Chronic Pain in Children and Adolescents
Pain that recurs or persists over a period of at least 3 months is categorized as "chronic pain." The etiology of chronic pain is variable and may be related to injury, as a consequence of a chronic or underlying disease process, or as a condition itself without any specific, identifiable injury or disease. Biological/physical, social and psychological factors have all been implicated in predicting the onset and course of chronic pain.
Prevalence and Course
In epidemiological surveys, the median prevalence of chronic pain reported in community samples of children and adolescents is 11 to 38 percent.
Common pain conditions include: musculoskeletal pain, abdominal pain, headache, neuropathic pain, fibromyalgia, temporomandibular disorders and disease-related pain such as related to sickle cell disease, arthritis, cancer, inflammatory bowel disease and severe neurological impairment.
Children with chronic pain often have continuing complaints of pain over one- to two-year periods. Long-term outcome studies indicate that children with chronic abdominal or headache pain are at risk in adulthood for experiencing chronic pain, physical and psychiatric complaints.
Health and Psychosocial Consequences
An estimated 5 to 10 percent of youth have significant impact or disability related to the pain in such areas as school attendance and academics, physical functioning, participation in social activities, sleep, emotional functioning and family functioning.
Evidence-based Psychological Assessment
Domains of assessment relevant for the child with chronic pain include pain characteristics, physical, social, emotional and family functioning, and health habits. A variety of evidence-based assessment tools are available (see PedIMMPACT guidelines; see JPP empirically supported assessment article on functional disability and quality of life).
Culture, Diversity, Demographic and Developmental factors
Although most children treated in pain clinics are Caucasian, the impact of race and ethnicity on prevalence and course of pediatric chronic pain has received little attention and remains an important gap in knowledge.
Developmental factors are important. With increasing age and more advanced pubertal development, the occurrence of pain problems increases. Across most forms of chronic pain in childhood and adolescence, females assume a much higher prevalence in comparison to males.
Meta-analytic reviews support the efficacy of cognitive-behavioral interventions, including relaxation, biofeedback and multicomponent interventions, for pain reduction in children with headache, abdominal pain and musculoskeletal pain.
Huguet, A., & Miro, J. (2008). The severity of chronic pediatric pain: an epidemiological study. Journal of Pain, 9(3), 226-236.
King, S., Chambers, C.T., Huguet, A., MacNevin, R.C., McGrath, P.J., Parker, L., & MacDonald, A.J. (2011). The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain, 152, 2729-2738.
McGrath, P.J., Walco, G.A., Turk, D.C., et al. (2008). Core outcome domains and measures for pediatric acute and chronic/recurrent pain clinical trials: PedIMMPACT recommendations. Journal of Pain, 9, 771-783.
Palermo, T.M., Eccleston, C., Lewandowski, A.S., Williams, A. C., & Morley, S. (2010). Randomized controlled trials of psychological therapies for management of chronic pain in children and adolescents: An updated meta-analytic review. Pain, 148(3), 387-397.
Walker, L.S., Dengler-Crish, C.M., Rippel, S., & Bruehl, S. (2010). Functional abdominal pain in childhood and adolescence increases risk for chronic pain in adulthood. Pain, 150(3), 568-572.