Chronic musculoskeletal pain in children and adolescents

Abstract

Paediatricians review a large number of children who have a wide variety of musculoskeletal pains. The most common chronic pain conditions reviewed in paediatric rheumatology settings include diffuse idiopathic musculoskeletal pain (also called juvenile fibromyalgia or chronic widespread pain), chronic pain related to childhood hypermobility, complex regional pain syndromes (CRPS), chronic back pain, and persistent joint pain following previous or controlled inflammation, e.g. juvenile idiopathic arthritis (JIA). The chronic experience of pain often has a large and wholly negative impact on physical and psychological well-being and also a serious negative impact on financial well-being. The annual financial burden of adolescent chronic pain on the United Kingdom economy is conservatively calculated at £3840 million. Children who suffer persistent musculoskeletal pain and associated symptoms have a significant chance of developing chronic widespread pain and continuing to have pain and pain-associated disability in adult life. This chapter reviews the epidemiology of musculoskeletal pain in childhood, current theories of the aetiology of pain, the impact of chronic pain, the clinical features of common pain presentations and their relevance to diagnosis and treatment planning, and rehabilitation interventions aimed at the management of chronic pain.