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Bay COA, Willacy RA, Moses AR, Coleman TE, Wilson RH. Nonspecific wrist pain in pediatric patients: A systematic review. J Orthop 2020; 22:308-315. [PMID: 32647467 DOI: 10.1016/j.jor.2020.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/28/2020] [Accepted: 06/07/2020] [Indexed: 11/26/2022] Open
Abstract
Determining the cause of wrist pain is a challenge for clinicians due to the complex biomechanical characteristics of the multiple articulations which comprise the wrist, and the intricacies of the soft tissue supporting them. Patients presenting with wrist pain can be diagnosed by obtaining a detailed history, physical examination and radiographic images. For some patients, a diagnosis remains elusive even after a complete appropriate work up, and the pain may persist following conservative management. The aim of this systematic review was to analyze the effect that psychosocial factors have on the development chronic idiopathic wrist pain in children and adolescents.
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Affiliation(s)
- Charles O A Bay
- Howard University College of Medicine, Howard University Hospital, 520 W St NW, Washington, DC, 20059, USA
| | - Rolanda A Willacy
- Howard University College of Medicine, Howard University Hospital, 520 W St NW, Washington, DC, 20059, USA
| | - Akini R Moses
- Howard University College of Medicine, Howard University Hospital, 520 W St NW, Washington, DC, 20059, USA
| | - Thomas E Coleman
- Howard University College of Medicine, Howard University Hospital, 520 W St NW, Washington, DC, 20059, USA
| | - Robert H Wilson
- Howard University College of Medicine, Howard University Hospital, 520 W St NW, Washington, DC, 20059, USA.,Department of Orthopedic Surgery and Rehabilitation, Howard University Hospital, 2401 Georgia Ave NW Suite 4300, Washington, DC. 20060, USA
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Lefèvre H, Loisel A, Meunier BB, Deslandre C, Lemoine N, Moro MR, Quartier P, Lachal J. Chronic idiopathic musculoskeletal pain in youth: a qualitative study. Pediatr Rheumatol Online J 2019; 17:86. [PMID: 31882011 PMCID: PMC6935211 DOI: 10.1186/s12969-019-0389-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/13/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Chronic musculoskeletal pain (MSP) is frequent in adolescents and has major medical and social consequences. In many cases, when no cause has been clearly established, this pain may be considered to be chronic idiopathic MSP. Our study seeks to identify general criteria for this type of pain through the experience of professionals from tertiary care centers with expertise in pediatric and adolescent chronic MSP. METHODS Cross-sectional multicenter qualitative study. Semi-structured interviews of 25 professionals at a rheumatology reference center and in its network for pain management, including diverse specialists and professions. Interpretative Phenomenological Analysis is used to explore the data. RESULTS This approach led us to identify 10 themes organized around three superordinate themes covering different stages of the diagnostic process: 1) the medical pain history up to the consultation at the reference center; 2) the professional's subjective feelings about the clinical presentation; 3) from the clinical examination to diagnosis and treatment of chronic idiopathic MSP. The main elements guiding this diagnosis do not come from the physical examination but from the medical history and the professionals' subjective feelings, that is, their clinical judgment. The professionals' impression of uneasiness and frustration, induced by patients and their parents, is of major importance. CONCLUSION The principal elements guiding the diagnosis of chronic idiopathic MSP do not come primarily from the physical examination but rather from the pain history and the health professional's subjective feelings. Our results suggest that the concept of Juvenile Fibromyalgia (JFM) does not appear to cover all situations of chronic idiopathic MSP in adolescence. A constellation of non-organic criteria enables diagnosis of the latter; these criteria should be validated to avoid medical nomadism and multiple investigations and to shorten the interval until patients receive optimal pain management. CLINICAL TRIAL REGISTRATION clinicaltrials.gov, NCT03171792, https://clinicaltrials.gov/ct2/show/NCT03171792?term=LACHAL&cntry=FR&city=paris&rank=1.
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Affiliation(s)
- Hervé Lefèvre
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Université de Paris, PCPP, Boulogne Billancourt, France
- French Clinical Research Group in Adolescent Medicine and Health, Toulouse, France
| | - Alexandra Loisel
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Université de Paris, PCPP, Boulogne Billancourt, France
- APHP, Trousseau Hospital, Paris, France
| | - Brigitte Bader Meunier
- Université de Paris, Institut IMAGINE, Centre de Référence National Pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémiques Rares de l'Enfant (RAISE), Paris, France
- APHP, Necker-Enfants Malades Hospital, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Paris, France
| | - Chantal Deslandre
- Université de Paris, Institut IMAGINE, Centre de Référence National Pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémiques Rares de l'Enfant (RAISE), Paris, France
- APHP, Necker-Enfants Malades Hospital, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Paris, France
| | | | - Marie Rose Moro
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Université de Paris, PCPP, Boulogne Billancourt, France
| | - Pierre Quartier
- Université de Paris, Institut IMAGINE, Centre de Référence National Pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémiques Rares de l'Enfant (RAISE), Paris, France.
- APHP, Necker-Enfants Malades Hospital, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Paris, France.
- Unité d'Immunologie, Hématologie et Rhumatologie Pediatrique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, 149 Rue de Sevres, 75015, Paris, France.
| | - Jonathan Lachal
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Université de Paris, PCPP, Boulogne Billancourt, France
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W Guite J, Sherry DD, Jarvis EW, O Lewen M, Khan S, Wickham Kraemer F. Medication use among pediatric patients with chronic musculoskeletal pain syndromes at initial pain clinic evaluation. Pain Manag 2017; 8:15-25. [PMID: 29199542 DOI: 10.2217/pmt-2017-0034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To characterize medication use by adolescents with chronic musculoskeletal pain syndromes before an initial multidisciplinary clinic visit. PATIENTS & METHODS A cross-sectional sample of 120 adolescents and parents reported on standardized assessment measures, with medication use data extracted from the medical chart and categorized. RESULTS On average, 3.2 medications were reported; 70% used more than one pain-specific medication including opioids (17%), nonopioids (31%), psychotropics/neuropathics (45%) and other medications (13%). Adolescents with complex regional pain syndrome consistently reported greatest use of opioid, psychotropic/neuropathic and other pain medications. A regression model explained 17% of the variance in pain medication use. Nonpain medication use and disability contributed unique variance - pain duration and intensity did not. CONCLUSION Greater attention to factors contributing to prescriptive practices, medication use and long-term outcomes is warranted.
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Affiliation(s)
- Jessica W Guite
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.,Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.,Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT 06032, USA.,Center for Behavioral Health, Connecticut Children's Medical Center, Hartford, CT 06106, USA
| | - David D Sherry
- Department of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Esther W Jarvis
- Department of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Margaret O Lewen
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.,Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.,Department of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Sarosh Khan
- Center for Behavioral Health, Connecticut Children's Medical Center, Hartford, CT 06106, USA
| | - Francis Wickham Kraemer
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.,Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
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The prevalence, risk factors, prognosis and treatment for back pain in children and adolescents: An overview of systematic reviews. Best Pract Res Clin Rheumatol 2016; 30:1021-1036. [DOI: 10.1016/j.berh.2017.04.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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The Challenges of Providing Effective Pain Management for Children in the Pediatric Intensive Care Unit. Pain Manag Nurs 2016; 17:372-383. [DOI: 10.1016/j.pmn.2016.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/16/2016] [Accepted: 08/22/2016] [Indexed: 11/20/2022]
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Zemel L, Blier PR. Juvenile Fibromyalgia: A Primary Pain, or Pain Processing, Disorder. Semin Pediatr Neurol 2016; 23:231-241. [PMID: 27989331 DOI: 10.1016/j.spen.2016.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Juvenile fibromyalgia (JFM), a chronic disorder of widespread musculoskeletal pain in combination with autonomic, sensory, and cognitive dysfunction, is responsible for considerable morbidity and impaired quality of life in affected patients and their families. Historically, fibromyalgia has been incorrectly characterized as a psychosomatic or psychogenic disorder, but new understanding of the science of pain has demonstrated unambiguously that it is an organic disorder of the pain processing system itself. This new science provides a framework for understanding the pathophysiology of fibromyalgia and for developing rational therapeutic interventions. Advances in JFM include the verification of adult criteria for diagnosis in pediatric patients and the publication of effective therapies based on cognitive and physical neuromuscular intervention. Although primarily nonpharmacologic therapy can include adjunctive medications as well. Finally, the recognition that JFM is a disorder of the central and peripheral nervous systems suggests that neurologists can be important in the care of these patients.
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Affiliation(s)
- Lawrence Zemel
- Department of Pediatrics, University of Connecticut School of Medicine, Springfield, MA; Pediatric Rheumatology, CT Children's Medical Center, Hartford, CT.
| | - Peter R Blier
- Department of Pediatrics, University of Massachusetts Medical School-Baystate, Springfield, MA; Pediatric Rheumatology, Baystate Children's Hospital, Springfield, MA
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Abstract
OBJECTIVE To define the demographic, diagnostic, procedural, and episode of care characteristics for children admitted with chronic pain. METHODS We used the Pediatric Health Information System database to obtain data on demographic characteristics, length of stay, readmission rates, diagnoses, and procedures for children admitted with chronic pain. Patients with sickle cell disease, cancer, burns, cerebral palsy, transplants, and ventilator-dependent children were excluded. RESULTS A total of 3752 patients with chronic pain were identified from 2004 through 2010. Admissions increased by 831% over this time period. The mean age of these patients was 13.5 years, the most common race was white (79%), and female subjects outnumbered male subjects by 2.41 to 1. The most common admission and principal discharge diagnosis was abdominal pain; comorbid diagnoses were common, with a mean of 10 diagnoses per patient. In total, 65% of patients had a comorbid gastrointestinal diagnosis and 44% had a psychiatric diagnosis. The mean length of stay was 7.32 days, with an expected length of stay of 4.24 days; 12.5% were readmitted at least once within 1 year. They underwent a mean of 3.18 procedures per patient. CONCLUSIONS The average child admitted with chronic pain is a teenaged female with a wide variety of comorbid conditions, many of which are gastrointestinal and psychiatric in nature. Admissions for chronic pain are rising and account for substantial resource utilization. Future studies should further characterize this population, with the overall objective of improving outcomes and optimizing cost-effective care.
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Affiliation(s)
- Thomas A Coffelt
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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Hoftun GB, Romundstad PR, Zwart JA, Rygg M. Chronic idiopathic pain in adolescence--high prevalence and disability: the young HUNT Study 2008. Pain 2011; 152:2259-2266. [PMID: 21683528 DOI: 10.1016/j.pain.2011.05.007] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 05/02/2011] [Accepted: 05/11/2011] [Indexed: 11/20/2022]
Abstract
The aim of this study was to determine the prevalence of self-reported chronic idiopathic pain among adolescents in relation to age and gender, and to explore how pain interferes with daily activities. The study was performed in Nord-Trøndelag County, Norway in 2006-2008. All adolescents were invited to participate; the response rate was 78%. Participants completed a comprehensive questionnaire, including questions about pain and interference with everyday life. Chronic idiopathic pain was defined as pain at least once a week during the last 3 months, not related to any known disease or injury. The final study population, with complete pain questionnaires, consisted of 7373 adolescents aged 13-18 years. Chronic pain was reported by 44.4% of the participants, and 25.5% reported pain in at least 2 locations. Chronic idiopathic musculoskeletal pain was most prevalent (33.4%), and the neck/shoulder was most commonly affected. Musculoskeletal pain in 3 or more locations was reported by 8.5%. Pain almost daily was reported by 10.2%. More girls than boys reported pain. In girls, the prevalence of pain increased with age. A high number of pain-associated disabilities were reported, and 58.5% described difficulties doing daily activities in leisure time. Subjective disabilities were higher in girls, and increased with the frequency of pain and the number of pain locations, as shown by high disability in adolescents with musculoskeletal pain in 3 or more locations. Chronic idiopathic pain, especially multisite pain, is common among adolescents, and those suffering from it report a major impact on several areas of daily living.
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Affiliation(s)
- Gry Børmark Hoftun
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway Department of Neurology, Oslo University Hospital, Ullevål and University of Oslo, Norway
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What do the parents of children who have chronic pain expect from their first visit to a pediatric chronic pain clinic? Pain Res Manag 2010; 15:158-62. [PMID: 20577658 DOI: 10.1155/2010/958792] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chronic pain in childhood is increasingly recognized as a significant clinical problem. Best-practice management of pediatric chronic pain in a multidisciplinary pain clinic involves a variety of treatment modalities. It is important that parents of children treated in these settings understand the different treatment options available for their children. By involving parents more effectively, care providers may more efficiently address unmet treatment needs and improve tailoring of treatment programs aimed at increasing function, reducing pain-related disability and improving quality of life. OBJECTIVES To explore the expectations held by parents for their first visit to a pediatric multidisciplinary pain clinic. METHODS Fourteen parents completed a paper-based survey exploring their expectations immediately before their first visit to a multidisciplinary pediatric pain clinic in a tertiary care children's hospital. RESULTS Responses from parents suggest a clear desire for information about the causes of their child's pain, treatment options available at the pain clinic, effective strategies to enhance children's ability to cope with pain, and the effects of pain on both body and mood. Most parents rated the various treatment options as important for their child. All parents indicated it was very important to have the pain team 'be there' for them. CONCLUSIONS These findings indicate that parents want more information about chronic pain and treatment options. Pediatric chronic pain clinics have the ability to assist children with chronic pain and their families considerably by providing information about chronic pain and the various treatment options available to them.
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Gembar KL. Paediatric pain: an important area for research in physical therapy. PHYSICAL THERAPY REVIEWS 2009. [DOI: 10.1179/108331909x12540993897937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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The Severity of Chronic Pediatric Pain: An Epidemiological Study. THE JOURNAL OF PAIN 2008; 9:226-36. [DOI: 10.1016/j.jpain.2007.10.015] [Citation(s) in RCA: 405] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 10/03/2007] [Accepted: 10/08/2007] [Indexed: 11/23/2022]
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Avoiding the Impact of Musculoskeletal Pain on Quality of Life in Children With Hemophilia. Orthop Nurs 2008; 27:103-8; quiz 109-10. [DOI: 10.1097/01.nor.0000315623.59385.2b] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Dedicated multidisciplinary pain management centres for children in Canada: the current status. Can J Anaesth 2007; 54:985-91. [DOI: 10.1007/bf03016632] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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