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Idiopathic musculoskeletal pain syndromes in children
P N Malleson1, M al-Matar, R E Petty
1Department of Pediatrics, University of British Columbia, Vancouver, Canada.
Insights
Idiopathic musculoskeletal pain is common in children, often presenting as localized or diffuse pain. Many cases are linked to significant stressors and can lead to long-term pain issues.
Area of Science:
- Pediatric Rheumatology
- Pain Medicine
- Child Psychology
Background:
- Idiopathic musculoskeletal pain is a frequent reason for pediatric rheumatology referrals.
- This pain can manifest as localized or diffuse symptoms, impacting children's well-being.
Purpose of the Study:
- To investigate the characteristics and outcomes of children with idiopathic musculoskeletal pain.
- To identify potential associations with specific diagnoses and psychosocial stressors.
Main Methods:
- Retrospective review of 81 children diagnosed with idiopathic musculoskeletal pain between 1982 and 1990.
- Classification into localized or diffuse pain groups.
- Assessment for specific conditions like reflex neurovascular dystrophy and fibromyalgia.
- Evaluation of pain persistence, recurrence, and associated stressors.
Main Results:
- 41 children had localized idiopathic pain; 24 met criteria for reflex neurovascular dystrophy.
- 40 children had diffuse idiopathic pain; 35 met criteria for fibromyalgia.
- 10% of localized pain patients developed diffuse pain; 10% of diffuse pain patients had prior localized pain.
- Pain recurrence and persistence were common.
- Significant psychosocial stressors were identified in many patients.
Conclusions:
- Idiopathic musculoskeletal pain is a prevalent condition in pediatric rheumatology, often chronic.
- Conditions like reflex neurovascular dystrophy and fibromyalgia are common in these children.
- Psychosocial factors may play a crucial role in the development and persistence of pain.
- Early identification and management of associated stressors are important for improving outcomes.
Abstract:
Between 1982 and 1990, 81 children with localized or diffuse musculoskeletal pain, for which no cause could be found were seen in a pediatric rheumatology clinic. Forty-one children had localized idiopathic pain and 40 had diffuse idiopathic pain. Twenty-four of the patients with localized idiopathic pain fulfilled criteria for definite reflex neurovascular dystrophy. Thirty-five patients with diffuse idiopathic pain fulfilled criteria for fibromyalgia. Four patients with localized idiopathic pain (10%) developed diffuse idiopathic pain during followup; four patients with diffuse idiopathic pain (10%) had a history of localized idiopathic pain and one patient had previously been diagnosed as having Tietze's syndrome. Recurrences or persistence of pain was very common. Many children had potentially important stressors including single parent families, histories of sexual abuse, and learning difficulties. Idiopathic musculoskeletal pain is a common cause of referral to a pediatric rheumatology clinic and is often associated with significant morbidity.