Chronic pain in children and adolescents: observational studies

In adults, chronic pain is by most people involved considered to be a serious disorder. Although chronic pain in adults is in general not life-threatening, a considerable amount of literature elucidates the large number of sufferers, the high cost to the person in question and to the society as a whole, and the often crushing effects it has on personal and family life.' Both in children and adolescents however, there is only little objective information available about the prevalence and prognosis of different types of pain, and the related consequences. Pain in children and adolescents probably does not create the same economic burden of illness as does pain in adults.' However, a better understanding of pain in children and adolescents is warranted to gain more insight in the etiology of pain, to relieve the associated burden for children and their families, and for the adequate allocation of health care resources. Does a subset of the children and adolescents with chronic pain become adults with debilitating chronic pains that are often resistant to effective treatment? If so, it might be possible to reduce the proportion of adults with chronic pain if these syndromes were identified and managed in childhood. The International Association for the study of Pain (!ASP) agreed on a common definition of pain: Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Note: Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life-' The !ASP definition highlights the fact that learning about pain and how to respond to painful situations occurs during childhood. Like for adults, pain is an unpleasant sensory and emotional experience for children. Their pain perceptions are subjective. Like their other perceptions, it is impossible to know exactly what a child's pain experience is like, even though there are methods available to measure different aspects of pain. Children describe their pains according to the unpleasantness or aversive dimension, the sensory attributes, the intensity, quality (such as aching, sharp), location, and duration. They understand the concept of pain and the multidimensional nature of pain; even very young children describe the emotional and suffering aspects of pain as well as the physical aspects.4 Obviously, their concepts of pain differ according to their age, sex, cognitive level, and pain experience. From this perspective, studies on pain in children have to include not only measures on the sensory aspects of pain, but also measures of disability and handicap.