Pediatric Pain Syndromes and Management of Pain in Children and Adolescents with Rheumatic Disease

Assessment and Management of Pain in Juvenile Idiopathic Arthritis

“…Proper pain assessment in children and adolescents with arthritis has historically been hindered by a lack of valid and reliable tools, which is suspected to have led to a general underestimation and resultant undertreatment of pain in these individuals (41). However, the importance of this domain has been highlighted recently with the inclusion of pain assessment as an indicator of the quality of pediatric arthritis care (32).…”

“…Moreover, it has been recommended that pain be assessed using age-appropriate, reliable and valid tools (32). Additionally, as the multidimensional aspect of pain in children and adolescents with JIA is appreciated (41,42), the need for assessment tools to attend to these different dimensions becomes increasingly important. While there are several validated paper tools to assess chronic pain in children, they are not routinely used in everyday clinical practice, nor do they allow clinicians and researchers to track pain over time.…”

“…NSAIDs, such as naproxen, have both analgesic and anti-inflammatory effects and have been the mainstay of pain treatment in pediatric patients with rheumatic disease (60). In addition, acetaminophen may be used in combination with NSAIDs and can provide good analgesia for mild pain (41,61). For more severe or refractory pain (eg, related to avascular necrosis), the use of opioids is an option.…”

“…Consultation with a specialized chronic pain team may be warranted in these cases. For acute pain, short-acting agents, such as oxycodone or hydrocodone, may be most beneficial, whereas longer-acting agents such as methadone are useful for persistent pain (41,61,64).…”

“…The most successful psychological interventions for improving pain and associated impairments are based on cognitive-behavioural therapy (CBT) (78,79). CBTs incorporate normalization of the patient's experience through education regarding the condition and its impact, training in specific strategies, managing disease-related and other stressors, and providing guidance on developing and implementing a long-term plan for selfmanaging the condition (41). In a recent systematic review of psychological therapies in children and adolescents with chronic pain (79), psychological therapies reduced pain intensity by at least 50% in significantly more youth, compared with control conditions at posttreatment.…”