At MCAM, we are here to help children and adolescents manage their chronic or complex pain - without the use of opioids.

“I see many patients going from doctor to doctor trying to find out what is wrong with them. But nobody and no test can find a cause for the pain. The pain may become debilitating. Besides, patients often suffer from fatigue and not being able to focus and concentrate. Pain and fatigue can cause them not to attend school, sports, or social activities. Furthermore, nothing has really helped to alleviate the pain.  Patients and families often become very frustrated.

There’s currently no single medication, “quick fix”, or any easy solution, proven to help kids with chronic pain. However, the current standard of care involves medical, physical, and psychological therapies. Physicians, nurses, physical therapists, counselors, psychologists, or psychiatrists and/or other healthcare professionals will build a team and help children from different angles overcoming their hassle with pain and returning to a functional life.”

- Kerstin Gerhold, MCAM physician

What can you expect in the pain clinic?

Before your first visit and throughout your care in the MCAM Pediatric Chronic Pain Clinic, your child and you can expect the following:

  • Your child and you will be treated with dignity and respect.
  • Your child’s pain will be treated with the current evidence-based practice philosophies. Treatment will not include the use of opioids.
  • Your child’s pain will be treated in a multifaceted way and may involve medical, physical, and psychological measures. Together with yourself and your child, the doctor will create a care plan that best suits your child. A nurse, a physical therapist, a social worker, and/or a counsellor, psychologist or others may become part of the care team, and respective referrals may be made. The team will work hand in hand with your child and yourself to help manage your child’s pain.
  • As part of a comprehensive approach, your doctor will evaluate all concerns important to you and your child that have been raised during your child’s journey. Your doctor will encourage you and your child to raise questions and worries and will address them as best as possible. Many children have complex health concerns, and it may take more than one visit to address these concerns.
  • It may or may not be possible for your doctor and the treatment team to determine a proximate cause of your child’s pain, but your doctor will consider the usually broad spectrum of diagnoses in her treatment suggestions.

What can you expect at your first visit to the pain clinic?

At your first visit, your doctor will take the history of your child and will perform a thorough physical exam. If applicable, she will explain what chronic pain means and how it can be treated in more detail. Then, an initial care plan will be discussed.

Please be prepared that your child’s first visit may take 2 hours and sometimes longer.

How can you prepare for the visit?

  • Please bring all the medical information you have about your child, such as your own notes, your doctor’s notes, X-ray reports, and blood test results.
  • Please bring all medications your child takes.
  • If you would like, please write down all the questions your child and you have prior to your visit, so that they are easy to remember, and we can discuss them during your appointment.
  • Please bring shorts and a T-shirt for your child; the physical exam will be easier and more comfortable for both your doctor and your child.

How to refer to the pain clinic?


What is chronic or complex pain?

Pain is described as an unpleasant feeling and emotional experience. There are many words that can be used to describe pain. A few examples are “achy,” “burning,” “sharp,” “shooting,” or “throbbing.”

Acute pain is pain caused by injuries or illnesses. This pain serves as a warning signal for the body to stop the harm; the pain tells us “Don’t put your finger on the hot stove” or “Don’t walk on your fractured leg.” Acute pain gets better and finally goes away when the injury heals, the illness resolves, or the symptoms of a chronic, long-standing disease become controlled.

Chronic or complex pain is different. It is often defined by how long the pain has been present - usually more than three months. However, the main feature of chronic pain is that the pain continues even though an acute injury or illness to the body has healed; the pain has lost its function to be a warning signal for the body. It may even occur without an actual injury. A chronic disease may be present, such as arthritis, but may not be solely responsible for the pain someone experiences.

Chronic pain can affect the head, abdomen, joints, muscles, or the entire body. Sometimes the affected areas of the body become very sensitive to pain. Then, pain can be triggered even by light touch such as when clothes touch the skin.

Chronic or complex pain is considered an illness itself. If it is severe, it can cause a person to step back from daily life activities such as attending sports, school, or social activities.

What are other symptoms of a chronic pain disorder?

Pain is often only one symptom of a child’s chronic pain condition. Many children and adolescents also complain about one or more of the following symptoms:

  • Poor sleep
  • Daytime tiredness (fatigue)
  • Low energy
  • Poor appetite
  • Mood changes, such as being unusually quiet, frustrated, sad, depressed, anxious, worrisome, moody, irritable, angry
  • Low or no interest in friends and family and socializing
  • Difficulties to focus and concentrate at school or for homework, or even to attend school

Pain may cause these symptoms, but the symptoms also work together to make the pain worse. For instance, worrying about pain naturally comes up and may also worsen the pain.

What causes chronic pain?

Unfortunately, it is not always clear why a person develops chronic pain. Researchers around the world are trying to find the actual causes. However, some risk factors have been identified that may contribute to the development and continuation of chronic pain. These risk factors are summarized as the “biopsychosocial” model of pain. Not a single factor seems to be responsible but the interplay between various factors. Here are some examples:

  • Biological factors: injuries and illnesses; the way, the nervous system deals with signals leading to pain
  • Psychological factors: mood changes and emotions such as being worried or sad
  • Social factors: stressful life events such as a death of a close person or break-up with a significant other; conflicts with family members or friends; lack of support and connections in and outside school; bullying and gossip; learning difficulties; perfectionism or high pressure to succeed; overwhelming daily schedules


How is chronic pain diagnosed?

Chronic pain is usually diagnosed through a detailed history and physical exam. Healthcare providers who are experienced in making a diagnosis of chronic pain will ensure that all necessary tests have been done before they confirm the diagnosis. A diagnosis of chronic pain may raise concerns that a serious health problem has been missed, because there is no defined cause of the disorder. Please discuss these concerns with your primary provider or the team at MCAM’s Clinic for Pediatric Chronic and Complex Pain.

How can chronic pain be treated?

Treating chronic pain is not as simple as many would hope. With the own words of an adolescent living with chronic pain: “One of the most difficult parts of living with chronic pain is letting go of the idea of having a ‘quick fix’ or a single pill for the pain.”

There are many different treatment options for people who live with pain. These treatment options cover all three factors of the “biopsychosocial” model of pain, including physical, psychological, and social measures. Combining these measures is usually necessary to manage chronic pain successfully. Such as taking measures to make the body less sensitive to pain, to improve negative emotions, and to get support to deal with stressful events.

Medical disclaimer

Please be aware that the information on this page is not meant to diagnose health problems or to replace professional healthcare or professional medical advice. If you have any question about your child’s health, please talk to your healthcare provider.