Family-oriented rehabilitation for unexplained chronic pain.

Dear Editor: We present a case report to illustrate our experience with a family-oriented rehabilitation program for children and adolescents suffering from unexplained chronic pain. Case Report A girl, aged 12 years, had a 6-month history of unexplained abdominal pain described as a "hurt feeling inside," fatigue, decreased concentration, sleep difficulty, and school avoidance. She was described as an excellent student and a perfectionist in all her activities. Consultations from a pediatrician, gastroenterologist, neurologist, and allergist ruled out significant organic pathology to explain her symptoms. Her parents were angry that a medical cause was not found and denied the existence of psychosocial Stressors. The child's aunt had recently died from a tumour that presented with unexplained pain symptoms for months prior to diagnosis. Psychometric testing revealed an anxious coping style and perfectionist traits. During the assessment, the family expressed their feelings of anger about their aunt's death and began to confront their unresolved grief. The patient began taking fluvoxamine 100 mg every night. As a goal of rehabilitation, we emphasized enhanced functioning, specifically, improved sleep, increased activities, and school attendance. We encouraged the parents to support these goals. After 3 weeks, the patient's sleep improved, and her fatigue and pain decreased. She went to overnight camp for 2 months, returned home, and attended school. Monthly family meetings continued for 6 months. Fluvoxamine was discontinued, and the patient continues to be well at 9 months. Discussion Pediatric unexplained chronic pain (UCP) presents a diagnostic and management challenge. Typically, families believe that UCP has solely an organic cause and frequently resist suggestions that psychosocial factors may be responsible for its development or perpetuation (1,2,6). Consequently, such patients develop a pattern of help-seeking behaviour involving multiple diagnostic investigations, repeated emergency department visits, hospital admissions, and prolonged hospital stays (3). Family physicians, pediatricians, and specialists in gastroenterology, rheumatology, endocrinology, and neurology are consulted frequently. To address this problem, we have established a multidisciplinary, family-oriented, and rehabilitation-focused program to treat patients with UCP. We use a battery of psychosocial self-report scales to evaluate perfectionism, anxiety, and depressive symptoms (4,5,7). …