ld achieve it. (See the top 10 medical breakthroughs of 2008.)
The control group of kids was treated for far longer than 10 weeks; in fact, they had an average of 23 weekly sessions, although those sessions were divided among physicians, physical therapists and a psychologist or psychiatrist. Each day, these kids were also given up to 100 mg of amitriptyline, a sedating drug that used to be prescribed as an antidepressant but is now used more often as a treatment for chronic pain.
ACT proved to be the better approach by far. Even when the ACT kids were interviewed 18 weeks after their last session, they reported less discomfort than did the control group, as well as less fear of injury and greater capacity to do things like go to school regularly. The authors conclude that drugs, while they can help in the short term, don't stimulate long-term behavior change. By contrast, with ACT, "the target in treatment is to clarify and reduce avoidance behaviors that prevent the patient from living a vital life," the study says. (Read "On the Couch Online: Does Tele-Therapy Work?")
How this succeeds isn't entirely clear, but the researchers used a simplified version of ACT with the kids. Typical ACT sessions with adults require difficult meditation strategies, but psychologist Rikard Wicksell, who led the Swedish team, says the researchers wanted to make sure their strategy was age-appropriate, so they didn't require meditation and instead focused on behavioral activation: getting the kids moving.
"Most of the things they want to do in life are associated with having to experience pain," says Wicksell. The kids want to play soccer or basketball, they want to go to movies, they want to be able to tell friends they can spend a whole Saturday with them. But for many of these kids, just standing up from a sofa can hurt a little. "So we discuss pros and cons the short- and long-term consequences of not doing things with friends," says Wicksell. The kids eventually learn how to take their pain along with them to social outings how to hold it close rather than dragging it at a heavy distance. (See the most common hospital mishaps.)
Parents also must be educated. According to Lynnda Dahlquist, a professor at the University of Maryland, Baltimore County, and co-author of the chronic-pain chapter in the Handbook of Pediatric Psychology (2003), many parents reinforce avoidance behavior in kids with chronic pain by doing something that comes naturally to parents: being kind to their kids. "Let's say Johnny's back pain flares up during math class," says Dahlquist. "He feels terrible, so he says, 'I can't do my math.' Mom comes, takes him home, puts the TV on and gives him a back rub. Well, math isn't fun. And who wouldn't like a back rub?" Instead of being indulged, kids with chronic pain often need a push.
ACT can provide that push but one that comes from within. The new study suggests a less sentimental approach for kids with chronic pain: sympathy but never pity.