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.

The Prevalence of Pediatric Chronic Pain

December 29, 2014January 18, 2016 / Thomas Cohn, MD

Pediatric chronic pain is a growing problem in the United States. According to recent statistics, 1 in 5 children between the ages of 7 and 18 report that they have weekly headaches, and nearly 1 in 10 experience regular abdominal pain. Additionally, 14 percent say they frequently deal with back pain, and four percent are plagued by musculoskeletal pain.

The biggest concern, however, may be that more children are experiencing chronic pain on a regular basis. According to research published in the journal Pediatrics, the number of children admitted to the hospital due to chronic pain rose from 143 in 2004, to 1,188 in 2010 – an increase of 831 percent. With a growing need for pediatric pain treatment, it’s no wonder that more than 30 hospitals nationwide have opened pediatric pain centers of the past few years. These centers provide children with:

Specialized care

Acupuncture sessions

Unique exercise facilities

Sleep specialists

Extensive outpatient therapy treatment

“Kids may be having more pain than in previous generations, but physicians are also more attentive to it and doing more about it,” said Dr. Navil Sethna, clinical director of the rehabilitation center at the Mayo Family Pediatric Pain Rehabilitation Center, one of the top pediatric pain centers in America. Clinics like the Mayo Family Center focus on treating difficult chronic conditions, like fibromyalgia, frequent migraines or ailments resulting from a virus or other injury.

Dr. Lonnie Zektzer, director of the children’s pain and comfort care program at Mattel Children’s Hospital ULCA, said he’s referred children to the Mayo Family Center, and those types of clinics are growing in demand.

“Such programs are becoming more of a trend because they’re so badly needed.”

Pain Management vs. Pain Cure

For many of these facilities, curing the pain is the ultimate goal, but that’s not always possible. Instead, these clinics focus on helping children manage their pain and strengthen their bodies so they experience a gradual reduction in pain over time.

“We teach them how to handle any pain that comes from getting jostled in a hallway or gym class,” said Jenna Duckworth, an occupational therapist who works at the Mayo Family Pediatric Rehabilitation Center.

Judy Gaughan, a nurse and clinical coordinator at the same facility echoed Duckworth’s sentiments, saying, “The treatment goal is to maintain and regain function, not a complete alleviation of pain.”

The center notes that nearly 90 percent of children who finish their program still experience pain symptoms, but the majority report a gradual reduction over several months as they return to normal life.

A 2012 study also shows that the center is improving chronic conditions in children without heavy reliance on painkillers. Nearly all of the 56 children admitted to the program during its first year were taking fewer prescription pain medications 10 months after discharge, the children on meds were usually on a non-addictive preventative drug, and 30 percent weren’t on pain meds at all.

Related source: Boston Globe