September is Pain Awareness Month

September 8, 2015 / Thomas Cohn, MD

September is Pain Awareness Month, and as the name implies, the goal of the month is to help raise awareness and spread the word about chronic pain. As we’ve stated before, more than 100 million Americans suffer from chronic pain. We want to help share their stories and explain what they go through on a regular basis, so here’s more information about one of the leading causes of disability in America.

Chronic Pain Problems

Chronic pain can affect any part of your body. Below is a closer look at some areas that are commonly affected by chronic pain, and some of the symptoms that accompany those painful areas.

Chronic Arthritis – Arthritis pain is caused by inflammation in your joints, and millions of Americans suffer from chronic arthritis in their fingers, knees and toes. Most people associate arthritis pain with older individuals, but nearly 300,000 children suffer from juvenile rheumatoid arthritis.

Chronic Headaches – Headaches and migraines are another chronic condition that can make it hard to go about your daily routine. Crippling or shooting pain in your head can be caused by a chemical imbalance or a poor diet. If exercise and diet modifications don’t stop the headaches, pain injections or other treatment options can provide temporary relief.

Chronic Back Pain – Chronic back pain is probably the condition I treat most at my clinic. Whether chronic pain develops from overuse or acute injury, it can make life extremely painful for the patient. Luckily, modern medicine continues to improve how we diagnose and treat back injuries. Through physical therapy, injections or even surgery, most people find some sort of pain relief.

Chronic Leg Pain – Chronic leg pain typically occurs when there is an issue with nerves in your legs and feet. Nerve issues in your leg can cause shooting pain in your legs and spine. Again, physical therapy and injections can help treat the issue, as well as surgery to remove the damaged nerves.

Chronic Neck Pain – Chronic neck pain typically sets in after an acute injury, like whiplash from a car accident or a sports injury. Neck pain can make it extremely painful to turn your head or preform routine activities. Treatment of whiplash typically involves rest, physical therapy, injections and strengthening exercises.

If you or someone you know deals with chronic pain on a regular basis, encourage them to seek out professional help. You shouldn’t have to live life in pain, so speak to a pain specialist today.

Could Dad Be To Blame For Chronic Pain Woes?

August 31, 2015 / Thomas Cohn, MD

A study out of Japan suggests that how parents bond with their children during adolescence could impact the child’s likelihood of developing chronic pain later in life.

Furthermore, the study suggests that children who had a poor bond with their father were the only group to show a significant increase in chronic pain likelihood.

The goal of the study was to better understand chronic pain as a complex biopsychosocial condition and how outside psychosocial factors like pain, pain-related fear, self-efficacy, anxiety, depression and psychological distress feed into that perception of pain.

For their study, researchers polled nearly 800 adults about their relationship with their parents and their overall health. Participants completed the Parental Bonding Instrument, a self-administered questionnaire that assessed perceived parental bonding, as well as a health assessment. The PBI test asked respondents several questions about their relationship with their parents growing up, including questions about the perceived level of bonding, over/underparenting, affection and discipline as well as control and understanding. Participants took the survey twice, once while contemplating their relationship with their father and the next while answering questions about their mother.

After comparing the PBI results with the results from the health exam, researchers uncovered:

Compared to the optimal bonding group, the odds ratio for having chronic pain was much higher in the affectionless control group for paternal bonding and for maternal bonding.

When adjusting for other factors, significance remained only for parental bonding.

“The fact that fathers have been shown to be much more likely to use physical punishment and abuse than mothers in several epidemiological studies may also be related to these findings,” the study authors wrote. “Clearly, further studies are needed to elucidate the mechanism(s) whereby parental care affects the development of chronic pain in a gender-dependent fashion.”

Researchers concluded by saying that mass-education on parenting behaviors for optimal bonding may be one of the most promising chronic pain prevention techniques that few are pursuing.

The Correlation Between Sports, Headaches and Concussions

August 24, 2015August 24, 2015 / Thomas Cohn, MD

Fall sports season has begun and now is the time for football and soccer among other fall activities. Most sports run some type of risk for a head injury, especially if a helmet is part of the safety equipment. Any sport where the head can be hit or suddenly moved is a risk for a concussion. Head trauma used to be thought of as a minor inconvenience, but now we are beginning to understand the severity of the problem, especially concussions.

Wearing protective equipment such as helmets was thought to be the only necessary precaution to prevent injury. As information collection and the use of computers has grown, the ability to study medical problems and spot trends has allowed us to understand simple and complex issues like head trauma. Awareness of the issues became evident when athletes begin developing unusual early onset of diseases like dementia, ALS, and Parkinson’s disease, or much more frequently than the rest of the population. The significance of severe head trauma was always known – statistics just allowed us to find the effects of smaller trauma that was repetitive.

Effects of Head Trauma

Any repetitive head trauma is bad, but severe head trauma can be really problematic. Trauma to the brain can cause permanent damage. The need to wear appropriately fitted and designed helmets is without question. Unfortunately, with better gear, people tend to take more risks, which may lead to more trauma. For example, when football players played without helmets, very few players led with their head when making a tackle. Today, players are launching themselves headfirst at other players because they believe their heads are protected by the helmet.

The brain is the most complex structure in the body, and how it processes information so effectively is amazing. There is an extremely complex interaction within and between the cells of the brain. Smashing the head can disrupt the subtle interactions in the brain. If the brain is shaken, then the connections between cells can be disrupted. The result of this is a degree of confusion, and often is accompanied by ongoing headaches. No athlete should immediately return to a sport if any signs of a concussion have occurred. All coaches and athletic trainers should be aware of the signs. If you have had any confusion after a head trauma, immediately stop what you are doing and sit down to rest. The brain needs time to recover, so do not force the issue.

Signs of a Concussion

Headaches, dizziness, light sensitivity, fatigue and confusion all are signs of a concussion. Return to sports and even school or work needs to wait until all signs of a concussion have cleared. If headaches or any other signs of head injury last longer than a day, one should see a doctor. If there is an immediate severe headache after trauma, a doctor should be consulted immediately. Rest and symptomatic management of head trauma is necessary.

A headache after sports trauma is not a good sign. We only have one brain, and it is not replaceable. It needs to be kept safe. If it is injured, and one has headaches, see a doctor, as a head scan may be necessary. With a significant injury, recovery can be prolonged. Until the headaches are gone, returning to any high level activity should be limited. Many professional athletes have ended their careers due to head injury. Now, we are beginning to learn the late effects of multiple small injuries to the brain, and these are even scarier. A young athlete needs to realize they have only one brain, and no sport is worth permanent damage.

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.

Raising a Child With Chronic Pain

August 17, 2015 / Thomas Cohn, MD

Being a parent is a difficult job. There are many things to worry about daily when your children are growing up. The challenge is creating the environment for your child to become successful and independent in the future. Furthermore, everyone else has advice on how to raise a child. When you have a child with a chronic medical condition, all these challenges are amplified. The problems associated with a child who has chronic pain may be extremely difficult.

Pain is an extremely complex condition when it is chronic. There are actual physical components to the pain, and then there are all the things that happen in the brain when the signals are perceived and translated. As a pain specialist, hopefully that is what one spends their time learning about and then using to provide care to others. The best specialists can transform scientific data into specific treatment for most of their patients. Of course, one often cannot treat everyone, and sometimes that includes yourself, family, and close friends. Having chronic pain and family with issues does give one special insight into the problems.

The first overall concern for treating any sub-acute and chronic pain is that the person is fully diagnosed. A full history is needed, and exam should correlate to the problems expressed by the patient. Then if possible, appropriate studies should confirm the diagnosis. Without a diagnosis, the best treatment approaches are hard to determine. Unfortunately, many patients who show up at my office know they have pain, but this is a symptom, and determining all the causes is the first challenge before treatment can be fully implemented. If the pain has been an ongoing issue and is chronic (over 3 to 6 months or longer), then there is often more than one problem, and often the problems are not reversible. When the problems are not reversible, then goal is developing a management strategy.

If the patient is a child, one wants to make sure that there is a correct diagnosis for all the problems present. In a child, this may be a very prolonged process, since many problems heal and can be treated. Thankfully, few medical problems result in chronic pain problems for children, as most issues tend to resolve. Pediatric specialists are essential to diagnosing and treating all the issues that can be resolved. Treatment of children is usually a team process, requiring a number of physicians and therapists working together to manage the problems.

A few children do develop conditions that cause sub-acute and chronic pain. Those that have shown up in my office are usually related to musculoskeletal problems causing joint pain, or spine pain. Orthopedic surgery consultation often is involved to determine if surgical intervention is advisable. Ongoing pain that is not surgical is an extremely tough problem to treat. Currently, if the pain is chronic, then a Pediatric Pain specialist is extremely helpful to lead the management.

In the end, helping children with chronic pain comes down to a full diagnosis and a team-based approach. No one person can heal their child’s chronic pain on their own, and working with others can help everyone better understand and treat the condition. If you child complains of frequent pain or headaches, swing into an injury center for an examination.