Clinical Management of Musculoskeletal Pain Syndromes

B.C. McClain and S. Suresh (eds.), Handbook of Pediatric Chronic Pain: Current Science and Integrative Practice, DOI 10.1007/978-1-4419-0350-1_7, © Springer Science+Business Media, LLC 2011 The child presenting to the general practitioner with complaints of musculoskeletal pain is common and pediatricians need to be more knowledgeable of these conditions. It presents a challenge to make the diagnosis without invasive and expensive testing. A complete physical exam is essential. Often, simple reassurance, analgesics, physical therapy, and lifestyle changes are sufficient for most complaints. More specific knowledge of the multidisciplinary approach needed to treat fibromyalgia (FM) and myofascial pain syndrome (MFPS) can be helpful. Muscles represent 40% of the body mass by weight. Muscles lift the corners of children’s mouths so they can smile; raise the arm, and wrist so they can wave and lift the legs so they can walk. Musculoskeletal pain (MSP) has long plagued children and, although common, has received less attention than other areas of chronic pain in children, such as headache and abdominal pain. Musculoskeletal pain in children is widespread, affecting 7–15% of school-age children (Goodman and McGrath 1991). An analysis of 1,000 consecutive general pediatric visits, found MSP complaints 6.1% of the time, with complaints including knee arthralgias (33%), other joint (ankle, wrist) arthralgias (28%), soft tissue pain (18%), hip pain (6%), and back pain (6%) (de Inocencio 1998) . In addition, there were also reports of pain from repetitive sports injuries, juvenile rheumatoid arthritis, systemic lupus, fibromyalgia, myofascial pain, hip disorders, cancer, and benign growing pains. This chapter covers more benign forms of MSP in children and adolescents, namely fibromyalgia, myofascial pain, sports injuries, and growing pains. It will discuss occurrence, possible etiologies, and clinical management. In the evaluation of a child with MSP, history and physical examination of the musculoskeletal system is important. Trauma and overuse injuries are usually self-evident on history and physical examination. The majority of MSP in children are benign, but systemic diseases such as joint infections, malignancies, or rheumatologic conditions may present initially as MSP and full evaluation is crucial. Lynn M. Rusy