Recurrent pain in children and adolescents

Abstract

ResumoObjetivo: realizar revisão bibliográfica sobre dores recorrentes na infância e na adolescência, com enfoque no diagnóstico diferencial e manejo desses pacientes. Fontes de dados: levantamento bibliográfico no Medline eLilacs, abrangendo os últimos quatro e dez anos, respectivamente, além de estudos e textos clássicos que tratam sobre o tema.Síntese dos dados: estudos realizados em diferentes partes do mundo demonstram que as dores recorrentes mais freqüentes na infância e adolescência são dor abdominal, cefaléia e dor em membros. A ocorrência de causa orgânica é baixa, observada em 5% a 10% dos casos. Dentre as causas orgânicas bem definidas de dor abdominal recorrente, cefaléia e dor em membros, não se observa nenhuma etiologia predominante. Foram analisados os principais avanços quanto à fisiopatologia das dores recorrentes, nas suas diferentes localizações, apresentando-se uma orientação para abordagem diagnóstica e terapêutica das afecções mais freqüentes em pediatria.Conclusões: as dores recorrentes na infância e adolescência são muito freqüentes e determinam significativa demanda aos serviços de saúde. A anamnese, o exame físico e o seguimento do paciente constituem a base para abordagem dessas crianças e adolescentes.J Pediatr (Rio J) 2003;79(Supl.1):S65-S76: dor, dor abdominal, cefaléia, dor em membros. AbstractObjective: to perform a bibliographic review of recurrent pain in children and adolescents, focusing on differential diagnosis and management of such patients.Sources of data: search of Medline and Lilacs databases, covering the last four and ten years, respectively. Classical studies and texts related to the matter were also included.Summary of the findings: studies carried out in different parts of the world demonstrate that the most frequent kinds of recurrent pain in children and adolescents are abdominal pain, headache, and limb pain. The occurrence of organic etiology is low, observed in 5% to 10% of the cases. Among the well defined organic etiology, no predominance is observed. The main advances regarding the pathophysiology of recurrent pain in its main localizations were analyzed. Guidelines for the diagnostic and therapeutic approach of the most common infantile diseases related to recurrent pain are presented.Conclusions: recurrent pain in children and adolescents is very common and determines significant demand on healthcare services. Defined etiology is only presented by 5% to 10% of patients. Anamnesis, physical examination and follow-up are extremely important instruments for dealing with such patients. Dores recorrentes na infância e adolescênciaRecurrent pain in children and adolescents Considerações geraisVárias afecções dolorosas, de evolução aguda ou crôni-ca, podem acometer a criança, gerando sofrimento e importante demanda aos serviços de saúde. Muitos fatores modificam a expressão da dor na criança, como idade, sexo, nível cognitivo -percepção que a criança tem da dor -, experiências dolorosas prévias, aprendizado, padrões culturais, relações familiares e comportame...

Pain and distress outcomes in infants and children: a systematic review

“…Acute pain has been shown to be positively associated with distress and anxiety (6,7), and chronic pain with helplessness and depression (8,9). Acute painful procedures are a major source of distress in pediatric patients and may have long-term consequences on behavior (10), memory (11), pain perception (12), and developmental outcomes in children (13).…”

Headache and Recurrent Abdominal Pain: A Controlled Study by the Means Of The Child Behaviour Checklist (CBCL)

“…Children with RAP often have at least one parent who also suffers from FAP (14,16,18); (iv) paroxysmal trend and heterogeneous symptoms, with clinical features that may suggest severe organic pathology: a differential diagnosis is needed by instrumental examinations (3,(20)(21)(22); (v) risk of life-time duration (18,(23)(24)(25); (vi) burden on the quality of life and high (personal and familial) costs (6,17,(26)(27)(28)(29); (vii) influences of psychological triggering factors (3,6,8,(29)(30)(31); (viii) parental characteristics and response to childhood pain (18,26,27). Poor family atmosphere: severe familial disorder, stress, conflict or tension at home (3,26,30,32,33); (ix) common personality characteristics: fearful of novelty, prone to separation concerns, shy and withdrawn (3,27,(34)(35)(36); (x) psychiatric comorbidity: mainly anxiety and depression (8,16,18,37,38); (xi) a role for serotonin has been suggested in both conditions (4,(38)…”

Lower Limb Pain in a Preadolescent Population: Prognosis and Risk Factors for Chronicity—A Prospective 1- and 4-Year Follow-up Study

“…[1][2][3][4] The annual cumulative incidence of this condition has recently been estimated as 30%. 5 Traditionally, the term "growing pains" has been used to describe cases with intermittent nonarticular limb pain that usually occurs late in the day and may awaken the child at night.…”