The Psychosocial Characteristics and Somatosensory Function of Children and Adolescents Who Meet the Criteria for Chronic Nociplastic Pain

Abstract

Purpose Nociplastic pain distinguishes individuals with pain and hypersensitivity in body regions with apparently normal tissues, without any signs of neuropathy, but with contribution of central and/or peripheral sensitization. There is a lack of literature describing nociplastic pain in the pediatric population. The objective of this study was to investigate the differences between pediatric patients with nociplastic pain compared with patients with non-nociplastic pain. Patients and Methods This study included 414 pediatric patients followed at an interdisciplinary centre for complex pain. All patients underwent an exhaustive pain assessment consisting of face-to-face interviews, validated self-report questionnaires and quantitative sensory testing. Recently established criteria for chronic nociplastic pain, and quantitative sensory testing was used to describe and stratify our cohort. Results One hundred and sixty-five patients (40%) were stratified as having possible nociplastic pain and two hundred and forty-nine (60%) patients, as non-nociplastic pain. Patients with nociplastic pain displayed pain hypersensitivity in the region of pain, more symptoms of panic and social phobia, and worse sleep quality than patients with non-nociplastic pain. The proportion of patients achieving a meaningful clinical outcome after completion of their treatment (medications, physiotherapy, psychology, nursing, social worker, and/or interventional procedures) was lower in patients with nociplastic pain (62%) than those without nociplastic pain (86%). Conclusion Our results suggest that patients who meet the criteria for nociplastic pain can be identified in a population of children and adolescents being treated in a center for complex pain. Combining screening with validated questionnaires and quantitative sensory testing facilitates the phenotyping and graded severity of patients with nociplastic pain in daily clinical practice.

Update: Noziplastischer Schmerz

“…Die Bedeutung einer Klassifikation als noziplastisch für den Therapieerfolg wurde inzwischen in einer größeren Anzahl von Studien untersucht. Relativ einheitlich und unabhängig von der Medikamentenklasse sind die Befunde zu einem höheren Verbrauch von Analgetika (NSAIDs, Opioide, Cannabis) bei gleichzeitig verringerter Wirkung, aber vermehrten Nebenwirkungen 72 73 74 und einem generell geringeren Therapieerfolg und früherem Therapieabbruch 75 76 77 .…”

Attrition from Face-to-Face Pediatric Outpatient Chronic Pain Interventions: A Narrative Review and Theoretical Model

“…Suffice to say, that a considerable number of patients who commenced the interventions did not complete these. Some reasons for attrition provided by these studies were loss to followup [25,33,36], scheduling conflicts [26,27,34,35], transportation difficulties [27,34], required psychiatric treatment [26,27,35] and caregivers unable to get leave from work [24].…”

Chronic Postsurgical Pain in Children and Adolescents: A Call for Action

“…These patients also exhibited higher rates of psychiatric comorbidities, including panic disorder and social phobias, poor sleep quality, along with compromised functional status, as evidenced by less meaningful outcomes achieved after completing treatment. 113 Similar work should be completed for patients with CPSP. To that end, a brief QST protocol in two cohorts of youth with post-surgical and post-traumatic pain was recently published.…”