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.

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 Your Child’s Backpack Be Causing Chronic Pain?

August 6, 2015 / Thomas Cohn, MD

Summer is still in full swing, but if you’ve been to the store lately, you’ve probably noticed that the shelves are starting to fill up with back to school supplies. Soon enough it will be time to fill your child’s backpack with crayons, folders and textbooks, which can weigh heavy on your child’s back. If your not careful, that heavy backpack could be causing your child some pain. Today, we examine if your child’s backpack is a health risk, and how you can pick out the best backpack for your child.

Back Pack Pain

Just two years ago, the U.S. Consumer Product Safety Commission reported that emergency rooms treated 5,415 patients with backpack-related injuries. The injuries ranged from acute back pain to chronic discomfort, and researchers noted that heavy backpacks were contributing to the problem.

“Wearing a backpack incorrectly or wearing one that’s too heavy can be a contributing risk factor for discomfort, fatigue, muscle soreness, and pain, especially in the lower back,” said Karen Jacobs, EdD, OTR/L, CPE, a clinical professor of occupational therapy at Boston University. Physical Therapist Samantha Dutrow added to Jacobs’ comments, noting that heavy loads can also cause neck and shoulder problems. “Injury can occur when a child is trying to adapt to the heavy load by using improper postures, such as leaning forward, arching the back, and leaning to one side.”

The problem, however, is that with active children, it’s often difficult to determine if the backpack is actually the problem. Backpacks are designed to adequately disperse weight to regions that can handle extra weight, and school-aged children are often involved in numerous activities on a daily basis, which can all contribute to back pain.

Lighten The Load

Here are three tips for picking out a good backpack for your child.

Avoid Rolling Backpacks – Some children like the option of rolling their backpacks around the halls, and yes, it can take some of the load of their back, but the constant picking up and setting down in class and on any stairs will be bad on your child’s back.

Double Strap It – Despite Channing Tatum’s assurances in 21 Jump Street that “one strapping it” is the cool way to wear a backpack, only wearing your backpack over one shoulder can put excess stress on parts of your body. Find a backpack with two straps so its weight is evenly distributed over both shoulders.

Look for Quality – We’re not saying that you need to shell out big coin for a backpack, but don’t just buy the cheapest one off the rack. Look for a quality made backpack with a padded back and a plastic frame sheet, which will help with weight distribution.

If your child complains of back pain, consider looking at their backpack habits, but if problems persist, swing on in to our clinic!