Leading article Chronic musculoskeletal and other idiopathic pain syndromes

Chronic or recurrent pain in children and adolescents, for which no specific cause can be found, is very common with a point prevalence of at least 15%. Such idiopathic pain conditions are usually “benign” in the sense that they are relatively easy to diagnose with a minimum of investigations, and are treated eVectively with reassurance and use of simple measures including appropriate use of analgesics. A number of children develop a chronic pain syndrome and become quite disabled. How frequently this “malignant” outcome occurs, and how many children with chronic pain become adults with chronic pain is uncertain, but is probably not rare. 3 Several studies show that idiopathic musculoskeletal pain persists in both the short and medium term in a significant minority of children, but there are no long term data available. Adolescents with chronic pain are often fatigued and adolescents diagnosed with chronic fatigue syndrome frequently have musculoskeletal pain. It has been suggested that chronic fatigue syndrome in adolescents and juvenile fibromyalgia syndrome (one form of chronic pain syndrome) may be overlapping clinical entities, that may be indistinguishable by current diagnostic criteria. Many individuals with either a chronic pain syndrome or with chronic fatigue syndrome could be considered as having a somatoform disorder according to the DSM IV criteria. Somatisation refers to individuals who report symptoms that have no organic cause, or who report symptoms that greatly exceed those expected by the physical condition. Psychosomatic refers to symptoms that may be exaggerated by psychosocial factors. These terms suggest a dualistic (mind/body) model to approaching symptoms of uncertain cause. Increasingly the term biopsychosocial is being used to describe a model that more fully encompasses the biological, psychological, and social factors that may be important in the manifestations of chronic symptom complexes such as chronic pain and chronic fatigue syndrome. We would argue that this latter model allows a more eVective approach to the management of chronic pain in adolescents. The aim of this article is to discuss some of these factors using musculoskeletal pain as the focus, although most of the issues are probably germane to other types of childhood pain such as recurrent abdominal pain and headache, as well as to chronic fatigue syndrome.