Kamaruddin bin Ibrahim1, Mary Cardosa1, KS Ng1
We report a case of an adolescent with chronic abdominal pain which illustrates that parents may influence the pain experience of adolescents.
A 17-year-old girl was referred to Hospital Selayang Pain Clinic (HSPC) in 2011 for chronic abdominal pain. The pain started in 2008, and she was initially treated as acute appendicitis; laparoscopic appendicectomy found a normal appendix. She continued to experience recurrent colicky abdominal pain associated with loose stools, and was diagnosed to have Crohn’s disease after colonoscopy. Her abdominal pain persisted and she was treated with multiple pain medications including strong opioids with minimal relief.
At HSPC, a diagnosis of chronic abdominal pain with visceral hyperalgesia was made. Management was using a multimodal approach by a multidisciplinary team of pain specialists, clinical psychologists and physiotherapists. In 2012 she attended the ‘Menang’ Programme, a cognitive-behaviour therapy-based pain management programme (PMP); she was taught non-pharmacological techniques of pain management including relaxation, activity pacing, and thought challenging, and stopped all pain medications. After the PMP she managed her pain well, completed secondary schooland started college.
In 2014 she experienced flare-up of her abdominal pain; she restarted strong opioids, and became distressed and disabled again. On reassessment at HSPC, we discovered a major conflict between her parents with potential divorce. With the support of her mother and proper practice of pain management strategies, she reduced the opioids and regained control over her chronic pain.
Conclusion: The role of parents may be both negative and positive in adolescents with chronic pain.
Keywords: Chronic pain, Pain Management Programme,parents, adolescent.