Chronic Pain Syndromes
Chronic Pain Syndromes in Pediatrics
Chronic pain syndromes in pediatrics represent a complex group of conditions characterized by persistent pain lasting longer than 3 months or beyond the normal tissue healing time. These conditions significantly impact a child's quality of life, academic performance, and social interactions.
Key Points
- Affects 15-30% of children worldwide
- Often multifactorial in origin
- Requires comprehensive biopsychosocial assessment
- Management typically involves multimodal approach
Types of Chronic Pain Syndromes
1. Musculoskeletal Pain
- Complex Regional Pain Syndrome (CRPS)
- Fibromyalgia
- Hypermobility-related pain
- Growing pains
2. Neuropathic Pain
- Post-surgical nerve injury
- Phantom limb pain
- Chemotherapy-induced neuropathy
3. Headache Disorders
- Chronic migraine
- Tension-type headache
- New daily persistent headache
4. Abdominal Pain
- Functional abdominal pain
- Irritable bowel syndrome
- Abdominal migraine
Clinical Presentation
Physical Manifestations
- Persistent pain in affected area
- Altered sensory perception
- Decreased mobility or function
- Sleep disturbances
- Fatigue
Psychological Impact
- Anxiety and depression
- School avoidance
- Social withdrawal
- Decreased participation in activities
Associated Symptoms
- Autonomic changes
- Altered temperature regulation
- Changes in skin color or texture
- Muscular changes
Diagnostic Approach
History Taking
- Pain characteristics (OPQRST)
- Impact on daily activities
- Sleep patterns
- Psychological assessment
- Family history
- School performance
Physical Examination
- Detailed musculoskeletal examination
- Neurological examination
- Pain mapping
- Functional assessment
Assessment Tools
- Pain scales (Faces Pain Scale-Revised)
- Pain diaries
- Functional Disability Inventory
- Child Depression Inventory
Treatment Approaches
Non-pharmacological Interventions
- Physical therapy
- Cognitive behavioral therapy
- Biofeedback
- Mindfulness techniques
- Occupational therapy
Pharmacological Management
- NSAIDs
- Anticonvulsants for neuropathic pain
- Antidepressants (TCAs, SNRIs)
- Topical agents
Interdisciplinary Approach
- Pain specialist
- Psychologist
- Physical therapist
- Occupational therapist
- School liaison
