Childhood chronic pain
Chronic pain in childhood can be caused by a number of conditions, including juvenile fibromyalgia, complex regional pain syndrome, chronic abdominal pain, chronic headache, and juvenile arthritis.[1] Estimates of the prevalence of chronic pain in childhood range considerably, but conservative epidemiological studies calculate it as at least 5%. Rates of paediatric chronic pain have also increased in the past 20 years.[2] While chronic pain conditions vary significantly in severity, they often affect children's mental health, academic performance, and general quality of life.[3]
Classification and epidemiology
Chronic pain is defined as pain that lasts at least 3-6 months and, in the case of injury or surgery, remains present after standard recovery time has elapsed.[4] The ICD-11 provides seven categories for diagnosing chronic pain:
- Chronic primary pain
- Chronic cancer pain
- Chronic postsurgical and posttraumatic pain
- Chronic neuropathic pain
- Chronic headache and orofacial pain
- Chronic visceral pain
- Chronic musculoskeletal pain[4]
Chronic pain, especially chronic headache, is more common in girls, older children, and children from low socioeconomic status backgrounds.[2] According to researchers Anna Huguet and Jordi Miró, the most common locations for paediatric chronic pain are the head and abdomen. These two locations are more likely to be sources of chronic pain for girls, whereas boys are more likely to experience lower limb pain. Girls are also more likely than boys to experience multiple sources of pain.[5] The prevalence of chronic pain among girls increases sharply between the ages of 12 and 14, which leads some researchers to believe that it is linked to menarche and other hormonal changes during adolescence.[6]
Management
Chronic pain can be treated in a number of ways, and often varies depending on the type and severity of the condition. Common pain medications prescribed to children include paracetamol, ibuprofen, and acetylsalicylic acid.[5] Researchers have also found that psychotherapies are often helpful in reducing functional disability in children with chronic pain. A meta-analysis by Christopher Eccleston and colleagues found that cognitive behavioural therapy (CBT) significantly reduced pain severity for children with chronic headaches.[7] Additionally, biofeedback and relaxation therapy can be used in conjunction with CBT to treat chronic pain. Studies thus far have typically found small effects for improving psychological wellbeing, but more robust outcomes for pain relief.[8]
Outcomes
Chronic pain often interferes with children's ability to attend and succeed in school. Children with severe disorders are particularly likely to miss school because of debilitating pain, as well as for medical appointments. High rates of school absence are associated with poor adjustment and psychosocial wellbeing among children with chronic illnesses.[9]
References
- ^ "Pediatric Chronic Pain Management - Academy of Integrative Pain Management Blog". Academy of Integrative Pain Management Blog. 2016-01-11. Retrieved 2017-02-15.
- ^ a b King, Sara; Chambers, Christine T.; Huguet, Anna; MacNevin, Rebecca C.; McGrath, Patrick J.; Parker, Louise; MacDonald, Amanda J. (2011-12-01). "The epidemiology of chronic pain in children and adolescents revisited: a systematic review". Pain. 152 (12): 2729–2738. doi:10.1016/j.pain.2011.07.016. ISSN 1872-6623. PMID 22078064.
- ^ Weiss, K. E.; Hahn, A.; Wallace, D. P.; Biggs, B.; Bruce, B. K.; Harrison, T. E. (2013-08-01). "Acceptance of Pain: Associations With Depression, Catastrophizing, and Functional Disability Among Children and Adolescents in an Interdisciplinary Chronic Pain Rehabilitation Program". Journal of Pediatric Psychology. 38 (7): 756–765. doi:10.1093/jpepsy/jst028. ISSN 0146-8693.
- ^ a b Treede, Rolf-Detlef; Rief, Winfried; Barke, Antonia; Aziz, Qasim; Bennett, Michael I.; Benoliel, Rafael; Cohen, Milton; Evers, Stefan; Finnerup, Nanna B. (2017-02-15). "A classification of chronic pain for ICD-11". Pain. 156 (6): 1003–1007. doi:10.1097/j.pain.0000000000000160. ISSN 0304-3959. PMC 4450869. PMID 25844555.
{{cite journal}}: CS1 maint: PMC format (link) - ^ a b Huguet, Anna; Miró, Jordi. "The Severity of Chronic Pediatric Pain: An Epidemiological Study". The Journal of Pain. 9 (3): 226–236. doi:10.1016/j.jpain.2007.10.015.
- ^ Perquin, Christel W.; Hazebroek-Kampschreur, Alice A.J.M; Hunfeld, Joke A.M.; Bohnen, Arthur M.; Suijlekom-Smit, Lisette W.A. van; Passchier, Jan; Wouden, Johannes C. van der. "Pain in children and adolescents: a common experience". Pain. 87 (1): 51–58. doi:10.1016/s0304-3959(00)00269-4.
- ^ Eccleston, Christopher; Morley, Stephen; Williams, Amanda; Yorke, Louise; Mastroyannopoulou, Kiki. "Systematic review of randomised controlled trials of psychological therapy for chronic pain in children and adolescents, with a subset meta-analysis of pain relief". Pain. 99 (1): 157–165. doi:10.1016/s0304-3959(02)00072-6.
- ^ Palermo, Tonya M.; Eccleston, Christopher; Lewandowski, Amy S.; Williams, Amanda C de C.; Morley, Stephen. "Randomized controlled trials of psychological therapies for management of chronic pain in children and adolescents: An updated meta-analytic review". Pain. 148 (3): 387–397. doi:10.1016/j.pain.2009.10.004. PMC 2823996. PMID 19910118.
{{cite journal}}: CS1 maint: PMC format (link) - ^ Midence, K. (1994). The effects of chronic illness on children and their families: An overview. Genetic, Social & General Psychology Monographs, 120(3), 311.