TMS in Teens & Adolescents

Hello TMS Wiki!

Jamie Shafir, a therapist and team member at our group practice (the Mind Body Therapy Center), specializes in working with adolescents and teens. She recently wrote an article about her approach, research, and her personal experience with chronic pain in adolescents. I wanted to post it here.

If you are a teen or adolescent dealing with chronic pain, or are the parent of one, please reach out to us we'll put you in touch with Jamie! www.mindbodytherapycenter.org

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Parents of adolescents with chronic pain often sit side-by-side with their children for appointment after appointment - watching their children undergo a litany of tests followed by more tests. Will this next test find something conclusive? When no structural causes are found disempowerment can set in. Parents often suffer alongside their children, experiencing immense grief around missed experiences and what they envisioned for the future. Additionally, parents may feel an extreme pressure to “keep things together” and put on a “brave face” for their children, while simultaneously both the parent and child feel disempowered. What is the path forward? Is it another practitioner?

Frequently, an adolescent starts to work with me at the recommendation of another practitioner. I always have consultations with a prospective adolescent client, because chances are they have been through the hope-disappointment cycle so many times, and they might be thinking am I just one more person who will disappoint them. Also, they deserve agency. They are entitled to ask me questions, to literally interview me! I at least want them to be able to say “I like you” or “You suck” or anything in-between. Depending upon how they feel, specifically if they want to work with me, I schedule a consultation with their parent(s) or guardian(s). Sometimes this is in reverse order, either way, I always talk to the adolescent before our first session.

Assessing an adolescent with pain is different than assessing an adult. Treatment must also be different and delivered through a developmentally informed lens. Initially, my goal is to foster openness, trust, interest in the neuroscience of pain, and levity. We are chiseling away at years of conditioning that structural causes are always the culprit of chronic pain. Leaning into the psychoeducation, particularly the neuroscience of chronic pain, is a way to start to deconstruct the pervasive narrative that chronic pain is always caused by structural damage in the body. Hello, threat response! Here is where I cite research to buttress such assertions:

Assessing a child or adolescent with low back pain is different to assessing an adult with low back pain

Exploring the concept of pain of Australian children with and without pain: qualitative study

Talking to Teens about Pain: A Modified Delphi Study of Adolescent Pain Science Education

Often chronic pain feels like a life sentence, which can be terrifying. With the average life expectancy of Americans being 76.4 years, imagine receiving a life altering diagnosis at 15. I apologize, diagnoses including a: foot drop, herniated discs (C4-C6 and L2-S1), degenerative disc disease, and severe spinal stenosis. 16 years ago this was my younger sister. At 15 she was put on bedrest. She’s pretty incredible (I’m also totally biased). Before her pain, she was a competitive gymnast, modern dancer, and always caught bigger fish than me when our dad would take us fishing as kids. It felt so unfair she had to deal with a foot drop, and was told she needed surgery. She was winning gold medals, and then suddenly she was frail. My mom, a pretty fierce advocate for her kids, took my younger sister from surgeon to surgeon for consults. Finally, one surgeon said it’s possible that the foot drop could get better on its own.

Recently, I was talking to my younger sister and asked, “Hey, what would you have wanted your doctor’s to tell mom and dad?”

“When I was diagnosed at 15, I was told to stop whatever you’re doing that causes pain, stop doing those activities. Also, take a bunch of medication. Don’t do anything that causes pain or hurts. Now people realize you have to keep moving, that movement is still safe. I was taught to be so scared of pain. I was treated differently because of my pain, I didn’t want that. People need to find some sort of movement or activity that they enjoy.”

Now, I’m a mindbody therapist, and she is biking to work everyday in her 30s.

 

Thank you Jan! That's very kind of you.

 

I agree. It was a great episode!

 

Daniel, I would LOVE to interview you about this specific topic on my podcast, The Mind and Fitness Podcast, if you're interested. I have interviewed Christi Uipi 3 or 4 times now and have admired your content from afar for awhile. Let me know if you're into that!

 

Nice to see you, too! I'm still around, lurking every couple of weeks or so!!