Children are innocent creatures that may be vulnerable to different types of chronic pain disorders. These disorders have over the years taken a death toll on young innocent bodies – children. The chronic pain affects at least 5% of the population under the age of 18, according to conservative epidemiological studies.
Rates of pediatric chronic pain have also increased in the past 20 years. While its conditions vary significantly in severity, they often affect children’s mental health, academic performance, activities of daily living, social participation, and general quality of life.
It can be treated in a number of ways, and varies depending on the type and severity of the condition. Common pain medications prescribed to children include paracetamol, ibuprofen, and acetylsalicylic acid. The management of chronic pain in children aims also to help the child and their family reintegrate into a more functional routine and improve their daily struggle.
The focus changes from immediate pain relief to enhancing functional improvements while managing the presence of 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.”
Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in pediatrics: primary headaches, centrally mediated abdominal pain syndromes, and/or chronic/recurrent musculoskeletal and joint pain. There are several types of chronic pain disorders in children:
Neuropathic Pain
- Peripheral neuropathic pain as the case post-herpetic neuralgia or diabetic neuropathy
- Central neuropathic pain – cerebral vascular accident sequella
Nociceptive Pain
- Pain due to actual tissue injuries such as burns, bruises, or sprains
Musculoskeletal Pain
- Back pain
- Myofascial pain
Inflammatory Pain
- Autoimmune disorders (rheumatoid arthritis)
- Infection
Conversion Disorder
- Conversion disorder is a condition, in which the patient may present with numbness, paralysis, blindness, inability to speak, and/or other neurologic symptoms that cannot be explained by medical evaluation and for which diagnostic testing does not reveal any physical cause.
Psychogenic Pain
- Pain caused by psychologic factors such as headaches or abdominal pain caused by emotional, psychological, or behavioral factors
Mechanical Pain
- Expanding malignancy
Centrally Mediated Abdominal Pain Syndrome
- It occurs as a result of central sensitization with disinhibition of pain signals, rather than increased peripheral afferent excitability.
Primary pain disorders (formerly “functional pain syndromes”) are common, under-diagnosed and under-treated in children and teenagers. These key aspects which support understanding the development of pediatric chronic pain, points to the current pediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology.
Pediatric chronic pain is a significant problem with conservative estimates that posit 20% to 35% of children and adolescents affected by it worldwide. Pain experienced in children’s hospitals is known to be common, under-recognized, and under-treated, with more than 10% of hospitalized children showing features of chronic pain.
Although the majority of children reporting chronic pain are not greatly disabled by it, about 3% of pediatric chronic pain patients require intensive rehabilitation.
Untreated chronic pain in children incurs a high risk for the subsequent development of pain and psychological disorders later in life. Seventeen percent of adult chronic pain patients reported a history of chronic pain in childhood or adolescence, with close to 80% indicating that the pain in childhood continued and persisted until adulthood
