Essay on Adolescent Chronic Pain And Disability A...

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01/02/2007

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ORIGINAL ARTICLE

Adolescent chronic pain and disability: A review of the current evidence in assessment and treatment
Christopher Eccleston PhD1, Jacqueline Clinch MD2

C Eccleston, J Clinch. Adolescent chronic pain and disability:
A review of the current evidence in assessment and treatment.
Paediatr Child Health 2007;12(2):117-120.
Adolescents who suffer from chronic pain also report complex syndrome-associated disability and distress that can detrimentally affect the quality of their lives and the lives of their family members.
Over the past 10 years, there have been significant developments in both methods of assessment and in treatment programs. There have also been good developments in clinical assessment tools, although many need further study. However, the evidence base of available treatments remains small, and there is an urgent need for new trials in both pharmacological and nonpharmacological treatments. The greatest challenges are organizational, and the concern is how to bring patients in contact with available treatments. Many patients who could benefit from evidence-supported treatments are not currently able to access treatment. Theoretical developments aimed at explaining chronic pain within the context of the family, as well as family attempts at coping with complex disability, are underway.

La douleur chronique et l’incapacité à l’adolescence : Une analyse des données probantes courantes en matière d’évaluation et de traitement
Les adolescents qui souffrent d’une douleur chronique déclarent également des invalidités complexes associées à leur syndrome et une détresse qui peut nuire à leur qualité de vie et celle des membres de leur famille. Depuis dix ans, les méthodes d’évaluation et les programmes de traitement ont connu des progrès importants, à l’instar des outils d’évaluation clinique, bien que nombre d’entre eux doivent être étudiés de manière plus approfondie. Cependant, le nombre de traitements probants disponible demeure limité, et il est urgent de mener de nouveaux essais de traitements pharmacologiques et non pharmacologiques. Les plus grands défis sont d’ordre organisationnel et portent sur la manière de mettre les patients en contact avec les traitements existants. De nombreux patients qui pourraient profiter de traitements probants ne peuvent pas y accéder. Des processus théoriques visant à expliquer la douleur chronique dans le contexte familial, et des tentatives familiales en vue d’affronter des invalidités complexes, sont en cours.

Key Words: Adolescents; Children; Chronic pain; Disability; Pain;
Pain assessment; Pain management

dolescents report chronic pain with a similar prevalence and incidence as adults (1). Although pain has been under-recognized and undertreated (2), we are now beginning to respond to the needs of adolescents and their families, who report unmanaged pain, disability and distress. The challenge is to bring evidence in support of local practice and to guide the development of services for adolescents and their families struggling to cope with pain. In the present paper, we briefly summarize the research evidence on the impact of pain, introduce methods of assessment, review the current evidence base for chronic pain management and discuss current developments in treatment. We offer only an introduction to this field, seeking to raise awareness and guide further investigation.

A

THE IMPACT OF CHRONIC PAIN
There are few studies on the prevalence of pain reported by young people. An early review paper (3) cited the prevalence

of medically unexplained chronic pain to be approximately
15% for children and adolescents. A recent large-scale
Dutch study (1) has reported a greater estimate of 25%.
Some features are repeated across most epidemiological- and clinical-based studies. First, girls report more severe pain, and they report it more frequently than boys (4). Second, the most common type of pain in childhood

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