If everything is physically normal, what causes my child's pain?
Experiencing pain when there is no underlying physical problem is surprisingly common. It can be difficult for children, who may feel as though their friends and family will think they are inventing the pain or that they are suspected of imagining it. It is important to explain that you know that their pain is real and that it needs to be managed and treated just as much as if it came from a broken bone.
Pain and the brain
Although injury, pressure and stretching of our bodily tissues cause pain, the sensation of pain can also be made, increased or altered by the brain. There are pain 'centres' in the brain, which receive signals from body tissues but also from the thinking and emotional areas of the brain. The final pain sensation is created by the brain from all three.
Many of us will have experienced the brain's effect on pain: we get headaches when worried, feel sick when given bad news and develop loose stools when anxious. In the same way, stress can affect physical pain - for instance, by making even normal activity of the bowel painful.
We are more likely to feel pain - or feel the pain more intensely - when we are expecting pain, where we believe we have a worrying illness, or where we are anxious or depressed. Focusing on the location of a pain will sensitise the nerves and make it worse. People sometimes use a technique of focusing on another part of their body to manage pain - for example, clenching fists or focusing on toes when having an injection.
The body may create the sensation of pain as a substitute for the sensation of other distress such as bullying, unhappiness at school, worry about exams, worries about friendships or worries about weight and body image. Distress may be experienced as real tummy (abdominal) pain, headaches or both.
In IBS, doctors additionally believe that the intestines are abnormally sensitive and overactive, which is a major source of pain.
What reduces the pain?
We know that painkillers are not always particularly helpful in this form of 'brain-induced' pain and that painkillers come with side-effects. In many cases, the side-effects may include making the bowel more sensitive, or upsetting the normal working of the bowel by causing constipation or indigestion. However, understanding how the pain is made shows us that working on the emotional and anxious areas of the brain through reassurance is just as likely to be effective.
We also know that the body contains natural pain-reducing substances, including adrenaline (epinephrine), cortisol and endorphins. This is why, in a sudden accident, even a severe injury is often not initially painful. It also means that increasing levels of these positive chemicals can be helpful. Endorphins, for example, are increased in exercise, and adrenaline (epinephrine) by both exercise and excitement. It follows from this that if your child is able to increase their exercise levels and to find enjoyable and fun things to do, this is more than a distraction, it will also have a direct and real effect on the pain and it may allow them to feel more in control of their situation.
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