Chronic Musculoskeletal Pain in Children: Assessment and Management

Jacqui Clinch; Christopher Eccleston

Disclosures

Rheumatology. 2009;48(5):466-474. 

In This Article

Abstract and Introduction

Abstract

Paediatricians and paediatric rheumatologists review a large number of children with ongoing pain (disease and non-disease related). A small number of these develop chronic pain conditions that are complex and distressing. Over recent years studies of the epidemiology, aetiology and rehabilitation of pain and pain-associated disability in children have revealed a large prevalence of clinically relevant pain, and have emphasized the need for early recognition and intervention. Medication has a role when part of a multidisciplinary framework, although there is little evidence for or against the effectiveness of most pharmacotherapy. There is strong evidence to support early targeted psychological and physical intervention, and an understanding that parental education and involvement is essential if progress is to be maintained. In this review, an overview of the assessment is presented and management of childhood chronic musculoskeletal pain conditions with reference to main research findings to date.

Introduction

Paediatricians, particularly paediatric rheumatologists, review a large number of children who have a wide variety of musculoskeletal pains.[1,2] Many of these children do not have easily identifiable inflammatory or other obvious disease processes that can help us understand and explain the cause of pain. However, for most young people presenting to clinic, regardless of whether the cause of their pain is known, the chronic experience of pain has often had a large and wholly negative impact on the physical and psychological well-being of the young person and their family.[2] Recent data have shown that chronic pain also has a serious negative impact on financial well-being, not only for each family but also for the economy as a whole. In the only published cost of illness study of this population we conservatively calculated the financial burden of adolescent chronic pain on the UK economy in 1 year, 2005, to be £3840 million.[3] Childhood chronic pain is a modern public health disaster. The extent of unacknowledged suffering and dependency in our healthcare systems is only now coming to light.

In this article, we have five related objectives. First, we review the epidemiology of musculoskeletal pain in childhood. Secondly, we address the current theories of the aetiology of pain. Thirdly, we review the impact of chronic pain, the clinical features of common pain presentations and their relevance to diagnosis and treatment planning. Fourthly, we introduce rehabilitation interventions aimed at the management of chronic pain. Finally, we make recommendations for further action.

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