved to be Very helpful to me and I am sure to all the commenters here! It’s always nice when you can not only be informed, but also entertained! kub slot
  23. Liwovosa | Jun 30, 2022
    I high appreciate this post. It’s hard to find the good from the bad sometimes, but I think you’ve nailed it! would you mind updating your blog with more information? www.romaslotvip.com
  24. qk | Jun 29, 2022
    A very awesome blog post. We are really grateful for your blog post. You will find a lot of approaches after visiting your post. เครดิตฟรี123
  25. waqas | Jun 29, 2022
    I read that Post and got it fine and informative. Digital Marketing Service
  26. sa | Jun 29, 2022
    Thanks for sharing nice information with us. i like your post and all you share with us is uptodate and quite informative, i would like to bookmark the page so i can come here again to read you, as you have done a wonderful job. link sbobet88
  27. sa | Jun 29, 2022
    Yes i am totally agreed with this article and i just want say that this article is very nice and very informative article.I will make sure to be reading your blog more. You made a good point but I can't help but wonder, what about the other side? !!!!!!Thanks slot demo pragmatic
  28. sa | Jun 29, 2022
    I have recently started a blog, the info you provide on this site has helped me greatly. Thanks for all of your time & work slot gacor
  29. Liwovosa | Jun 29, 2022
    You know your projects stand out of the herd. There is something special about them. It seems to me all of them are really brilliant! acting classes for teens
  30. sa | Jun 29, 2022
    You make so many great points here that I read your article a couple of times. Your views are in accordance with my own for the most part. This is great content for your readers. slot gacor
  31. Dofollow Blog Comments | Jun 29, 2022
    Only aspire to mention ones content can be as incredible. This clarity with your post is superb and that i may think you’re a guru for this issue. High-quality along with your concur permit me to to seize your current give to keep modified by using approaching blog post. Thanks a lot hundreds of along with you should go on the pleasurable get the job done. Dofollow Blog Comments
  32. sa | Jun 29, 2022
    I want you to thank for your time of this wonderful read!!! I definately enjoy every little bit of it and I have you bookmarked to check out new stuff of your blog a must read blog!!!! slot gacor
  33. qasreo | Jun 29, 2022
     After all I’ll be subscribing to your feed and I hope you write again soon! Link building services
  34. Atik77 | Jun 28, 2022
    The benefits of Satta king 786 game result are this, on Satta King 786 website, you will get Faridabad Satta King Ghaziabad Satta King Galli Satta King Diswar Satta King, you will get benefit from Satta King 786 in every game, from these games you will get Satta King 786 Lucky Number Satta King Black Lucky Number Satta King Game Result Satta King Chart You will also get all the information of Satta King.
  35. SEO | Jun 28, 2022
    Jarvis is a social media marketing agency uk . We offer a variety of services such as social media marketing search engine marketing SEO and Shopify store setup. We are dedicated to helping our clients grow their businesses online and reach their target audiences.
  36. as | Jun 28, 2022
    Thanks for a very interesting blog. What else may I get that kind of info written in such a perfect approach? I’ve a undertaking that I am simply now operating on, and I have been at the look out for such info. judi joker123
  37. assignment help | Jun 28, 2022
      Reach out to the best assignment help in Canada for top-quality writing support. I have worked with the professionals of greatassignmenthelp.com for a very long period of time. I haven't ever been unhappy with the support to date. Definitely recommend this assignment help servcie to other students in Canada! 
  38. as | Jun 27, 2022
    Thanks for taking the time to discuss this, I feel strongly about it and love learning more on this topic. If possible, as you gain expertise, would you mind updating your blog with extra information? It is extremely helpful for me. situs capsa online
  39. waqas | Jun 27, 2022
    This article gives the light in which we can observe the reality. This is very nice one and gives indepth information. Thanks for this nice article. judi tembak ikan
  40. skyward fbisd | Jun 27, 2022
    I felt very happy while reading this site. This was really very informative site for me. I really liked it. This was really a cordial post. Thanks a lot!. skyward fbisd
  41. Liwovosa | Jun 27, 2022
    I really appreciate this wonderful post that you have provided for us. I assure this would be beneficial for most of the people. slot joker388
  42. sasa | Jun 27, 2022
    If you are looking for more information about flat rate locksmith Las Vegas check that right away. Top Architectural Firms in Lahore
  43. johny | Jun 26, 2022
    You made such an interesting piece to read, giving every subject enlightenment for us to gain knowledge. Thanks for sharing the such information with us to read this...hard money loans
  44. qk | Jun 26, 2022
    I can’t imagine focusing long enough to research; much less write this kind of article.  You’ve outdone yourself with this material.  This is great content. slot ikan
  45. Liwovosa | Jun 26, 2022
    The best place to get car themed signs for your Garage, Man Cave, Home Office or Bar car accessories shop near me
  46. waqas | Jun 26, 2022
    I am happy to find this post very useful for me, as it contains lot of information. I always prefer to read the quality content and this thing I found in you post. Thanks for sharing. slot joker388
  47. asd | Jun 26, 2022
    I like viewing web sites which comprehend the price of delivering the excellent useful resource free of charge. I truly adored reading your posting. Thank you!  Storeboard
  48. asd | Jun 26, 2022
    I was reading some of your content on this website and I conceive this internet site is really informative ! Keep on putting up. สล็อต888 ฟรีเครดิต
  49. Call gril | Jun 25, 2022

    child life is very enjoying in every  time from children 

    <a href="https://www.callgril.in/bangalore/">Call Girls in Bangalore</a>|| 

  50. asd | Jun 25, 2022
    Very informative post! There is a lot of information here that can help any business get started with a successful social networking campaign. Texas Bug

    Child Life Profession