Research completed primarily by non-physical therapist healthcare professionals delineate assessment tools and psychosocial pain management techniques that hold promise for evaluating and reducing pain that occurs during PT procedures for children with CP.

Further research is needed to determine the feasibility of using behavioral pain assessment measures during physical therapy sessions. Physical therapist continuing education regarding nonpharmaceutical pain interventions is indicated.

This perspective article advocates for pediatric physical therapists to increase their role and visibility in the primary and secondary prevention of chronic pain during 2 critical developmental periods: infancy and early adolescence. The opioid epidemic and the disabling aspects of chronic pain are adversely affecting children and their families. Health care disciplines are adopting measures that address risk factors for the development of chronic pain in children, including strategies to minimize acute procedural pain and parental education to reinforce healthy pain-coping behaviors. Pediatric physical therapists are uniquely positioned to develop and adopt strategies to aid in this effort. They routinely screen and evaluate children for developmental delays and work with children who are at increased risk for developing chronic pain as a sequela of their health condition or as a consequence of painful medical procedures.

This chapter is divided into four sections. The first section provides an overview of the theoretical foundations that can be used as a framework for possible mechanisms of effect for physical therapy (PT) interventions and identification of PT interventions oriented towards maximizing participation of children with pain in valued roles and life activities. The second reviews the literature on active therapies as interventions for children with pain. The third section reviews the literature on passive therapies and safety and efficacy for manual therapy or therapeutic modalities for pain. The importance of the therapeutic relationship and pain education will also be discussed. The final section reviews the literature on procedural pain from a PT perspective and provides recommendations on procedural pain management. Although PT practice settings and the treatment needs of infants, children and adolescents with pain vary widely, this chapter provides a structure for development of a theoretical and evidence-based physical therapeutic approach for all children with pain.