Psychological Treatments and Parenting With Chronic Pain

August 19, 2015August 25, 2016 / Thomas Cohn, MD

As we mentioned in Monday’s post, treating pediatric chronic pain is a comprehensive process. Today, we take a look at the psychological side of chronic pain in children.

Pain is extremely complex when it becomes chronic. Oftentimes it takes multiple strategies to modify the impact of pain. When it hurts, it’s harder for your body to function normally, and if the body does not have the ability to fully cooperate, pain and function may decrease. It may be a constant challenge to control pain.

Psychological challenges are enormous, as the brain wants to focus on the pain signals and the patient wants the brain to ignore them. Furthermore, the centers for pain in the brain and centers for anxiety and depression are next to each other, and sometimes their signals can interact. Preventing this short circuit and diminishing the transmission of pain signals is a constant cognitive and physical activity that can be extremely fatiguing. In complex cases of chronic pain, often it takes every type of intervention to combat the pain signals from physical activity, to complementary medicine, to natural remedies and then traditional medications, interventions and psychological treatments. The battle is not easy on either the patient or the parent watching the struggles.

That’s where a pediatric pain psychologists can be extremely helpful in developing treatment strategies that help in managing the interactions of pain and stress in the brain. They can help the patient understand why they’re experiencing pain and how to deal with pain when it rears its ugly head. By better understanding pain, we can help prevent some common side effects, like anxiety and depression during a crucial time of childhood development.

Parenting Kids With Pain – My Story

As a parent of a child with chronic pain, the most important role is to encourage wellness and a normal lifestyle. Never encourage the sick role of the child and never reward pain behavior. It should never be better to be at home and be rewarded for having pain while being excused from all other normal activity. Watching a child struggle with pain is not a fun experience, but seeing them later conquer life independently is amazing. It is what is often reffered to as “tough love”. It may make you cry a little at times, but your role is to be the coach and get them back out there in life.

From my own experience, dealing with a child with significant chronic pain is extremely challenging. Trying to make the right decisions is not easy. Often, every nontraditional method to manage pain may be an option. Having the correct diagnosis and treatment often is also a challenge. Furthermore, with all challenging cases, 90 percent of the doctors and therapists do a good job. Unfortunately, on complex cases, you may need to find those 10 percent of doctors who are far superior to the others and this isn’t an easy task. As a physician, it is difficult when you can see the problem, but are not in the position to change the situation. The one truth is always be supportive and guide the person in the best direction possible. Empathy does go a long ways, but they do not need your sympathy.

Pain Supplements and Their Processes, Part 1

August 10, 2015 / Thomas Cohn, MD

Joint pain affects millions in the United States. The CDC estimates that over 50 million people in the US have arthritis, or about 25% of the population. The vitamin and supplement business in the United States is a multi-billion dollar enterprise.

The proof for the effectiveness of any of the compounds is very limited. In general, the best that can be said is that they may be helpful, and the only harm that is likely is possibly a hole in your pocket book. Today, we take a look at some supplements, their common dosages and what they treat. Be sure to check back in later in the week for more information on other pain supplements.

Supplement Guide

Glucosamine is one of the top supplements recommended for joint health. This is a chemical that can be found naturally in the human body. As we age, the levels tend to decrease. It is used by the body in helping build tendons, ligaments, cartilage and the synovial fluid in and around joints. Most commonly it is recommended for those with osteoarthritis. Knee pain is the most common location. In rare cases, side affects have included increases in blood pressure, cholesterol and blood sugars. The dose that has been studied is 500 mg three times a day.

Mixed with glucosamine is chondroitin, and this is also normally found in the cartilage of joints. It is manufactured from animal sources, commonly cow cartilage or shark cartilage. Chondroitin is supposed to help with arthritis pain and may help with osteoporosis. It is supposed to work by slowing down breakdown of joint cartilage. A caution is recommended if you have asthma or are on a medicine to prevent blood clots since this may interfere with both conditions. The typical dose is 200 to 400 mg two to three times a day, but it may be all taken at once.

Omega 3 fatty acid supplements are used for a variety of conditions. It has been recommended for blood pressure control, cholesterol, depression, ADHD, diabetes, osteoporosis and inflammatory conditions causing pain including arthritis. Omega 3 fatty acids in fish oil are not made by the body, so ingesting them is necessary, and they reduce pain and swelling. For any condition, this supplement is said to help, but literature also indicates there is a possibility it may also worsen that condition. The dosing for arthritic conditions is about 4 grams a day.

Ginger root is commonly used for muscle and joint pain along with stomach pain. The chemicals in ginger root are thought to work in the stomach and intestines as well as the nervous system to affect inflammation. There is a definite interaction with blood clotting medications, like Coumadin, increasing bleeding problems, so if you are on those, do not take ginger root. There are various ginger extracts on the market and suggested dosing is 170 mg three times a day to 250 mg four times a day.

That’s all we’re going to cover today. Swing back on Wednesday for more information on supplements.

Could Alcohol Help Ease Chronic Pain?

July 22, 2015July 22, 2015 / Thomas Cohn, MD

People who regularly reported having a beer or two appear to be less likely to experience chronic pain, according to researchers at the University of Aberdeen in Scotland.

According to researchers, adding a beer or two to your regular routine could help ease pain and lessen the handicap caused by chronic pain. For their study, researchers examined 2,239 individuals who suffered from chronic pain caused by fibromyalgia. After taking a closer look at their alcohol consumption habits, researchers discovered that individuals who regularly reported having a beer or two experienced lower levels of disability than chronic pain sufferers who never drank.

“Although we cannot say that alcohol consumption causes less disability among people with chronic widespread pain, the observed link warrants further investigation,” said Gary Macfarlane of the University of Aberdeen.

Alcohol and Chronic Pain

The study asked patients to estimate their weekly alcohol consumption in an effort to see what role alcohol played in the chronic pain equation. Researchers uncovered that individuals who drank between 21 and 35 drinks a week were 67 percent less likely to experience inability to perform certain daily tasks. For reference, one drink was classified as an 8-oz beverage, or about the size of a small glass of win.

Although the findings are interesting, it doesn’t mean you should start pounding beers after dinner. The Arthritis Foundation wrote that moderation is key.

“The important part of that message is that “alcohol in moderation” means one or two glasses of wine, beer or spirits. Not three,” the Arthritis Foundation wrote on their website.

Related source: Mirror.Uk

What It’s Like To Be Young And Have Chronic Pain

July 17, 2015 / Thomas Cohn, MD

Chronic pain is a debilitating condition at any age, but we naturally slow down a bit as we get older, so dealing with constant pain at a young age isn’t something most can relate to very easily. People in their 20’s and 30’s often feel misunderstood or that they have to hide their condition from friends.

Recently, the Huffington Post ran an article titled “15 Things No One Tells You About Chronic Pain As A 20-Something.” The article makes some good points, and we decided to take the five most relevant points and expand on them in today’s blog.

5 Things They Don’t Tell You

Here’s a look at five things most people don’t know about dealing with chronic pain in your 20’s and 30’s.

1. The idea of going out and maintaining a “normal” 20-something social life is laughable.

Chronic pain takes a lot out of you, so some people just won’t understand why you don’t want to paint the town for hours or go hiking on a Saturday afternoon. You want to go out and hang with friends, but sometimes your body just isn’t up for it, or you’re afraid of a flare up in a group setting. Sometimes people take your decision not to attend a function as a personal slight, but that couldn’t be further from the truth. You’d love to join, but your pain makes it nearly impossible.

2. Some people are really open and kind about your chronic pain. Some are just the worst.

You likely have a close circle of family and friends who truly understand your condition and how it affects you, but you also probably know some people who are less than empathetic about your condition. They say things like “Oh you’re just faking it,” “You’re lazy” or worse “You’re just doing it for attention.” It’s best to just ignore these people and distance yourself from them if possible. They simply can’t comprehend what you’re going through, and their negativity only makes things worse.

3. There are good days and bad days.

Some days you feel like you can conquer the world, other days it’s an accomplishment if you can just get out of bed. You’ll have good days and bad days, just like everyone else, but what a lot of people don’t understand is that you never know what type of day it’s going to be. You can’t plan around chronic pain. Sometimes it flares up at the worst time, while other times your pain subsides at the perfect time.

4. Chronic pain is a full-time job.

Chronic pain fills up your daily and monthly calendars. Between seeing doctors and specialists, refilling your medications and getting in your daily exercise and physical therapy, chronic pain is a full-time job. When you throw in other activities, like work and social activities, you can start to feel overwhelmed by the condition. Be sure to make time for yourself, even if that just means marking off an hour to watch a few episodes of your favorite TV show on Netflix.

5. Get a Pain Guru.

Lastly, it’s important to find a professional who understands your condition and who helps you TREAT the symptoms, not just manage them. Any old doctor can prescribe painkillers and call it a day, but you need to find a specialist who believes in you, takes time to understand the condition and who works to help you get better.

Regular Exercise Isn’t Easy, But It’s Worth It

June 3, 2015June 3, 2015 / Thomas Cohn, MD

There is always a reason not to exercise. Being dedicated to exercise and staying healthy is extremely hard. For starters, it takes time to exercise, and the payoff of exercise is not immediate. Often, doing the necessary workouts seems to hurt. However, after getting into the routine, suddenly one realizes they hurt less. Everyone does need to exercise just to maintain a healthy body. When one has a chronic condition, it becomes more work, but it is also more important just to keep everything working in the best possible shape.

As a pain doctor, I often preach about exercising. It is one of the most important aspects of pain treatment. It is written about in most textbooks on pain. I used to talk about it less, but after having more problems with my own back, and seeing the effect on others who took exercise seriously, I began to be more vocal. The first step is committing to your health and to exercise. This means that you have to be dedicated to meeting a definite exercise goal and have a means to monitor whether you met the goal. A starting goal would be those by the American Heart Association for physical activity in adults. They include moderate to intense aerobic activity for 30 minutes, 5 days a week. Better, would be 25 minutes vigorous activity 3 days and moderate muscle strengthening 2 days a week.

What Counts as Exercise?

To count as exercise, it should be outside the realm of the activity that is being done for your employment. The reason is physical activity has a direct positive affect on the brain; maximize this by not distracting it from possible negative thoughts about work. One should also keep track of your exercise to see if you are meeting your goals. A fitness tracker, such as an app on your smartphone or a Fitbit, keeps one honest on whether you are meeting your goals.

I have had problems with low back pain. My lumbar spine has one very bad disc and severe spinal stenosis with pinching of the nerve roots. Once I became serious with a good exercise routine, management of my back pain improved. It is not easy to be consistent, but the reduced pain and better sleep is worth it. To get my exercise done, I need to do it before work, at the beginning of the day. Fortunately, I am a morning person, but I am awake before 5 a.m. to get it done. My goal daily is at least 30 minutes of moderate activity and 10,000 steps on my tracker.

The exercise routine I follow is during the week is 3 days of intense core and whole body strengthening with 2 days lighter core strengthening and intense aerobic activity. I exercise for about 45 minutes, combining strength and aerobic routines. On the weekends, one day usually I do a full strengthening routine with a full aerobic workout; the other day is light core and aerobic exercise. Every day I will do core strengthening, usually 10-20 minutes, with rubber tubing and floor exercise. Core exercises have greatly decreased the low back and leg pain, making it minimal most of the time. Aerobic conditioning keeps the overall endurance adequate to be active throughout the day.

If one wants to be healthy, one has to do the work to keep healthy. There is no free ride, not even for the doctor. There are sacrifices to be made to stay healthy, like getting up early in the morning. The pay off, less need to complain about your pain, fatigue, and health.