Teenage pain often dismissed as growing pains

teenage child back hip neck chronic pain

A common belief is that pain in children will just go away or be forgotten when life takes over.

In the absence of an identifiable injury such as a sprain or fracture, childhood and adolescent pain is often disregarded – by doctors and parents alike.

The most common type of pain is spinal (back or neck), and many more adolescents complain of pain than is commonly recognised. Between one-third and half of all adolescents aged 13 and over report back pain about every month or even more often1. In fact, the prevalence of these conditions rises so sharply in early adolescence the rates approach adult levels by 18 years.

It’s becoming increasingly clear so-called non-specific “musculoskeletal conditions”, the leading causes of disability worldwide, are significant health issues in children.

Non-specific conditions mean that pain cannot be attributed to a defined and diagnosable anatomical cause. In adults, these conditions are recognised as complex disease states that have biological, psychological and socioenvironmental underpinning.

For a significant proportion of adolescents, non-specific pain has extensive impacts on health and quality of life. For example, in a study in Western Australia, about 20% of 17-year-olds reported either missing school, seeking health care, taking medication, interference with normal activities, or interference with physical/sporting activities due to back pain2. There is also evidence that persistent pain symptoms in adolescence predict chronic pain problems in adulthood3.

The blame for pain in kids is often directed at school bags, computer and small-screen device usage, posture, and/or other biomechanical targets. It is also sometimes believed (permanent) damage is being done to the spine, with lifelong consequences.

However, there is little evidence this is true.

Studies show socioeconomic, lifestyle, cognitive and psychological factors are just as strongly, or even more strongly, related to pain (particularly chronic pain) as physical factors4. These societal beliefs about “physical” causes of pain may be not only incorrect, but detrimental if they cause worry about the spine being fragile and discourage children from physical activity.

To date the complex interaction between painful events, the growing body, health influences, social or environmental influences from family, health care providers and schooling is not fully understood. In particular, very little is known about what brings on initial episodes of painful conditions and whether this underpins the link with future chronic pain.

Given wide recognition that early life events are critical in shaping health as people grow older, understanding the context of common painful conditions in early life is critical to inform future health.

It is important to provide effective treatment to those at risk of developing persistent pain. It is also important not to create medical problems out of transient aches and pains, i.e. not every child needs to be sent off for diagnostic imaging and intensive treatments. But a shift away from the narrow and outdated focus on school bags, posture and damaged spines as the only source of problems is a must.

Efforts to update the narrative around pain are as important for children as for adults.

References:

  1. Kamper, S.J., et al., Musculoskeletal pain in children and adolescents. Braz J Phys Ther. http://dx.doi.org/10.1590/bjpt-rbf.2014.0149
  2. Beales, D.J., et al., Low back pain in 17 year olds has substantial impact and represents an important public health disorder: a cross-sectional study. BMC Public Health, 2012. 5 (12): p. 100.
  3. Hestbaek, L., et al., The course of low back pain from adolescence to adulthood: eight-year follow-up of 9600 twins. Spine, 2006. 31(4): p. 468-72.
  4. Chambers, C.T., et al., The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain, 2011. 152(12): p. 2729-38.

Why all migraine patients should be treated with magnesium

magnesiumMagnesium, the second most abundant intracellular cation, is essential in many intracellular processes and appears to play an important role in migraine pathogenesis.

Routine blood tests do not reflect true body magnesium stores since <2% is in the measurable, extracellular space, 67% is in the bone and 31% is located intracellularly. Lack of magnesium may promote cortical spreading depression, hyperaggregation of platelets, affect serotonin receptor function, and influence synthesis and release of a variety of neurotransmitters.

Migraine sufferers may develop magnesium deficiency due to genetic inability to absorb magnesium, inherited renal magnesium wasting, excretion of excessive amounts of magnesium due to stress, low nutritional intake, and several other reasons.

There is strong evidence that magnesium deficiency is much more prevalent in migraine sufferers than in healthy controls. Double-blind, placebo-controlled trials have produced mixed results, most likely because both magnesium deficient and non-deficient patients were included in these trials. This is akin to giving cyanocobalamine in a blinded fashion to a group of people with peripheral neuropathy without regard to their cyanocobalamine levels.

Both oral and intravenous magnesium are widely available, extremely safe, very inexpensive and for patients who are magnesium deficient can be highly effective. Considering these features of magnesium, the fact that magnesium deficiency may be present in up to half of migraine patients, and that routine blood tests are not indicative of magnesium status, empiric treatment with at least oral magnesium is warranted in all migraine sufferers.

Reference:

Mauskop, A., et al., Why all migraine patients should be treated with magnesium. J Neural Transm, 2012. 119 (5): p. 575-9.

Heat versus ice for pain

heat-vs-cold pain 550


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