The puzzle of pediatric pain

Early in her academic career, Jessica Fales realized that hardly anyone had studied what she most wanted to learn about—the relationship between chronic pain and social development in children and adolescents. There was little research and a wide-open field.

“The main thread that ties my research together is trying to understand why rates of chronic pain increase in adolescence, why girls are disproportionately affected, and how to prevent them from turning into adults with chronic pain. And for those with chronic pain, how can we improve their outcomes?” Fales said. She believes that social relationships may play a key role in pain onset, pain chronification and pain prevention.

Fales became interested in links between social functioning and pediatric pain while working on her graduate degree at the University of Maine. Determined to do her clinical internship year at an academic medical center with a pediatric pain specialty, she found Oregon Health & Science University in Portland. “I got to be in on the ground floor of a treatment they were developing for parents of children with chronic pain,” she said, “and after that I was hooked.” Fales completed a two-year fellowship in pediatric pain management at Seattle Children’s Research Institute in 2014.

Chronic pain is common in childhood, adolescence and young adulthood, Fales said. Things like headaches, stomach aches and limb pain may be caused by an injury or disease, or there may be no known cause. And while some children in pain function just fine in their social worlds, others struggle or withdraw from activities. That can impair their social development.

Since joining WSU Vancouver in 2014 as an assistant professor of psychology, Fales has not slowed down. In 2016 she received a New Faculty Seed Grant from WSU for research in her Adolescent Health & Wellness Lab on the Vancouver campus. She also works with two other WSU Vancouver psychology professors, Benjamin Ladd and Renee Magnan, as part of a broader project supported by Grand Challenges Seed Grant and Alcohol and Drug Abuse Program funding from WSU Pullman. In addition, she continues to collaborate with her former mentors and colleagues at OHSU, SCRI and worldwide.

A promising start

Fales has learned a few things about what pain can do to kids. For example, in a commentary written with Paula Forgeron of the University of Ottawa, Fales concluded that strong friendships may benefit youth with chronic pain. “Children and youth with chronic pain have fewer friends, are rated as less likeable by peers, and may be subjected to higher rates of peer victimization,” she wrote.

This indicates a need for more research into how friendship can impact pain and disability, how to help children with chronic pain develop more social skills and ultimately how to harness the power of peers in recovery efforts. “Understanding social functioning, particularly peer friendships, in youth with chronic pain is the next critical wave of research in helping youth manage the complexity of chronic pain and develop into healthy young adults,” she wrote.

Another avenue for research is the role of parents in pediatric chronic pain. For example, Fales has learned that teaching problem-solving skills to parents—so they experience less stress in their own lives—can also help their children suffer less pain.

In her work at WSU Vancouver, Fales explores whether bullying or social exclusion is linked to physical pain. She and her collaborators have discovered that adolescents with chronic pain experience similar rates of victimization compared to their peers without pain—but are sometimes more bothered by these experiences when they do occur.

Last semester, Fales and her team of undergraduate research assistants (Alivia Stone, Elizabeth Hardin, Abigail Bambilla and Rachel Murray) wrapped up an experiment looking at whether being socially excluded affected healthy adolescents’ perception of physical pain. Stone will present her findings at the Society for Pediatric Psychology’s annual conference this spring, and Hardin will present at the American Psychology Association’s annual conference in August.

“The team is now trying to figure out where to go from here,” Fales said. “We are hoping to build on these results in clinical populations.”

Similarly, the Grand Challenges Seed Grant opened the door to further research on health behaviors and marijuana use broadly. Fales’s part of that grant involved use of marijuana for chronic pain in young people. “Some young adults are primarily using cannabis for its presumptive pain-relieving properties,” she wrote. “Nevertheless, even in the context of longstanding heavy use, their pain persists.” Is it possible that the relief from cannabis inhibits the development of other pain management techniques and ultimately prolongs the pain over time?

These are questions Fales wants to answer. “My big interest is trying to figure out the social risk and protective factors that may contribute to the development of chronic pain,” she said. “Once you identify those, they can be harnessed to develop preventative interventions. Is there something we can do to encourage and promote peer relationships and build resilience factors for youth with chronic pain? How can we make our treatments more effective?” She keeps running into the same problem: What she wants to find out has never been done. She said, “I wish there were lots more psychologists working on this subject.”

Top photo: A subject in the Fales lab viewing the “pain scale”.

Originally posted at WSU Research Now, WSU Vancouver