Chronic pain problems in children and young people

Abstract

Chronic pain has been defined as pain persisting beyond the usual course of an acute disease or reasonable time for injury to heal (usually taken to be about 3 months) or pain that is associated with a chronological pathological process which causes continuous pain or recurrent pain which recurs at intervals for months or years. Contrary to popular belief, it is likely that substantial numbers of children suffer from chronic pain; population surveys in several countries have found that 20–60% of adolescents complain of significant recurrent pain lasting more than a year, although only a small number of these children seek medical advice, and even fewer require specialist care. Most chronic or recurrent pain in children is easily managed in primary care settings and does not result in significant functional impairment once serious treatable underlying causes have been identified or excluded. However, for a significant minority of children, pain becomes a dominant and refractory symptom needing multidisciplinary input from pain medicine specialists for effective treatment. Although chronic pain in children can arise from wellrecognized clinical conditions such as juvenile idiopathic arthritis (JIA) or inflammatory bowel disease, more commonly in those attending chronic pain clinics, the cause of pain cannot be easily linked to a known or even reasonably well-understood underlying pathology. In these children, chronic pain may present in various guises including complex regional pain syndrome (CRPS), widespread musculoskeletal pain ( juvenile fibromyalgia), recurrent abdominal pain (RAP), and chronic headache. In addition, although many conditions appear superficially to be similar to those found in adults, there are often important differences in epidemiology, presenting symptoms putative underlying mechanisms, appropriate treatments, and prognosis. Pain in childhood can have far-reaching effects, and not just for the child or family. The total financial burden on the UK economy of adolescent chronic pain in 2005 was estimated to be as high as £3840 million in one study. Despite this, and although clinical teams dedicated to the management of childhood chronic pain have been established in hospitals in many parts of the world, access to the most up-to-date treatment is often delayed or non-existent for many patients.