Including Parents in the Treatment Of Pediatric Complex Regional Pain Syndrome

Shayleigh K. Dickson, MSN, APN, CPNPAC, CPN


Pediatr Nurs. 2017;43(1):16-21. 

In This Article

Nursing Implications

Nurses can support adolescents with CRPS and their family members by acknowledging the adolescent's level of pain and functional disability. Although the pain seems disproportionate to the original injury and lasts longer after the injury than would be expected, the nurse must continue to practice based on the principle that pain is what the patient says it is. Nurses should encourage the adolescent to identify stressors that exacerbate pain, as well as adaptive coping strategies that relieve the pain. Strategies may include exercise, meditation, distraction, or cognitive reframing. Additionally, explaining that the pain may recur but that the development of these coping strategies can limit the exacerbation is an essential component of anticipatory guidance for patients. Nurses should promote adolescents' independence by encouraging them to perform activities of daily living with decreasing assistance. Another way to promote independence is to encourage adolescents to voice their own concerns and questions rather than having their parents speak for them. Nurses also have a role in supporting parents. Initially, nurses can play a direct role in promoting the adolescent's mobility, thus alleviating some burden from parents (Gaughan et al., 2014). Until the parent has developed a nuanced understanding of the treatment and the skills to intervene more effectively regarding the symptoms, the task of encouraging the adolescent in pain to participate in therapy is enormously difficult. By assuming this role, the nurse promotes the adolescent's mobilization and models for the parent appropriate ways to guide the adolescent toward independence. Nurses should also model for parents the use of positive language to promote the adolescent's strengths and limit excessive focus on the pain.

Adolescents with CRPS present a challenge to clinicians because of the complex interplay between biological, psychological, and social that contributes to the pain experience. The multidisciplinary therapy necessary to achieve remission and develop coping strategies to limit exacerbations is incomplete without inclusion of the family. In particular, the parent who develops ineffective management strategies when an adolescent has CRPS must be altered in order to encourage developmentally appropriate independence, reduce stress, and promote effective coping. Parents need the support of nurses to under stand CRPS and its treatment, develop adaptive parenting skills, and manage psychological distress. By utilizing a family-centered approach, nurses can best care for the adolescent with CRPS.