Landry Bradford W, Fischer Philip R, Driscoll Sherilyn W, Koch Krista M, Harbeck-Weber Cynthia, Mack Kenneth J, Wilder Robert T, Bauer Brent A, Brandenburg Joline E
Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
PM R. 2015 Nov;7(11 Suppl):S295-S315. doi: 10.1016/j.pmrj.2015.09.006.
Chronic pain in children and adolescents can be difficult for a single provider to manage in a busy clinical setting. Part of this difficulty is that pediatric chronic pain not only impacts the child but also the families of these children. In this review article, we discuss etiology and pathophysiology of chronic pain, along with variables that impact the severity of chronic pain and functional loss. We review diagnosis and management of selected chronic pain conditions in pediatric patients, including headache, low back pain, hypermobility, chronic fatigue, postural orthostatic tachycardia syndrome, abdominal pain, fibromyalgia, and complex regional pain syndrome. For each condition, we create a road map that contains therapy prescriptions, exercise recommendations, and variables that may influence pain severity. Potential medications for these pain conditions and associated symptoms are reviewed. A multidisciplinary approach for managing children with these conditions, including pediatric pain rehabilitation programs, is emphasized. Lastly, we discuss psychological factors and interventions for pediatric chronic pain and potential complementary and alternative natural products and interventions.
在繁忙的临床环境中，儿童和青少年的慢性疼痛对于单一医疗服务提供者来说可能难以处理。造成这种困难的部分原因在于，儿科慢性疼痛不仅会影响孩子，还会波及这些孩子的家庭。在这篇综述文章中，我们讨论了慢性疼痛的病因和病理生理学，以及影响慢性疼痛严重程度和功能丧失的变量。我们回顾了儿科患者特定慢性疼痛病症的诊断和管理，包括头痛、腰痛、关节活动过度、慢性疲劳、体位性直立性心动过速综合征、腹痛、纤维肌痛和复杂性区域疼痛综合征。对于每种病症，我们制定了一个路线图，其中包含治疗处方、运动建议以及可能影响疼痛严重程度的变量。我们还回顾了针对这些疼痛病症及相关症状的潜在药物。强调了采用多学科方法来管理患有这些病症的儿童，包括儿科疼痛康复项目。最后，我们讨论了儿科慢性疼痛的心理因素和干预措施，以及潜在的补充和替代天然产品及干预措施。
