Chronic idiopathic musculoskeletal pain in youth: a qualitative study

Hervé Lefèvre, Alexandra Loisel, Brigitte Bader Meunier, Chantal Deslandre, Noémie Lemoine, Marie Rose Moro, Pierre Quartier, Jonathan Lachal, Hervé Lefèvre, Alexandra Loisel, Brigitte Bader Meunier, Chantal Deslandre, Noémie Lemoine, Marie Rose Moro, Pierre Quartier, Jonathan Lachal

Abstract

Background: Chronic musculoskeletal pain (MSP) is frequent in adolescents and has major medical and social consequences. In many cases, when no cause has been clearly established, this pain may be considered to be chronic idiopathic MSP. Our study seeks to identify general criteria for this type of pain through the experience of professionals from tertiary care centers with expertise in pediatric and adolescent chronic MSP.

Methods: Cross-sectional multicenter qualitative study. Semi-structured interviews of 25 professionals at a rheumatology reference center and in its network for pain management, including diverse specialists and professions. Interpretative Phenomenological Analysis is used to explore the data.

Results: This approach led us to identify 10 themes organized around three superordinate themes covering different stages of the diagnostic process: 1) the medical pain history up to the consultation at the reference center; 2) the professional's subjective feelings about the clinical presentation; 3) from the clinical examination to diagnosis and treatment of chronic idiopathic MSP. The main elements guiding this diagnosis do not come from the physical examination but from the medical history and the professionals' subjective feelings, that is, their clinical judgment. The professionals' impression of uneasiness and frustration, induced by patients and their parents, is of major importance.

Conclusion: The principal elements guiding the diagnosis of chronic idiopathic MSP do not come primarily from the physical examination but rather from the pain history and the health professional's subjective feelings. Our results suggest that the concept of Juvenile Fibromyalgia (JFM) does not appear to cover all situations of chronic idiopathic MSP in adolescence. A constellation of non-organic criteria enables diagnosis of the latter; these criteria should be validated to avoid medical nomadism and multiple investigations and to shorten the interval until patients receive optimal pain management.

Clinical trial registration: clinicaltrials.gov, NCT03171792, https://ichgcp.net/clinical-trials-registry/NCT03171792?term=LACHAL&cntry=FR&city=paris&rank=1.

Keywords: Adolescent; Chronic pain; Musculoskeletal; Qualitative research.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

References

    1. De Inocencio J. Epidemiology of musculoskeletal pain in primary care. Arch Dis Child. 2004;89:431–434. doi: 10.1136/adc.2003.028860.
    1. Szer IS. Musculoskeletal pain syndromes that affect adolescents. Arch Pediatr Adolesc Med. 1996;150:740–747. doi: 10.1001/archpedi.1996.02170320086015.
    1. Weiss JE, Stinson JN. Pediatric Pain Syndromes and Noninflammatory Musculoskeletal Pain. Pediatr Clin North Am [Internet]. 2018 [cited 2019 Mar 3];65:801–826. Available from: .
    1. Palermo T, Eccleston C, Goldschneider K, Sethna N, Schechter N. Assessment and management of children with chronic pain. Position Statement Am Pain Soc. 2012;2012.
    1. Bogduk N, Merskey H. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. Seattle: IASP Press; 1994.
    1. Sperotto F, Brachi S, Vittadello F, Zulian F. Musculoskeletal pain in schoolchildren across puberty: a 3-year follow-up study. Pediatr Rheumatol [Internet]. 2015 [cited 2019 May 4];13:16. Available from:
    1. Perquin CW, Hazebroek-Kampschreur AA, Hunfeld JA, Bohnen AM, van Suijlekom-Smit LW, Passchier J, et al. Pain in children and adolescents: a common experience. Pain. 2000;87:51–58. doi: 10.1016/S0304-3959(00)00269-4.
    1. Goodman JE, McGrath PJ. The epidemiology of pain in children and adolescents: a review. Pain. 1991;46:247–264. doi: 10.1016/0304-3959(91)90108-A.
    1. Hunfeld JA, Perquin CW, Duivenvoorden HJ, Hazebroek-Kampschreur AA, Passchier J, van Suijlekom-Smit LW, et al. Chronic pain and its impact on quality of life in adolescents and their families. J Pediatr Psychol. 2001;26:145–153. doi: 10.1093/jpepsy/26.3.145.
    1. Prkachin KM, Schultz IZ, Hughes E. Pain Behavior and the Development of Pain-related Disability:The Importance of Guarding: Clin J Pain [Internet]. 2007 [cited 2019 May 4];23:270–277. Available from:
    1. El-Metwally A, Salminen JJ, Auvinen A, Kautiainen H, Mikkelsson M. Prognosis of non-specific musculoskeletal pain in preadolescents: A prospective 4-year follow-up study till adolescence: Pain [Internet]. 2004 [cited 2019 Mar 4];110:550–559. Available from:
    1. Michaleff Zoe A, Campbell Paul, Hay Alastair D, Warburton Louise, Dunn Kate M. Child and adolescent musculoskeletal pain (CAM-Pain) feasibility study: testing a method of identifying, recruiting and collecting data from children and adolescents who consult about a musculoskeletal condition in UK general practice. BMJ Open. 2018;8(6):e021116. doi: 10.1136/bmjopen-2017-021116.
    1. Anthony KK, Schanberg LE. Pediatric Pain Syndromes and Management of Pain in Children and Adolescents with Rheumatic Disease. Pediatr Clin North Am [Internet]. 2005 [cited 2019 May 4];52:611–639. Available from:
    1. McGhee JL, Burks FN, Sheckels JL, Jarvis JN. Identifying children with chronic arthritis based on chief complaints: absence of predictive value for musculoskeletal pain as an indicator of rheumatic disease in children. Pediatrics. 2002;110:354–359. doi: 10.1542/peds.110.2.354.
    1. Rashid Amir, Cordingley Lis, Carrasco Roberto, Foster Helen E, Baildam Eileen M, Chieng Alice, Davidson Joyce E, Wedderburn Lucy R, Ioannou Yiannis, McErlane Flora, Verstappen Suzanne M M, Hyrich Kimme L, Thomson Wendy. Patterns of pain over time among children with juvenile idiopathic arthritis. Archives of Disease in Childhood. 2017;103(5):437–443. doi: 10.1136/archdischild-2017-313337.
    1. Ting Tracy V., Barnett Kimberly, Lynch-Jordan Anne, Whitacre Catharine, Henrickson Michael, Kashikar-Zuck Susmita. 2010 American College of Rheumatology Adult Fibromyalgia Criteria for Use in an Adolescent Female Population with Juvenile Fibromyalgia. The Journal of Pediatrics. 2016;169:181-187.e1. doi: 10.1016/j.jpeds.2015.10.011.
    1. Tian Frances, Guittar Patsy, Moore-Clingenpeel Melissa, Higgins Gloria, Ardoin Stacy P., Spencer Charles H., Jones Karla, Thomas Bethanne, Akoghlanian Shoghik, Bout-Tabaku Sharon. Healthcare Use Patterns and Economic Burden of Chronic Musculoskeletal Pain in Children before Diagnosis. The Journal of Pediatrics. 2018;197:172–176. doi: 10.1016/j.jpeds.2018.01.076.
    1. Kashikar-Zuck Susmita, Ting Tracy V. Juvenile fibromyalgia: current status of research and future developments. Nature Reviews Rheumatology. 2013;10(2):89–96. doi: 10.1038/nrrheum.2013.177.
    1. Yunus MB, Masi AT. Juvenile primary fibromyalgia syndrome. A clinical study of thirty-three patients and matched normal controls. Arthritis Rheum. 1985;28:138–145. doi: 10.1002/art.1780280205.
    1. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum. 1990;33:160–172. doi: 10.1002/art.1780330203.
    1. Wolfe Frederick, Clauw Daniel J., Fitzcharles Mary-Ann, Goldenberg Don L., Katz Robert S., Mease Philip, Russell Anthony S., Russell I. Jon, Winfield John B., Yunus Muhammad B. The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity. Arthritis Care & Research. 2010;62(5):600–610. doi: 10.1002/acr.20140.
    1. Wolfe Frederick, Häuser Winfried. Fibromyalgia diagnosis and diagnostic criteria. Annals of Medicine. 2011;43(7):495–502. doi: 10.3109/07853890.2011.595734.
    1. Wolfe F, Clauw DJ, Fitzcharles M-A, Goldenberg DL, Häuser W, Katz RL, et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum [Internet]. 2016 [cited 2019 May 19];46:319–329. Available from:
    1. Draheim N., Ebinger F., Schnöbel-Müller E., Wolf B., Häuser W. Definition, Diagnostik und Therapie von chronischen Schmerzen in mehreren Körperregionen und des (sog.) Fibromyalgiesyndroms bei Kindern und Jugendlichen. Der Schmerz. 2017;31(3):296–307. doi: 10.1007/s00482-017-0208-z.
    1. de Sanctis V, Abbasciano V, Soliman AT, Soliman N, Di Maio S, Fiscina B, et al. The juvenile fibromyalgia syndrome (JFMS): a poorly defined disorder. Acta Bio Medica Atenei Parm [Internet]. 2019 [cited 2019 May 19];90:134–148. Available from:
    1. O’Sullivan P, Beales D, Jensen L, Murray K, Myers T. Characteristics of chronic non-specific musculoskeletal pain in children and adolescents attending a rheumatology outpatients clinic: a cross-sectional study. Pediatr Rheumatol [Internet]. 2011 [cited 2019 Apr 30];9:3. Available from:
    1. Connelly M, Schanberg L. Latest developments in the assessment and management of chronic musculoskeletal pain syndromes in children: Curr Opin Rheumatol [Internet]. 2006 [cited 2019 May 4];18:496–502. Available from:
    1. Lewandowski AS, Palermo TM, Stinson J, Handley S, Chambers CT. Systematic Review of Family Functioning in Families of Children and Adolescents With Chronic Pain. J Pain [Internet]. 2010 [cited 2019 May 4];11:1027–1038. Available from:
    1. Clinch J, Eccleston C. Chronic musculoskeletal pain in children: assessment and management. Rheumatol [Internet]. 2008 [cited 2019 Mar 5];48:466–474. Available from:
    1. Guite JW, Logan DE, Sherry DD, Rose JB. Adolescent Self-Perception: Associations With Chronic Musculoskeletal Pain and Functional Disability. J Pain [Internet]. 2007 [cited 2019 May 4];8:379–386. Available from:
    1. Wakefield Emily O., Zempsky William T., Puhl Rebecca M., Litt Mark D. Conceptualizing pain-related stigma in adolescent chronic pain. PAIN Reports. 2018;3:e679. doi: 10.1097/PR9.0000000000000679.
    1. Oen Kiem, Tucker Lori, Huber Adam M., Miettunen Paivi, Scuccimarri Rosie, Campillo Sarah, Cabral David A., Feldman Brian M., Tse Shirley, Chédeville Gaëlle, Spiegel Lynn, Schneider Rayfel, Lang Bianca, Ellsworth Janet, Ramsey Suzanne, Dancey Paul, Silverman Earl, Chetaille Anne-Laure, Cameron Bonnie, Johnson Nicole, Dorval Jean, Petty Ross E., Duffy Karen Watanabe, Boire Gilles, Haddad Elie, Houghton Kristin, Saint-Cyr Claire, Turvey Stuart E., Benseler Susanne, Cheang Mary, Yeung Rae S. M., Duffy Ciarán M. Predictors of early inactive disease in a juvenile idiopathic arthritis cohort: Results of a Canadian multicenter, prospective inception cohort study. Arthritis & Rheumatism. 2009;61(8):1077–1086. doi: 10.1002/art.24539.
    1. Craig KD, Versloot J, Goubert L, Vervoort T, Crombez G. Perceiving Pain in Others: Automatic and Controlled Mechanisms. J Pain [Internet]. 2010 [cited 2019 May 4];11:101–108. Available from:
    1. Eccleston C, Cooper TE, Fisher E, Anderson B, Wilkinson NM. Non-steroidal anti-inflammatory drugs (NSAIDs) for chronic non-cancer pain in children and adolescents. Cochrane Pain, Palliative and Supportive Care Group, editor. Cochrane Database Syst Rev [Internet]. 2017 [cited 2019 Feb 24]; Available from:
    1. Palermo TM, Eccleston C, Lewandowski AS, De C. Williams AC, Morley S. Randomized controlled trials of psychological therapies for management of chronic pain in children and adolescents: An updated meta-analytic review: Pain [Internet]. 2010 [cited 2019 May 4];148:387–397. Available from:
    1. Cooper TE, Fisher E, Anderson B, Wilkinson NM, Williams DG, Eccleston C. Paracetamol (acetaminophen) for chronic non-cancer pain in children and adolescents. Cochrane Pain, Palliative and Supportive Care Group, editor. Cochrane Database Syst Rev [Internet]. 2017 [cited 2019 May 4]; Available from:
    1. Cooper TE, Fisher E, Gray AL, Krane E, Sethna N, van Tilburg MA, et al. Opioids for chronic non-cancer pain in children and adolescents. Cochrane Pain, Palliative and Supportive Care Group, editor. Cochrane Database Syst Rev [Internet]. 2017 [cited 2019 Feb 24]; Available from:
    1. Gmuca Sabrina, Sherry David D. Fibromyalgia: Treating Pain in the Juvenile Patient. Pediatric Drugs. 2017;19(4):325–338. doi: 10.1007/s40272-017-0233-5.
    1. Black William R, Kashikar-Zuck Susmita. Exercise interventions for juvenile fibromyalgia: current state and recent advancements. Pain Management. 2017;7(3):143–148. doi: 10.2217/pmt-2016-0066.
    1. Tran ST, Guite JW, Pantaleao A, Pfeiffer M, Myer GD, Sil S, et al. Preliminary outcomes of a cross-site cognitive-behavioral and neuromuscular integrative training intervention for juvenile fibromyalgia. Arthritis Care Res. 2017;69:413–420. doi: 10.1002/acr.22946.
    1. Kashikar-Zuck S, Flowers SR, Strotman D, Sil S, Ting TV, Schikler KN. Physical activity monitoring in adolescents with juvenile fibromyalgia: findings from a clinical trial of cognitive-behavioral therapy. Arthritis Care Res. 2013;65:398–405. doi: 10.1002/acr.21849.
    1. Peacock Sue, Patel Shilpa. Cultural Influences on Pain. Reviews in Pain. 2008;1(2):6–9. doi: 10.1177/204946370800100203.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel