Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints

Primary pain disorders (formerly “functional pain syndromes”) are common, under-diagnosed and under-treated in children and teenagers.

This article reviews key aspects which support understanding the development of paediatric chronic pain, points to the current paediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology.

Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in paediatrics:

  • primary headaches,
  • centrally mediated abdominal pain syndromes,
  • and/or chronic/recurrent musculoskeletal and joint pain.

A significant number of children with repeated acute nociceptive pain episodes develop chronic pain in addition to or as a result of their underlying medical condition “chronic-on-acute pain.” This article provides the description of the structure and process of a interdisciplinary, rehabilitative pain clinic in Minneapolis, Minnesota, USA with accompanying data in the treatment of chronic pain symptoms that persist beyond the expected time of healing.

An interdisciplinary approach combining (1) rehabilitation; (2) integrative medicine/active mind-body techniques; (3) psychology; and (4) normalising daily school attendance, sports, social life and sleep are presented.

As a result of restored function, pain improves and commonly resolves. Opioids are not indicated for primary pain disorders, and other medications, with few exceptions, are usually not first-line therapy.

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