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.

Why A Medical Breakthrough May Be Bad For Society

August 26, 2015 / Thomas Cohn, MD

An article in today’s newspaper touts the discovery by Stanford University and their development of yeast that can produce hydrocodone. This is a synthetic opioid also known by the trade names Vicodin, Norco, or Lortab. It is a moderately powerful oral pain medication and has been one of the most highly prescribed pain drugs in the United States. Of all the hydrocodone produced worldwide, 90 percent or more is used in this country. Unfortunately, this makes it one of the most abused drugs in the country.

Stanford University has found a yeast that when mixed with sugar will produce hydrocodone as a byproduct. Most of us are familiar with yeast that is used to make bread or mixing a yeast with sugar and that will produce alcohol. Now a type of yeast has been produced that when mixed with sugar will produce an opioid. The benefit is that maybe it will lower the production cost of the drug and make this painkiller more available worldwide, especially where there is a lack of medication.

Pros Versus Cons

The larger question beyond the medical breakthrough is whether this is a good development. In the United States, we currently have an epidemic of opioid abuse and significant over-prescribing with misuse. Pain can be treated with multiple different strategies; medication is only one of the possible methods. Unfortunately, it has become the quick and easy solution for physicians. For patients, more effective strategies often require the patient to do more work, such as exercise, strengthen and stretch muscles, lose weight, eat differently, and take more control of their lives. In the rest of the world, often people have more realistic view of life and their bodies, and do not resort necessarily to a pill for pain relief. Readily available pain medications have already been shown to be a problem in the United States.

The other major issue is if Stanford University has been able to develop a yeast to cheaply and quickly manufacture an opioid, how long will it be before this technology gets into the hands of illegal drug manufacturers? We know that illegal drug use is a multi-billion dollar business. It is likely that someone is already trying to either steal a copy of the yeast, or develop their own yeast for the same purpose. The illegal drug trade and opioid addiction in the United States is a major problem. Finding an easy way to home brew opioids appears to be just around the corner. As a pain physician, this is likely to just be another problem and will be a boon for drug addiction centers and criminals. The cost to society may be much worse than making a drug cheaper and more available. Despite its potential, this may be the next societal disaster.

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.

Pain Supplements and Their Processes, Part 2

August 12, 2015 / Thomas Cohn, MD

For part 1 of “Pain Supplements and Their Processes,” click here. Below, we continue exploring some pain supplements, their dosages and their uses.

Turmeric is a plant and the main spice in curry. It is used for arthritis, headaches and fibromyalgia. The chemicals in it are thought to decrease inflammation. Caution is recommended if you are on a blood clotting medication, have diabetes, or have stomach irritability and heartburn problems. The recommended dosage to treat arthritis-related problems is 500 mg twice a day.

Boswellia, or Indian frankincense, is a tree native to India and Arabia. The sap or resin from the bark is extracted into this compound. It is used for osteoarthritis, rheumatoid arthritis, joint pain, tendonitis and bursitis. Boswellia is thought to decrease inflammation, and no significant side affects are known. The usual dose for joint pain is 100 to 250 mg a day.

Lastly, green tea is thought to be helpful for headaches and joint pain. This is tea or an extract made from the Camellia sinensis plant. Benefits are obtained from the polyphenols in the steamed fresh leaves. These compounds are thought to prevent inflammation and swelling, and protect and lessen joint cartilage degeneration. It also contains antioxidants that art protective to the heart. It should be noted that green tea does have small amounts of caffeine that could affect heart disease, blood pressure, diabetes, bleeding disorders and osteoporosis. The recommended dosing is about one to three cups of tea per day.

Taking natural supplements for pain may or may not be helpful. Above is a list of some of the compounds that have been recommended for treatment of painful joint conditions. Most have some sort of properties that affect inflammation, but the studies that prove their effectiveness have been somewhat limited. If you wish to try these remedies, and do not have other medical issues, they are likely to be mostly safe, but consult with your physician prior to starting any supplement regimen.