Unlike most other anesthesiologists, the idea of simply administering treatment to alleviate pain was not enough for the director of the pediatric pain management program at the Johns Hopkins Children’s Center, Dr. Irfan Suleman. Having successfully managed cases in which children experience chronic pain, Suleman has developed a multidisciplinary approach to his treatment methods. While most traditional methods of anesthesiology focus on the physical aspect of pain and aim to alleviate it, Suleman believes that there is a psychological element to this pain that must be treated, especially in young children and teens whose injuries can induce chronic pain. As a result, Suleman’s clinic includes a physical therapist and a psychologist, who cooperatively diagnose and treat patients.

Having previously administered a sacroiliac joint injection to a high school cheerleader who experienced pain in her right hip and an epidural steroid injection to a teenage soccer player with a lumbar disc protrusion, Suleman proudly maintains a high level success rate. With follow up pain scores of zero (which indicates that patients experience absolutely no pain), most of the children he has worked with spring back to full functionality. Previously unable to sleep, attend school, and socially uninteractive, his patients miraculously recovered completely from episodes of chronic pain and achieved normalcy in all aspects of their lives, physical and psychological.

However, what makes Suleman truly capable of relieving his patients from pain are the kinds of interventional procedures and methods practiced in his clinic. Unlike most other pediatric pain management programs in the country, Suleman uses ultrasound in addition to fluoroscopy to conduct his procedures, minimizing any possible risks and achieving the highest level of accuracy possible. While conservative methods only make use of fluoroscopy which reveals just bony structures, the addition of ultrasound enables better visualization by disclosing muscles and ligaments. As a result, the possibility of causing errors and creating greater damage is eliminated.

To Suleman, the goal of his treatments is to not only alleviate pain physically, but to also teach children how to approach pain from a psychological standpoint. While he strives to have his patients return to their daily activities, his biggest concern is that children who have suffered from chronic pain are at a high risk of undergoing psychological problems, especially anxiety and depression. Typically, while adults are mostly treated using narcotics, Suleman believes that administering prescription medication to children, especially younger ones, increases the risk of addiction later in life. As a result, these children are taught various techniques including breathing exercises through CBT or cognitive behavioral therapy, which is a type of treatment that teaches patients to better cope with the excruciating pain they experience by avoiding patterns of negative thoughts processes and behaviors as a response.
As a result, mastering this behavior enables children to calm their bodies down when they reach a heightened state of anxiety while experiencing pain.

The biggest challenge that these patients often face is returning to full, normal functionality despite healing from their injuries. This is due to a mechanism in which the brain signaling for pain is turned on during the 1-2 week healing process after a minor injury. As a result, the patient experiences what is is known as acute pain during the healing process. However, sometimes, while the patient may have fully recovered and the healing process is over, the brain signal doesn’t shut off and the patient continues to experience pain despite fully healing. At this point, the acute pain then turns over into chronic pain. To overcome this challenge, Suleman also incorporates physical therapy in his approach, which is geared toward pushing the patients to resume physical activity despite any pain they may experience.

To Suleman, watching his patients achieve physical and mental well being as a result of effective pain relief has always been rewarding. Having surgically intervened by placing a transversus abdominis plane block in a teenager who experienced constant abdominal pain since birth, Suleman successfully relieved the teenager of all pain symptoms. However, this is only one of the many cases that Suleman has worked with and successfully managed, despite engineering this very recent approach. While his approach is currently applied in fellowships in Boston and Cincinnati at the moment, Suleman hopes to begin a fellowship at Johns Hopkins in the near future. While anesthesiologists from across the country have been educated on this new method, there is still a long way to go before it establishes itself as a common procedure among all hospitals across the country.

Posted by Aishwarya Pradeep

Aishwarya is a freshman studying Cognitive Science. Besides being a member of the clinical medicine team on HMR, she is an actively involved in Kranti, the South Asian fusion a cappella group at Hopkins, Hindu Student Council, Pi Beta Phi, and works at the Ralph O’Connor Recreation on campus. She currently pursues research Alzheimer’s disease in the Neuropathology department at the Hopkins medical campus.