Chronic Pediatric Rheumatologic Pain Syndromes

Abstract

Chronic and recurrent musculoskeletal pain in children and adolescents is a common problem for primary care physicians to address. These pain syndromes are categorized in the spectrum of biopsychosocial syndromes that incorporate physical symptoms and signs with psychological components, often amplified by environmental or social influences through partially understood mechanisms. The patient may experience localized or widespread pain. The syndromes can be readily recognized by patterns of symptoms and signs that are illustrated in the chapter. Reflex sympathetic dystrophy, fibromyalgia syndrome, and benign hypermobility syndrome have physical findings that help to define the diagnosis; while growing pains are void of objective physical findings but are defined by the episodic nature and characteristic history. There is often an association with excessive school absences, anxiety, depression, and dysfunctional relationships with the parents. The characteristic patient profiles and the cardinal findings are illustrated. It is important to diagnose these pain syndromes early and institute therapy in order to avoid unnecessary investigations, identify contributing factors, improve function, and render pain relief. Most patients are amenable to treatment; however, recurrences are common, and underlying emotional contributions are difficult to eliminate.