When a child experiences pain that won't go away, families naturally focus on finding medical solutions.
However, research shows that psychological approaches like Cognitive Behavioral Therapy (CBT) can also play an important role in helping children manage their pain and maintain their quality of life by addressing the complex relationship between mind and body.
What is Pediatric Chronic Pain?
Chronic pain is diagnosed when a child experiences recurrent or persistent pain lasting longer than three months. This condition affects approximately one in five children and, without proper intervention, can persist well into adulthood. The impact extends far beyond physical discomfort. Children with chronic pain often struggle academically, withdraw from extracurricular activities, and experience strained relationships with peers and family members.
Why Psychological Treatment Matters
Many families initially question whether psychological approaches are appropriate when pain feels entirely physical. However, decades of research demonstrate that behavioral methods can effectively treat chronic pain. Since the late 1900s, these approaches have helped adults with chronic pain, and with developmentally appropriate modifications, they can be equally beneficial for children.
While medication provides temporary symptom relief, psychological treatments teach children to modify thought processes and behavioral reactions to pain, which can reduce distress and improve functioning. These approaches can also address co-occurring mental health challenges like anxiety and depression, which sometimes intensify chronic pain symptoms. The coping skills learned through therapy remain available to children long after treatment ends and medication wears off.
How CBT Works for Chronic Pain
Cognitive Behavioral Therapy equips children with practical tools to minimize the impact of pain on their daily lives. Through CBT, children learn how pain signals originate in the brain and influence the body, demystifying their experience and building a sense of control.
Key therapeutic strategies include:
Cognitive Reframing: Children identify negative thoughts about their pain and consciously replace them with more balanced, helpful perspectives. Since persistent negative thinking can amplify pain and distress, this skill proves especially valuable during difficult moments.
Mindfulness and Relaxation: Techniques such as deep breathing exercises help children calm their nervous systems and reduce pain-related anxiety.
Exposure Techniques: For children who have developed pain-related fears and avoidance patterns, CBT incorporates gradual exposure to feared situations, breaking the cycle of anxiety and limitation. Rather than avoiding activities due to fear of pain, children gradually reengage in meaningful activities, thereby improving overall functioning.
Research consistently demonstrates that these techniques reduce pain intensity, improve daily functioning, increase self-efficacy, and reduce stress associated with chronic pain.
The Role of Parents and Caregivers
Successful treatment extends beyond the child. Parents and caregivers play an essential role in reinforcing therapeutic strategies at home. Through parallel training, parents learn to respond effectively to their child's pain by using improved communication tools and emotion-regulation practices. When the entire family system supports healthy coping, children experience greater success in managing their symptoms.
Addressing Barriers to Access
Despite mounting evidence for psychological treatments in pediatric chronic pain, access remains limited. Urban areas often have long waitlists for specialized providers, whereas rural communities may lack practitioners altogether. Additionally, comprehensive chronic pain treatment typically requires a multidisciplinary approach, making it both time-intensive and costly for families.
Internet-based CBT interventions represent a promising solution to these accessibility challenges. These programs deliver evidence-based treatment remotely, reducing logistical barriers while maintaining effectiveness. Research shows that online CBT interventions can produce significant improvements in pain management, both in the short term and long term, though suitability depends on individual needs and circumstances.
Moving Forward
Pediatric chronic pain presents real challenges, but CBT can provide children with practical skills to better manage their daily experiences. By addressing both the psychological and physical dimensions of pain, this approach can help children participate more actively in school, activities, and relationships.
If your child struggles with chronic pain, a licensed psychologist trained in pediatric pain management can help determine whether CBT might be a useful part of their treatment plan.
References
Cunningham, N. R. (2025, June 12). Ask the expert: How can we help children who have chronic pain? MSU Health Sciences. https://www.healthsciences.msu.edu/news/ask-the-expert-how-can-we-help-children-who-have-chronic-pain
Coakley, R., & Wihak, T. (2017). Evidence-Based Psychological Interventions for the Management of Pediatric Chronic Pain: New Directions in Research and Clinical Practice. Children (Basel, Switzerland), 4(2), 9. https://doi.org/10.3390/children4020009
Pielech, M., Beckmann, E. A., & Dorsainvil, H. (2025). Optimizing psychological treatments for pediatric chronic pain to enhance outcomes, availability, and accessibility. Current Opinion in Psychology, 64, Article 102038. https://doi.org/10.1016/j.copsyc.2025.102038