Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints

Stefan J Friedrichsdorf, James Giordano, Kavita Desai Dakoji, Andrew Warmuth, Cyndee Daughtry, Craig A Schulz, Stefan J Friedrichsdorf, James Giordano, Kavita Desai Dakoji, Andrew Warmuth, Cyndee Daughtry, Craig A Schulz

Abstract

Primary pain disorders (formerly "functional pain syndromes") are common, under-diagnosed and under-treated in children and teenagers. This manuscript reviews key aspects which support understanding the development of pediatric chronic pain, points to the current pediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology. Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in pediatrics: primary headaches, centrally mediated abdominal pain syndromes, and/or chronic/recurrent musculoskeletal and joint pain. A significant number of children with repeated acute nociceptive pain episodes develop chronic pain in addition to or as a result of their underlying medical condition "chronic-on-acute pain." We provide description of the structure and process of our interdisciplinary, rehabilitative pain clinic in Minneapolis, Minnesota, USA with accompanying data in the treatment of chronic pain symptoms that persist beyond the expected time of healing. An interdisciplinary approach combining (1) rehabilitation; (2) integrative medicine/active mind-body techniques; (3) psychology; and (4) normalizing daily school attendance, sports, social life and sleep will be presented. As a result of restored function, pain improves and commonly resolves. Opioids are not indicated for primary pain disorders, and other medications, with few exceptions, are usually not first-line therapy.

Keywords: adolescents; biopsychosocial; children; chronic pain; interdisciplinary treatment; pediatric pain clinic; primary pain disorder.

Conflict of interest statement

S.F. is supported, in part, by the The Mayday Fund, National Institutes of Health/National Cancer Institute, Children’s Hospitals and Clinics of Minnesota Research Grant Program, National Institutes of Health/National Institute of Nursing Research, and the Canadian Partnership against Cancer. J.G. is supported, in part, by the Children’s Hospitals and Clinics of Minneapolis Foundation, the William H. and Ruth Crane Schaefer Endowment, and the Clark Family Foundation. Other authors declare no conflict of interest.

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Source: PubMed

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