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Childhood chronic pain

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Childhood chronic pain affects at least 5% of the population under the age of 18, according to conservative epidemiological studies. Rates of paediatric chronic pain have also increased in the past 20 years.[1] While chronic pain conditions vary significantly in severity, they often affect children's mental health, academic performance, and general quality of life.[2]

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.[3] 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[3]

Childhood chronic pain can be caused by a number of conditions, including the following:[4]

Condition Symptoms Known causes and risk factors Estimated prevalence Treatments
Chronic abdominal pain Recurrent abdominal pain, usually without a known organic cause[5] Usually unknown[5] 8.4%[6] Drug therapies, cognitive behavioural therapy (CBT) [5]
Chronic headache Recurrent headache (at least 15 days per month, 4 hours per day)[7] Sex (more common in females), psychological disturbances, obesity, overuse of caffeine or headache medication, other chronic pain conditions[7] 1.5% - 3.4% Antidepressants, beta blockers, anticonvulsants, NSAIDs, botulinum toxin, CBT[7]
Complex regional pain syndrome Severe burning/throbbing pain (usually in a limb), swelling, sensitivity, changes in skin colour and texture[8] Injury or trauma[8] Unknown[9] Pain relievers, corticosteroids, bone-loss medication, sympathetic nerve-blocking medication, intravenous ketamine, physical therapy, biofeedback, spinal cord stimulation[8]
Juvenile fibromyalgia Widespread muskuloskeletal pain, headache, sleep disturbances, fatigue[10] Genetics, sex (more common in females), infections, trauma, rheumatic disease[10] 1.2% - 6.2%[11] Antidepressants, anticonvulsants, pain relievers, CBT[10]
Juvenile rheumatoid arthritis Joint pain, swelling, and stiffness[12] Genetics, sex (more common in females)[12] 0.4%[13] NSAIDs, TNF blockers, immune suppressants, corticosteroids, physical therapy[12]

Management

Chronic pain can be treated in a number of ways, and varies depending on the type and severity of the condition. Common pain medications prescribed to children include paracetamol, ibuprofen, and acetylsalicylic acid.[14] 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.[15] Additionally, biofeedback and relaxation therapy can be used in conjunction with CBT to treat chronic pain. Research thus far has typically found small effects for improving psychological wellbeing, but more robust outcomes for pain relief.[16] Studies have also found significant pain relief effect for alternative medicine treatments, such as acupuncture[17] and herbal medicine[18]. Further research is needed to evaluate the efficacy of other alternative medicine techniques, such as arts therapy, homeopathy, and hypnosis.[18]

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.[19]

In a study of patients at a paediatric pain clinic, researchers found that chronic pain had a significant negative impact on quality of life. Depression was also prevalent, and was correlated with functional disability.[20] Additionally, psychosocial adjustment is a better predictor of school attendance than pain severity, which suggests that it is an important variable in examining outcomes of children with chronic pain.[21] Paediatric chronic pain often impacts quality of life for the families of children affected, with mothers having particularly low health-related quality of life on average.[22] Parents of children with chronic pain conditions allocate considerable physical, financial, and emotional resources towards health care for their child. For example, a study by Ho and colleagues found that primary caregivers for chronically ill children spent an average of around $8800 and 28.5 hours on medical appointments in the past three months, causing them to miss an average of 4 days of work.[23]

Factors affecting outcomes

Demographic factors

Chronic pain, especially chronic headache, is more common in girls, older children, and children from low socioeconomic status backgrounds.[1] 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.[14] 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.[24]

Age also has a significant impact on children's experiences with chronic pain. Young children often cannot describe their pain in ways that adults understand, and even older children may lack the vocabulary to clearly communicate with medical professionals.[25]

Family support

For chronic pain patients, family support is an important factor in promoting successful pain management and rehabilitation.[26] While healthy family interaction has a positive impact on paediatric pain patients, overprotectiveness and unhealthy relationship demands can foster depressive symptoms.[27]

School support

School support is also an important factor influencing paediatric chronic pain outcomes. When children receive appropriate support from teachers and school counsellors, they are more likely to achieve attain success and psychological wellbeing.[19] This process can often be facilitated by a paediatric nurse practitioner (PNP), who coordinates a child's education with his or her medical treatment.[28]

References

  1. ^ 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.
  2. ^ 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.
  3. ^ 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.
  4. ^ "Pediatric Chronic Pain Management - Academy of Integrative Pain Management Blog". Academy of Integrative Pain Management Blog. 2016-01-11. Retrieved 2017-02-15.
  5. ^ a b c Pain, Subcommittee on Chronic Abdominal (2005-03-01). "Chronic Abdominal Pain in Children". Pediatrics. 115 (3): 812–815. doi:10.1542/peds.2004-2497. ISSN 0031-4005. PMID 15741394.
  6. ^ Chitkara, Denesh K; Rawat, David J; Talley, Nicholas J (2005-08-01). "American Journal of Gastroenterology - The Epidemiology of Childhood Recurrent Abdominal Pain in Western Countries: A Systematic Review". Am J Gastroenterol. 100 (8): 1868–1875. doi:10.1111/j.1572-0241.2005.41893.x. ISSN 0002-9270.
  7. ^ a b c "Chronic daily headaches Symptoms - Mayo Clinic". Mayo Clinic. Retrieved 2017-03-07.
  8. ^ a b c "Complex regional pain syndrome Symptoms - Mayo Clinic". Mayo Clinic. Retrieved 2017-03-07.
  9. ^ Tan, Edward C.T.H.; Sandt-Renkema, Nienke van de; Krabbe, Paul F.M.; Aronson, Daniel C.; Severijnen, René S.V.M. "Quality of life in adults with childhood-onset of Complex Regional Pain Syndrome type I". Injury. 40 (8): 901–904. doi:10.1016/j.injury.2009.01.134.
  10. ^ a b c "Juvenile fibromyalgia Symptoms - Mayo Clinic". Mayo Clinic. Retrieved 2017-03-07.
  11. ^ Neumann, L., & Buskila, D. (2003). Epidemiology of fibromyalgia. Current pain and headache reports, 7(5), 362-368.
  12. ^ a b c "Juvenile rheumatoid arthritis Symptoms - Mayo Clinic". Mayo Clinic. Retrieved 2017-03-07.
  13. ^ Manners, Prudence Joan; Bower, Carol (2002-07-01). "Worldwide prevalence of juvenile arthritis why does it vary so much?". The Journal of Rheumatology. 29 (7): 1520–1530. ISSN 0315-162X. PMID 12136914.
  14. ^ a b Huguet, Anna; Miró, Jordi (2008). "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.
  15. ^ Eccleston, Christopher; Morley, Stephen; Williams, Amanda; Yorke, Louise; Mastroyannopoulou, Kiki (2002). "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.
  16. ^ Palermo, Tonya M.; Eccleston, Christopher; Lewandowski, Amy S.; Williams, Amanda C de C.; Morley, Stephen (2010). "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.
  17. ^ Kemper, Kathi J.; Sarah, Rebecca; LicAc, M. P. H.; Silver-Highfield, Ellen; LicAc§; Xiarhos, Elizabeth; Barnes, Linda; Berde, Charles (2000-04-01). "On Pins and Needles? Pediatric Pain Patients' Experience With Acupuncture". Pediatrics. 105 (Supplement 3): 941–947. ISSN 0031-4005.
  18. ^ a b Tsao, Jennie C. I.; Zeltzer, Lonnie K. (2017-03-07). "Complementary and Alternative Medicine Approaches for Pediatric Pain: A Review of the State-of-the-science". Evidence-based Complementary and Alternative Medicine. 2 (2): 149–159. doi:10.1093/ecam/neh092. ISSN 1741-427X. PMC 1142204. PMID 15937555.{{cite journal}}: CS1 maint: PMC format (link)
  19. ^ a b Midence, K. (1994). The effects of chronic illness on children and their families: An overview. Genetic, Social & General Psychology Monographs, 120(3), 311.
  20. ^ Kashikar-Zuck, S.; Goldschneider, K. R.; Powers, S. W.; Vaught, M. H.; Hershey, A. D. (2001-12-01). "Depression and functional disability in chronic pediatric pain". The Clinical Journal of Pain. 17 (4): 341–349. ISSN 0749-8047. PMID 11783815.
  21. ^ Weitzman, M. (1986). School absence rates as outcome measures in studies of children with chronic illness. Journal of Chronic Diseases 39(10), 799-808.
  22. ^ Jastrowski Mano, K. E.; Khan, K. A.; Ladwig, R. J.; Weisman, S. J. (2011-06-01). "The Impact of Pediatric Chronic Pain on Parents' Health-Related Quality of Life and Family Functioning: Reliability and Validity of the PedsQL 4.0 Family Impact Module". Journal of Pediatric Psychology. 36 (5): 517–527. doi:10.1093/jpepsy/jsp099. ISSN 0146-8693.
  23. ^ Ho, Ivy K.; Goldschneider, Kenneth R.; Kashikar-Zuck, Susmita; Kotagal, Uma; Tessman, Clare; Jones, Benjamin (2008-01-01). "Healthcare Utilization and Indirect Burden among Families of Pediatric Patients with Chronic Pain". Journal of Musculoskeletal Pain. 16 (3): 155–164. doi:10.1080/10582450802161853. ISSN 1058-2452.
  24. ^ 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 (2000). "Pain in children and adolescents: a common experience=". Pain. 87 (1): 51–58. doi:10.1016/s0304-3959(00)00269-4.
  25. ^ "Symptoms of Pain in Children". WebMD. Retrieved 2017-03-07.
  26. ^ Jamison, Robert N.; Virts, Kitti L. "The influence of family support on chronic pain". Behaviour Research and Therapy. 28 (4): 283–287. doi:10.1016/0005-7967(90)90079-x.
  27. ^ Fales, J. L.; Essner, B. S.; Harris, M. A.; Palermo, T. M. (2014-05-01). "When Helping Hurts: Miscarried Helping in Families of Youth With Chronic Pain". Journal of Pediatric Psychology. 39 (4): 427–437. doi:10.1093/jpepsy/jsu003. ISSN 0146-8693. PMC 3994319. PMID 24517921.
  28. ^ Rabin, Nancy B. "School reentry and the child with a chronic illness: The role of the Pediatric nurse practitioner". Journal of Pediatric Health Care. 8 (5): 227–232. doi:10.1016/0891-5245(94)90066-3.
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