Pictured left to right: Dr. Abi Kandasamy with Charlotte Sangers and her pain monster
July 8, 2025
When most people think of pain, they imagine a physical injury – like a broken bone or a scraped knee. But pain is more than just a physical feeling. It’s a complex experience that involves biological, psychological and emotional factors.
For people living with chronic pain, psychologists play a key role in their care. By helping patients understand how pain works, they can retrain their body, brain and emotions to work together to feel better.
Understanding pain
Pain is defined as an unpleasant sensory and emotional experience linked to actual or perceived damage to the body. There are two main types of pain: acute and chronic.
“Acute pain happens when you’re hurt, like if you fall off the monkey bars and break your elbow,” explains Dr. Abi Kandasamy, psychologist in the Paediatric Pain Program at Children’s Hospital at London Health Sciences Centre (LHSC). “It’s your body’s way of saying, 'I need help.’”
“But chronic pain is different,” she adds. “It continues after the body has healed or in the absence of a physical issue all together. It’s like your nervous system is stuck in alarm mode, sending danger signals to your brain even when you’re safe.”
Pain is considered chronic if it lasts more than three months and there’s no longer any physical proof of injury. Even though it starts in the brain, it has very real effects on the body.
Disrupting the pain cycle
With chronic pain, a person can experience pain sensitization, where the body creates 'shortcuts' to pain signals even when there is no real danger. This happens because the brain becomes overly sensitive to pain stimuli. The brain’s ability to change – known as neuroplasticity – can be used to retrain how it responds to them.
When someone is in pain, they may avoid physical activity to prevent discomfort. This lack of movement can weaken muscles over time, making it harder to stay active. Missing out on everyday activities can negatively affect mental health, which can make the pain feel worse. This creates a cycle that is difficult to break. Additionally, pain can disrupt sleep, and not getting enough rest can increase sensitivity to pain.
This is where psychologists come in.
“Psychologists help you change the way you think, which changes the way you feel,” says Dr. Kandasamy. “Our goal is to disrupt the pain cycle using treatments like cognitive behavioral therapy (CBT). It’s an important tool in our toolkit, as other treatments such as medication and physical therapy typically aren’t enough on their own.”
In some cases, CBT has been shown to be as effective as opioids, but without the risks.
Dr. Kandasamy says children with chronic pain often face extra challenges. For example, if nothing shows up on tests like x-rays or bloodwork, their pain might be dismissed by medical professionals. But chronic pain affects every part of a child’s life, from school and friendships to play and sleep. It can lead to feelings of anger, sadness and anxiety, which only make the pain worse. Emotional support and validation can improve kids’ moods and help them function better.
“Often, our young chronic pain patients become fearful of doing certain activities, worried they might make their pain worse. They may even stop themselves from doing these activities before experiencing any pain, simply out of anticipation,” says Dr. Kandasamy. “Thankfully, CBT and other psychological interventions help challenge some of these fears about pain and helps both kids and adults do more of what they love.”
Charlotte’s pain journey
Charlotte Sangers knows what it’s like to live with chronic pain. When she was just two years old, a swollen toe made it too painful for her to walk. She was too young to adequately express what was wrong, but after a year of seeing various specialists, she was diagnosed with juvenile arthritis.
Charlotte went through many treatments – including oral medications, injections and infusions – and while these helped, they weren’t enough to control her pain. As a result, she developed anxiety, which made her pain worse.
At just six years old, Charlotte became one of the youngest patients to be referred to the Paediatric Pain Program. She began working with Dr. Kandasamy, who Charlotte refers to as “Dr. Abi.” Together, they have tried various treatments aimed at reducing pain, including CBT, breathing and relaxation techniques, art therapy and more.
In one session, Charlotte and Dr. Kandasamy drew a “pain monster” to help her express her feelings. She also has a stuffed toy that shows how pain signals travel from the brain to the body. This is part of a concept Dr. Kandasamy refers to as “know pain, know gain,” which means the more a patient knows about pain, the more they will be empowered to control it.
Now 12, Charlotte has come a long way. With the help of Dr. Kandasamy and the rest of the paediatric pain team, her pain has dropped from an eight out of 10 to about a four.
“Charlotte’s now playing on her school basketball team and was able to enjoy our recent family trip to Disney World, where she ran around with the other kids,” says Charlotte’s mom, Marissa.
While Charlotte still has some aches and pains, they’re more manageable. She used to come home from school crying in pain, but now, the only time she misses school is when she has an appointment.
“My pain feels worse when my mental health isn’t good,” says Charlotte. “That’s why I see Dr. Abi. She teaches me about pain and helps me understand my emotions. It makes me feel better.”
The Paediatric Pain Program
One in five children experiences chronic pain. Fortunately, with the right support, they can still live full, active lives.
The Paediatric Pain Program at Children's Hospital is one of the only programs in the world led by a psychologist. It focuses on improving psychological well-being as a key part of treatment. The goal is to increase comfort, reduce pain and help kids do more of what they love.
The program uses a “three P approach” to treating pain: Pharmacology, physical and psychosocial. This means patients are treated using a combination of medication, movement and mental health supports.
Its interdisciplinary team is made up of various specialties that all play a vital role in each patient’s treatment plan, including a psychologist, anesthesiologist, psychiatrist, nurse, nurse practitioner, pharmacist, social worker and physiotherapist. Together, they treat inpatients and outpatients, also working closely with families so they know how best to support their child’s pain journey.
The Paediatric Pain Program supports patients from southwestern Ontario and as far north as Thunder Bay. It is generously supported by donors of Children’s Health Foundation.