Khanom Sonia, McDonagh Janet E, Briggs Michelle, Bakir Ebru, McBeth John
Centre for Epidemiology Versus Arthritis , School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 2.706 Stopford Building, Oxford Road, Manchester, M13 9PT, UK.
NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.
BMC Musculoskelet Disord. 2020 Oct 2;21(1):645. doi: 10.1186/s12891-020-03627-1.
Adolescents with chronic musculoskeletal pain experience daily fluctuations in pain. Although not all fluctuations are bothersome, pain flares are a distinct type of symptom fluctuation with greater impact. Since literature on the experience of pain flares is non-existent, the aim of this review was to (i) synthesise the qualitative literature on adolescents' experiences of fluctuating pain in musculoskeletal disorders in order to (ii) identify knowledge gaps to inform future research on pain flares.
Electronic databases (CINAHL, MEDLINE, EMBASE, PsycINFO), grey literature and reference lists were searched from inception to June 2018 for qualitative studies reporting adolescents' experiences of pain. Comprehensiveness of reporting was assessed using the Consolidated Criteria for Reporting Qualitative Health Research. Studies were analysed using thematic synthesis.
Of the 3787 records identified, 32 studies (n = 536) were included. Principal findings were synthesised under three key themes: 1) symptom experience, 2) disruption and loss, and 3) regaining control. The first theme (symptom experience) describes adolescent's perception and interpretation of pain fluctuations. The second theme (disruption and loss) describes the physical, social and emotional constraints faced as a result of changes in pain. The third theme (regaining control) describes coping strategies used to resist and accommodate unpredictable phases of pain. Each theme was experienced differently depending on adolescents' characteristics such as their developmental status, pain condition, and the duration of the pain experience.
Adolescents with chronic musculoskeletal pain live with a daily background level of symptoms which frequently fluctuate and are associated with functional and emotional difficulties. It was not clear whether these symptoms and challenges were experienced as part of 'typical' fluctuations in pain, or whether they reflect symptom exacerbations classified as 'flares'. Further research is needed to explore the frequency and characteristics of pain flares, and how they differ from their typical fluctuations in pain. The review also highlights areas relating to the pain experience, symptom management and health service provision that require further exploration to support more personalised, tailored care for adolescents with chronic musculoskeletal pain.
患有慢性肌肉骨骼疼痛的青少年每天都会经历疼痛波动。虽然并非所有波动都令人烦恼，但疼痛发作是一种具有更大影响的独特症状波动类型。由于目前尚无关于疼痛发作体验的文献，本综述的目的是：（i）综合关于青少年肌肉骨骼疾病中疼痛波动体验的定性文献，以便（ii）识别知识空白，为未来关于疼痛发作的研究提供信息。
检索电子数据库（CINAHL、MEDLINE、EMBASE、PsycINFO）、灰色文献及参考文献列表，检索时间从建库至2018年6月，以查找报告青少年疼痛体验的定性研究。使用《定性健康研究报告综合标准》评估报告的全面性。采用主题综合法对研究进行分析。
在识别出的3787条记录中，纳入了32项研究（n = 536）。主要研究结果归纳为三个关键主题：1）症状体验，2）干扰与损失，3）重新获得控制。第一个主题（症状体验）描述了青少年对疼痛波动的感知和解读。第二个主题（干扰与损失）描述了因疼痛变化而面临的身体、社会和情感限制。第三个主题（重新获得控制）描述了用于抵抗和适应不可预测的疼痛阶段的应对策略。每个主题因青少年的特征（如发育状况、疼痛状况和疼痛经历的持续时间）而有不同体验。
患有慢性肌肉骨骼疼痛的青少年每天都有一定程度的症状，这些症状经常波动，并伴有功能和情感方面的困难。尚不清楚这些症状和挑战是作为疼痛“典型”波动的一部分而经历的，还是它们反映了归类为“发作”的症状加重。需要进一步研究以探索疼痛发作的频率和特征，以及它们与典型疼痛波动的差异。该综述还强调了与疼痛体验、症状管理和医疗服务提供相关的领域，需要进一步探索以支持为患有慢性肌肉骨骼疼痛的青少年提供更个性化、量身定制的护理。
