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Rheumatology Advance Access originally published online on February 6, 2009
Rheumatology 2009 48(5):466-474; doi:10.1093/rheumatology/kep001
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

REVIEWS

Chronic musculoskeletal pain in children: assessment and management

Jacqui Clinch1,2 and Christopher Eccleston2

1Bath Centre for Pain Services, The Royal National Hospital for Rheumatic Diseases and 2Centre for Pain Research, The University of Bath, Bath, UK.

Correspondence to: Jacqui Clinch, Consultant Paediatric Rheumatology and Adolescent Chronic Pain, Bath Centre for Pain Services, Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath BA1 4RL, UK. E-mail: jacqui.clinch{at}ubht.nhs.uk


  Abstract

Paediatricians and paediatric rheumatologists review a large number of children with ongoing pain (disease and non-disease related). A small number of these develop chronic pain conditions that are complex and distressing. Over recent years studies of the epidemiology, aetiology and rehabilitation of pain and pain-associated disability in children have revealed a large prevalence of clinically relevant pain, and have emphasized the need for early recognition and intervention. Medication has a role when part of a multidisciplinary framework, although there is little evidence for or against the effectiveness of most pharmacotherapy. There is strong evidence to support early targeted psychological and physical intervention, and an understanding that parental education and involvement is essential if progress is to be maintained. In this review, an overview of the assessment is presented and management of childhood chronic musculoskeletal pain conditions with reference to main research findings to date.

KEY WORDS: Chronic pain, Children, Pain-associated disability, Diffuse idiopathic pain, Juvenile fibromyalgia, Complex regional pain syndrome, Localized idiopathic pain, Demedicalization, Pain education, Multidisciplinary rehabilitation

Submitted 13 May 2008; revised version accepted 5 January 2009.
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