Pediatric Chronic Pain: Biopsychosocial Assessment and Formulation

Abstract

Chronic pain in children is an increasingly recognized clinical problem with alarmingly high prevalence rates found in some populations. Although it is not understood why some children experience high levels of pain, the subjective experience of chronic pain (including its site, intensity, quality, unpleasantness, and associated suffering) has long been believed to result from interactions between multiple contributors, including nociceptive, affective, sociocultural, behavioral, and cognitive. Regardless of whether the antecedent of chronic pain is known or unknown, similar patterns of symptoms, behaviors, and disability are often seen. Historically, however, there has been an unhelpful tendency to dichotomize chronic pain as either physical or functional in origin. However, recent studies strongly support a biopsychosocial basis to all pain, revealing its sensory emotional nature by showing that large distributed neural networks are accessed during nociceptive processing. The development and maintenance of chronic pain involve long-term changes in multiple integrated peripheral, spinal, and brain regions interacting in a complex way to shape the individual's experience. Hence, chronic pain from any cause cannot be viewed as a purely physical or psychological phenomenon, nor should it be expected that a unimodal approach to treatment will succeed. It follows that when assessing children and young people with chronic pain, information on a wide range of developmentally relevant dimensions, conveniently classified as biological, psychological, and sociocultural, should be gathered to formulate the potential causes, contributors, and effects of pain to devise an appropriate multimodal management plan.

Mapping the evidence and gaps of interventions for pediatric chronic pain to inform policy, research, and practice: A systematic review and quality assessment of systematic reviews

“…This is problematic given the current recommendation for multimodal care to thoroughly address biopsychosocial contributors to pediatric chronic pain. 11 Although pediatric pain research is growing rapidly, 12 there remains a disconnect between existing scientific evidence and current clinical practice, a further challenge to developing pediatric chronic pain policy. 13 Estimates suggest that it can take up to 17 years for research to impact patient care, 14 and many children and adolescents with chronic pain struggle to access evidence-based treatment.…”

Chronic Pediatric Pain in Low and Middle Income Countries

“…Pediatric chronic pain is complex, with nociceptive, affective, sociocultural, behavioral, and cognitive components, and therefore requires multimodal management [24]. A systematic review on the epidemiology of chronic pain in children and adolescents found the prevalence rates of pain to be 8-83% for headaches, 4-53% for abdominal pain, 14-24% for back pain, 4-40% for musculoskeletal pain, 4-49% for multiple pains, and 5-88% for other pains.…”

Translational studies identify long-term impact of prior neonatal pain experience

“…A biopsychosocial approach to assessment and management of pain has been recommended for both adults [68] and children. [116]. Many psychosocial factors influence the development and trajectory of chronic pain, and may encompass "general" variables (eg.…”