Pain Management

Sunita Goel
Pain Management - Introduction
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

DiseaseProminent pain mechanismsAnatomical originEtiology
Juvenile Idiopathic Arthritis
NociceptiveJoints, tendon sheaths, entheses, often multipleGenetic, immune, unknown
Knee (Patello- Femoral) PainNociceptivePatella and related structures including chondromalaciaTrauma, overuse
Fibromyalgia syndromeNociceptive, neuropathic psychogenic, unknownSpinal structures including nerve rootsTrauma, developmental (e.g Scheurmann's), inflammatory (discitis)
Limb Pain Syndromes (growing pain)UnknownLimbs (especially legs)Unknown
Complex regional pain syndromes type 1 (RSD)Initially nociceptive, secondary neuropathic including sympathetic psychogenicLimbs (multiple structures)Trauma, unknown
Chronic daily headaches
Mixed (uncertain)Head (upper cervical spine)Trauma, psychosomatic
Brachial Plexus InjuryPeripheral neuropathyUpper limbTrauma
Somatization disorderPsychogenic, uncertainOften widespreadAnxiety, Stress

In 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.

Pain Management Pain Management 03/30/2001
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