23 Jun Welcome to our first blog post!
It’s here!! After much thought, welcome to our first blog from the Center of Pediatric and Adolescent Pain Care. The purpose of this blog is to explore the many aspects of pain and symptom management in children and young adults suffering with recurrent or chronic illness and to be a resource for patients and their families. Please leave comments and thoughts about the posts as we want to continue educating families and fellow physicians about chronic or recurrent pain, fatigue and nausea.
We will start with a brief discussion of chronic and recurrent pain in children.
Chronic and recurrent pain has many different names and faces: recurrent tension headaches, functional abdominal pain, juvenile fibromyalgia, complex regional pain syndrome, migraines, pain amplification syndrome, irritable bowel syndrome, non-cardiac chest pain, reflex sympathetic dystrophy, chronic fatigue syndrome and the list goes on. Although the actual mechanisms of each of these conditions are slightly different they all can be boiled down to a miscommunication in the nervous system. This miscommunication leads to ongoing pain, missed school days, missed social events, family stress, emotional distress and general suffering.
Pain is difficult to define! Pain is an individual, subjective perception of actual or potential tissue damage. Ok . . . so that means that you hurt when your nervous system thinks that there is something going wrong in your body. The systems that manage pain perception are more complicated than most of us realize.
Let’s take the example of stubbing your toe. Easy to imagine as we’ve all done this and know it hurts. The nerves that send touch, temperature and position sensation to your brain go crazy because you have just damaged yourself. These nerves communicate with nerves in your spine that inter send signals to different parts of your brain. They send signals to the part of your brain that makes you jump up and down and say things that you are not supposed to say in public as well as the part of your brain that makes you want to curl up in a ball and heal. The signal also goes to the part of your brain that is in charge of perceiving pain.
Well here comes the twist. There are other nerves whose job it is to change the pain signal before, during and after it reaches your brain. Many of these pathways turn pain signals down. Yes it is true our nervous systems have the ability to turn normal “acute” pain down. Take that stubbed toe for example. It often hurts for a much shorter time if you are in a rush to get to school than if you are trying to enjoy a weekend morning. Normally our nervous systems have the capacity to exert control over our pain.
So what happens with chronic pain when it seems that we lose the ability to control our own pain? Well just that . . . we have less control in our nerve pathways whose job it is to turn pain down and an increase in the sensitivity of the pain signaling pathways.
When a person’s pain control system becomes overwhelmed by physical or emotional stress, changes can happen in their central nervous systems. These changes cause a miscommunication between their body and their brain. The result is a central nervous system that is more pain sensitive in one particular part of the body or more likely generalized pain sensitivity. For some individuals this miscommunication can lead to deregulation in other body functions such as inflammation, bowel functions, blood pressure, memory, immune function and others. There is now good evidence that even children with recurrent tension headaches or growing pains are more pain sensitive than their peers.
Who can this happen to? Simply stated any child who has an injury in the wrong body part at the wrong moment in their development, severe pain, prolonged pain, family history of recurrent pain, developmental or intellectual disability, a chronic illness or any other condition that causes chronic stress to their nervous system. Other factors that predispose to chronic pain include family stress, genetic factors, coping style, parental modeling and response. In summary there are many different pathways to end up in the same place.
At this point you may be thinking, “That’s great Dr. Joseph but what can we do about it?” The “simple” answer is creating an environment that supports the child while they are encouraged to work to regain control of their central nervous system. The components of both the support and the “encouragement” are often similar for many people but need to be personalized for each individual.
Again, please leave comments and thoughts regarding this post. This blog is meant to be a resource for the readers. I am happy to write about what you want to know and would appreciate your thoughts.