Chronic pain in children and adolescents: observational studies

In adults, chronic pain is by most people involved considered to be a serious disorder. Although chronic pain in adults is in general not life-threatening, a considerable amount of literature elucidates the large number of sufferers, the high cost to the person in question and to the society as a whole, and the often crushing effects it has on personal and family life.' Both in children and adolescents however, there is only little objective information available about the prevalence and prognosis of different types of pain, and the related consequences. Pain in children and adolescents probably does not create the same economic burden of illness as does pain in adults.' However, a better understanding of pain in children and adolescents is warranted to gain more insight in the etiology of pain, to relieve the associated burden for children and their families, and for the adequate allocation of health care resources. Does a subset of the children and adolescents with chronic pain become adults with debilitating chronic pains that are often resistant to effective treatment? If so, it might be possible to reduce the proportion of adults with chronic pain if these syndromes were identified and managed in childhood. The International Association for the study of Pain (!ASP) agreed on a common definition of pain: Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Note: Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life-' The !ASP definition highlights the fact that learning about pain and how to respond to painful situations occurs during childhood. Like for adults, pain is an unpleasant sensory and emotional experience for children. Their pain perceptions are subjective. Like their other perceptions, it is impossible to know exactly what a child's pain experience is like, even though there are methods available to measure different aspects of pain. Children describe their pains according to the unpleasantness or aversive dimension, the sensory attributes, the intensity, quality (such as aching, sharp), location, and duration. They understand the concept of pain and the multidimensional nature of pain; even very young children describe the emotional and suffering aspects of pain as well as the physical aspects.4 Obviously, their concepts of pain differ according to their age, sex, cognitive level, and pain experience. From this perspective, studies on pain in children have to include not only measures on the sensory aspects of pain, but also measures of disability and handicap

Comparison between children and adolescents with and without chronic benign pain: consultation rate and pain characteristics

The aim of the study was to determine whether children with chronic benign pain are in contact with their general practitioner (GP) more frequently than those without chronic benign pain. A random sample of children and adolescents aged between 0 and 18 years of age was drawn from the records of ten general practices. According to their responses to a pain questionnaire, subjects were assigned to the chronic benign pain group (n = 95) if they had pain of more than three months' duration, or to the control group (n = 105) if they had pain of less than three months' duration or no pain at all. All the subjects had an average GP consultation rate of 2.6 contacts per year. No significant age and sex differences were found. Chronic benign pain in childhood and adolescence is not related to increased use of healthcare services, suggesting that somatisation does not play a major role in children with chronic benign pain

Chronic pain and its impact on quality of life in adolescents and their families

OBJECTIVE: To study chronic pain not caused by somatic disease in adolescents and the effect of pain on the quality of life of the adolescents and their families. METHODS: One hundred twenty-eight youngsters (12-18 years) who had reported chronic pain kept a 3-week diary of their pain and completed a questionnaire on quality of life. Their mothers completed a questionnaire on the impact of their youngster's pain on the family. RESULTS: The most prevalent pains were limb pain, headache, abdominal, and back pain. The pain increased during the day, with the highest frequency around dinner time and the highest intensity around bedtime. Girls reported more intense and more frequent pain than boys. The higher the intensity and frequency of the pain, the lower the self-reported quality of life of the female or male adolescent, especially regarding psychological functioning (e.g. feeling less at ease), physical status (a greater incidence of other somatic complaints), and functional status (more impediments to leisure and daily activities). Chronic pain also had a negative impact on family life. The mothers reported restrictions, particularly in social life, and problems dealing with the stress of the adolescent's pain. CONCLUSIONS: Chronic pain, not caused by somatic disease, was present to a higher degree in girls; the pain increased during the day and had a negative impact on quality of life of the adolescents and the family. There is a need for future research aimed at identifying risk factors for chronic pain and pain-associated quality of life in children and adolescents