There are no published satisfactory and comprehensive community surveys of the prevalence and impact of chronic
pain syndromes in children and adolescents. Assisting and guiding a child with a chronic pain disorder and the parents is an exceptional challenge.
The components of a comprehensive diagnosis of a chronic pain syndrome are:
- The underlying pathology, its cause, nature and extent and whether there is associated pain, tenderness consistent with primary allodynia/ hyperalgesia.
- The presence of a peripheral neuropathic disorder contributing to or causing pain.
- The clinical signs of cutaneous or/and deep tissue allodynia at sites where there is no apparent pathology that is secondary allodynia with potential implications about central sensitization of nociception.
- Interference with function
- Associated psychological factors
Representative pediatric disorders characterized by chronic pain
|Disease||Prominent pain mechanisms||Anatomical origin||Etiology|
|Juvenile Idiopathic Arthritis||Nociceptive||Joints, tendon sheaths, entheses, often multiple||Genetic, immune, unknown|
|Knee (Patello- Femoral) Pain||Nociceptive||Patella and related structures including chondromalacia||Trauma, overuse|
|Fibromyalgia syndrome||Nociceptive, neuropathic psychogenic, unknown||Spinal structures including nerve roots||Trauma, developmental (e.g Scheurmann's), inflammatory (discitis)|
|Limb Pain Syndromes (growing pain)||Unknown||Limbs (especially legs)||Unknown|
|Complex regional pain syndromes type 1 (RSD)||Initially nociceptive, secondary neuropathic including sympathetic psychogenic||Limbs (multiple structures)||Trauma, unknown|
|Chronic daily headaches||Mixed (uncertain)||Head (upper cervical spine)||Trauma, psychosomatic|
|Brachial Plexus Injury||Peripheral neuropathy||Upper limb||Trauma|
|Somatization disorder||Psychogenic, uncertain||Often widespread||Anxiety, Stress|
Cancer painIn recent years, it has become evident that the
appropriate assessment of a patient with cancer pain requires a multi-dimensional evaluation of the pain syndrome - the patient's clinical and psychological characteristics, and a number of specific prognostic factors that have a major impact on the treatment outcome and might help focus the care. It has also become apparent that pain should be considered in the context of other major symptom complexes that are also highly prevalent in patients with advanced cancers.