Persistent pain conditions in adolescents

Much has been written about persistent pain conditions in adults and the recommendations for clinical management. However, it is understood that such conditions also impact an adolescent population and it is important to understand these conditions and to investigate appropriate management. Importantly, 5-8% of children with persistent pain will develop significant impairments (Forgeron and Stinson 2014) and medical assessment is an important early step to exclude serious pathology (Altaf et al 2014).

A literature review conducted by Simons and Basch (2016) highlighted the issue of persistent pain in childhood and indicated that there is important research being conducted in this area. The authors suggested:

  • Pain can impact physical and emotional functioning that can persist into adulthood
  • The use of screening tools to match condition types to treatment is a way of enhancing accuracy of treatment
  • Treatment shown to benefit adults such as targeting pain related fear, attentional biases and comorbid conditions should be applied to children and adolescents
  • Forms of cognitive-behavioural therapy often with parental involvement has been shown to be of benefit
  • Multidisciplinary pain programs have shown to demonstrate positive findings

On the whole, these treatment recommendations are consistent with those for the adult population. Managing long term pain condition has also been the topic of a previous AHC blog “The brain’s role in pain, the link between mind and body”.

Juvenile fibromyalgia, for example, is less studied compared to its adult equivalent, however evidence suggests a significant proportion of adolescents with fibromyalgia continue to experience the condition into adulthood. This highlights the importance of early recognition and management of common issues including psychological comorbidities. Research has also indicated CBT and exercise, typical pain management program components, are appropriate management approaches (Kashikar-Zuck et al 2016). 

Multidisciplinary Pain Management Programs are often considered appropriate for adult patients, however this review indicates that they may well be appropriate for younger patients as well, aiming to prevent progression of a pain condition into adulthood.


Matt Richards, is a Physiotherapist with Advance Healthcare in Bundoora. Matt has a special interest in complex and persistant spinal pain, and is a current PhD candidate on this topic. Matt provides expert physiotherapy services to Bundoora, Thomastown, Reservoir and surrounding areas.

 


References;

Forgeron PA, Stinson J. Fundamentals of chronic pain in children and young people. Part 1. Nurs Child Young People. 2014 Oct;26(8):29-34

Altaf F, Heran MK, Wilson LF. Back pain in children and adolescents. Bone Joint J. 2014 Jun;96-B(6):717-23

Kashikar-Zuck S, King C, Ting TV, Arnold LM .Juvenile Fibromyalgia: Different from the Adult Chronic Pain Syndrome? Curr Rheumatol Rep. 2016 Apr;18(4):19

Simons LE, Basch MC. State of the art in biobehavioral approaches to the management of chronic pain in childhood. Pain Manag. 2016;6(1):49-61