Health Chats
Pediatric Pain
Wednesday Oct 14, 2009, 12:00PM - 01:00PM (EST)
Program Director, Pediatric Rehabilitation Program & Behavioral Pediatrics Treatment Service
Cleveland Clinic
Center for Pediatric Behavioral Health, Cleveland, OH
Join Dr. Gerard Banez, PhD, staff member of the Cleveland Clinic Children’s Hospital’s Center for Pediatric Behavioral Health and director of the Pediatric Pain Rehabilitation Program, for a live chat and get answers on managing chronic pain from one of the foremost experts in the field. <br><br> Living in constant pain is difficult for anyone – but for children and adolescents, it can be disabling. <br><br> Parents or caregivers may feel helpless and frustrated as they watch a child: - miss school and stop doing things with their friends - drop out of sports and outside activities - avoid personal and family responsibilities - experience increased stress, and/or develop symptoms of depression and anxiety - give up their dreams and goals, and feel increased hopelessness <br><br> Your child is not alone - nor are you. Our Pediatric Pain Rehabilitation Program at Cleveland Clinic Children’s Hospital is specifically designed for children and teens whose chronic pain interferes with their normal activities. Our number one goal is to get your child back to doing things they love to do, while learning to manage their pain. <br><br> Cleveland Clinic Children’s Hospital’s Pediatric Pain Rehabilitation Program is the only one of its kind – in northern Ohio or nationally - that consists of both an in-patient AND out-patient component. This comprehensive, multi-disciplinary approach provides each patient and family with the most complete plan of understanding and managing pain.
Welcome everyone to today's health chat on Pediatric Pain. Dr. Banez will be joining us at 9 am Pacific/12 pm Eastern, but feel free to submit your questions now.
Welcome everyone to today's health chat. And a big welcome to Dr. Banez! We're very excited to have you here today to answer questions on the topic of pediatric pain. Thank you for taking the time to be with us today. Let's get started!
My son is 3 1/2 year old. Once in a month or two, he gets up in the night and complains that his foot is hurting usually one foot. Usually on that night, he will get up 3 times and cry as if it is hurting him too much. In the daytime, he is fine. The day incident occurs, he will normally complain of foot pain before sleeping. This has been going on for the last 6-8 months. He complains that pain is usually at the bottom of the foot and asks us to press his foot.

Dr. Gerard Banez, PhD:
Hard to know exactly what is going on. It sounds like the pain he experiences at night is related to something that has happened during the night (eg, overuse, soreness, fatigue). For various reasons, maybe physical and sometimes psychological, many children experience night pain as worse than the pain they experience during the day.
Dr. Gerard Banez, PhD:
The encouraging part of what you report is that, for the most part, he does not experience a lot of pain during the day. The first thing I would recommend is a visit to your pediatrician to ensure that there is nothing physically or structurally wrong with the foot.
Hi Doctor Banez, My daughter is 8 years old. She was having abdominal pain that began on September 10th. Over the last month she has undergone blood tests, urine tests, bowel movement tests, X-rays and C.A.T. scans. In the beginning the doctors found out that she was constipated and it had backed up into her large intestine so the doctors prescribed Magnesium Citrate to clear out her bowels. They had her using the Magnesium 3 times a day for a week to clean her out (which they found out later may have been too much). After the Magnesium they have her on Zantac twice a day with Miralax once a day to keep her stool soft but her intestines are spasming causing crippling pain that last all morning from 5am to almost noon and then they taper off to a dull pain only to return to a crippling pain at roughly 7pm. The crippling spasms are what caused her doctors to do a C.A.T. scan but so far all of her tests have come back either clear or normal so they can't figure out what's wrong. HELP!
Dr. Gerard Banez, PhD:
Abdominal pain like you describe can be very challenging to understand and complex to treat. I am assuming you are working with a pediatric GI specialist, which is where I would start in terms of understanding physical aspects of her pain. As a pediatric psychologist, I am often asked to
Dr. Gerard Banez, PhD:
see pts who have real pain albeit no physical or organic cause is found. The pattern of pain you describe is one that I often see and makes me think abt situation/environmental factors that may be affecting her pain, like possible school stressors.
Dr. Gerard Banez, PhD:
My suggestion is to talk to your doctors abt possible psychological/social factors that may be involved as well as the influence of nutrition on her symptoms. Often psychologists can be helpful in teaching kids to better cope with their pain so that it doesn't interfere with their daily activities. Dietary recommendations/restrictions may also be quite useful.
My 2 year old seems to have audible airway obstruction  when she sleeps on her back at night. She wakes up screaming sometimes, but when she is on her side or face down, she sleeps fine. What could be the cause of this.
Dr. Gerard Banez, PhD:
This question falls outside my specialty area or expertise. There could be a number of explanations, and I suggest that you consult with your child's pediatrician to try to find answers.
My name is Vanessa and I'm 16. For 2 years going on 3, I have been dealing with chronic pain and global symptoms..but the doctors can't find what's wrong with me. I've been checked for psychological problems because that's what they thought at first and then I started having heart and BP what I was wondering was if you had any advice???
Dr. Gerard Banez, PhD:
I suggest that you schedule an appt with an interdisciplinary chronic pain clinic where you can be evaluated by a coordinated team of professionals who are very familiar with situations like yours.
Dr. Gerard Banez, PhD:
Often, no specific serious physical/organic causes are found for chronic, but there may be certain physiological contributors that can be addressed by a qualified medical expert on chronic pain.
Dr. Gerard Banez, PhD:
While some people with chronic pain do have significant psychological problems, many do not. At the same time, we know that for all people stress, mood, emotions, and how you cope influence perceptions of and functioning with pain. A pain specialty psychologist is well versed in this and will be more helpful than traditional mental health professionals. You can get all of this and more from an interdisciplinary chronic pain program.
I have been wondering about this for a while.  2 yrs ago at age 12 my daughter experienced severe abdomen pain that lasted for progressed to joint pains, severe migraines, and finally leg weakness and a total inability to walk or even stand.  Through her hospitalization, 5 days, tests kept coming back normal.  A psychiatric evaluation was also normal.  There were no answers.  It took months of begging for referrals and evaluations to get any answers at all.  Repeat visits to the psychiatrist ended up with a diagnosis of conversion disorder, but tests that came afterward put that in doubt also.  We are at a loss - can you suggest what further steps we might take?
Dr. Gerard Banez, PhD:
Your daughter is the kind of patient that we see often in our Pediatric Pain Rehabilitation Program at Cleveland Clinic. We see kids whose chronic pain has not responded to traditional medical/behavioral treatments and has begun to affect their daily functioning (missed school days, social limitations). Our approach to care is based on a rehabilitation model.
Dr. Gerard Banez, PhD:
We aim to help kids learn to cope with their pain and, as or more importantly, we help them learn to function normally despite their pain. While we cannot guarantee that we can make pain go away, we find that as our pts return to normal activity, their pain becomes less of a problem for them.
Dr. Gerard Banez, PhD:
Our care is interdisciplinary in nature and addresses the medical, psychological and physical aspects of the pts we see. If you want more info, pls feel free to contact me at (216) 448-6253.
Could you tell me where to find resources for chronic pain post cardiac surgery or chronic pediatric chest wall pain? I am a pediatric cardiologist nurse. Many thanks!
Dr. Gerard Banez, PhD:
Am not sure abt specifics for pediatric chest wall pain, but I have found American Pain Society to be very helpful in terms of patient and professional resources and would suggest APS as a place to start.
How would you treat Epilepsy in a 3 year old who has suffered with seizures since birth with no treatment and no diagnosis of a seizure disorder all her life?
Dr. Gerard Banez, PhD:
I suggest that you consult with a pediatric neurologist who specializes in the treatment of kids with epilepsy. That person can inform you of the most helpful treatments.
Hi - I don't know if my question is right for this health chat, but we just found out that my 16 year old daughter is cutting herself. She had to see her doctor and when he examined her he found cuts on her upper thighs.  We are devastated and want to help her.  Her pediatrician has recommended a psychiatrist but my husband doesn't have much faith in them.  Can our daughter be cured?  We are desperate!
Dr. Gerard Banez, PhD:
I wholeheartedly agree with the referral to see a psychiatrist. Cutting can be symptomatic of various problems but is often reflective of depression or some other emotional adjustment problem. A psychiatrist or psychologist is absolutely the right professional to see for this. Medication may be indicated, and I am almost sure that some therapy/counseling will be indicated. The key is finding
Dr. Gerard Banez, PhD:
a mental health professional that your daughter and both of you are comfortable with. Ask your pediatrician for recommendations of a psychiatrist that he/she has had good experience with. A good fit for your daughter is also very imp. If she does not feel comfortable talking with this person, trx will not be helpful.
Hi, I was playing in  a soccer game a few days ago, when I got cleated on the inside of my knee. There is some discoloration, swelling, and a lot of pain. What should I do? My sister said I should go to the ER, should I?
Dr. Gerard Banez, PhD:
I hate to take sides with your sister, but I do agree that you should be seen, either in an ER or by your regular doctor. The fact that your symptoms have persisted after a few days make me think this may be more than the normal bumps and bruises you get when playing soccer. If it's just that, then that is good news. If it's more, the sooner you get appropriate treatment, the better. Hope you get back to the pitch soon.
My 6 yr old daughter is a very poor eater. She only weighs about 37 lbs.  She says her tummy hurts or is full after about 3 bites of food. She has been this way for years. She had an abdominal ultrasound and all was fine. Also had blood test for celiacs (I am sensitive to wheat) it was normal.  Any ideas at what could be going on?
Dr. Gerard Banez, PhD:
If your doctor does not think there is anything medically wrong with her, the problem may be behavioral in nature. Behavioral feeding problems are not uncommon and, important, are treatable. Ask your doctor for a recommendation of a psychologist who specializes in feeding problems and get that professional's opinion. Even better, if there is a multidisciplinary feeding program in your area, they may be of even more help.
My 17 year old was recently diagnosed with fibromyalgia. Any recommendations?
Dr. Gerard Banez, PhD:
As with most chronic pain disorders, I recommend an interdisciplinary approach, incl medical, psychological, & physical therapies. In our setting, rheumatologists are the experts on fibromyalgia and can assist with medical mgt, incl any medications that can be of use. Research also shows that cognitive-behavioral pain mgt training, offered by psychologists, can be very helpful. Involvement with a physical therapist can address/prevent the soreness/fatigue often reported by pts with fibromyalgia.