The Impact of COVID-19 on Youth with Chronic Pain and their Parents

Brought to you by CHYP’s Parenting Blog

January 3, 2022

By: Lonnie Zeltzer, MD

I read a recent article in the Journal of Pain by Alex Neville and colleagues entitled, “Pediatric chronic pain in the midst of the COVID-19 pandemic: Lived experiences of youth and parents” published December 16, 2021. The full text is available here.

This was a study based at a pediatric pain center in Western Canada and involved interviews with 20 adolescents in treatment for chronic pain, as well as interviews with their parents. The questions were based on the impact of COVID-19 restrictions on their lives, as perceived by these teens and parents.

The findings indicated both hardships and resilience.

Difficulties with Peers

Difficulties ensued for teens who tended to be more outgoing and social, and needed the stimulation of friends in school. The isolation provided less distraction and peer support.

Teens with chronic pain who typically coped by pushing themselves, and who were involved in sports, orchestra/band, chorus, or dance, no longer had those activities to engage in. Thus, they had more time to notice, be worried by, and be impacted by their pain.

They also felt less understood by healthy friends who made comments such as, “Oh, now I know what you’ve been through. I’m going through isolation because of COVID.” Since their own experience was very different than the isolation their friends experienced due to COVID, teens with pain felt even more distanced from their healthy peers.

It was noteworthy that teens who tended to be introverted actually benefited by remaining at home with online school since other classmates also had to engage in online school. Thus, these teens with pain did not miss the in-classroom activities.

Difficulties with Family

Difficulties also related to autonomy. Adolescence is a time for developing one’s own identity by spending time with peers as well as experiencing autonomy. Isolation at home restricted what many adolescents viewed as their own social and emotional growth.

Tensions developed in homes where teens felt that their parents were too intrusive. Teens were also affected by more exposure to difficulties in interactions between other family members. For some adolescents, seeing their parents as more stressed made them reluctant to seek help from them or to let their parents know about their suffering.

Other Difficulties

Teens with learning disabilities, ADHD, or executive function problems have found it hard to learn online and have gotten further behind in schoolwork. This has created new stressors — especially for going back to school — as these teens are now further behind their peers academically.

Access to care was made more difficult by the COVID-19 pandemic. As some adolescents commented, in-person, human-to-human interaction provided something special that online connections did not provide. They experienced an increased void because of reduced direct contact with physical therapists, physicians, nurses, occupational therapists, and psychotherapists. Other treatments like acupuncture were gone.

On a psychological level, adolescents had more time to notice world events and reported being more worried about their future. They saw peril in global events, the economy, the environment, and in how people were treating other people generally, at a societal level.

While this study was carried out in Canada, the findings of this study parallel other related studies in the U.S. Research has shown that adolescent depression and suicide overall have increased in the U.S. We already know that adolescents with chronic pain have a higher prevalence of depression, which isolation has made worse.

Resilience

For all the difficulties, though, many adolescents and their families have shown resilience and growth during the stressors placed on them by the pandemic. Some positive things from the COVID-19 isolation involve both parents’ and teens’ reappraisal of their situation, their lives, and their future. The need for a variety of creative outlets and opportunities for online peer and parent support, education, coping strategies, and other activities will be critical.

This may become especially important as we move forward with the Omicron variant, which is so highly contagious. It may create even more uncertainty about attending or not attending school, depending upon COVID positivity rates. (I want to remind readers that we offer online resources and activities for youth and parents here on our website.)

A note for parents: Allow your adolescent to develop opportunities for independence and autonomy, even within the home environment. Reliance and growth evolve through parental support and encouraging discussions within the family — not just about positive emotions, but also about fears and negative emotions which can build up inside if there are no outlets for expression. Home family activities can also provide stimulation and a non-pain focus.

It will be interesting to see how resilience emerges over this next year with the uncertainty related to the COVID-19 virus. Notice resilience in small bits in your family and allow its growth.

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Lonnie Zeltzer, M.D., is a Distinguished Research Professor of Pediatrics, Anesthesiology, Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA and Immediate Past-Director of the UCLA Pediatric Pain and Palliative Care Program. She is a co-author on the Institute of Medicine report on Transforming Pain in America and is a member of the national steering committee assigned to provide directions for pain research at the National Institutes of Health (NIH).  She has received, among other awards, a Mayday Pain and Policy Fellowship and the 2005 Jeffrey Lawson Award for Advocacy in Children’s Pain Relief from the American Pain Society (APS).  Her UCLA integrative pediatric pain program received a 2009 Clinical Centers of Excellence in Pain Management Award from APS and a 2012 award from the Southern California Cancer Pain Initiative.  She is active in advocacy for pain care and research. She was an invited member of the Institute of Medicine National Expert Panel on pain in American and was a co-author of the IOM publication on the committee findings in 2011. She was an invited member of the Centers for Disease Control (CDC) Special Advisor on The State of Opioids in America. She is also an invited member of the FDA Committee on Analgesia, Anesthesia, and Addiction, where new pain-related drugs are given FDA approval or not, as well as an invited member of the Expert Advisory Committee on Hemoglobinopathies as a pain expert for the National Heart, Lung, and Blood Institute (NHLBI) at NIH.  She is also on an expert panel for the NIH on a national study on a mind-body intervention for teens with fibromyalgia. She is also a member of the national Autism Think Tank as a pain expert in autism. Her research includes yoga, mindfulness, hypnotherapy, and other self-help interventions, including mobile technologies, to help children and adolescents who have chronic pain, as well as understanding biopsychosocial pain mechanisms in irritable bowel syndrome, cancer, sickle cell disease, headaches, dysmenorrhea, and other conditions. She has over 350 research publications on childhood pain and complementary therapies, has written more than 80 chapters, and published her first book for parents on chronic pain in childhood (HarperCollins, 2005) and her second book for parents on chronic pain in children and young adults (Shilysca Press, 2016).