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FEATURE | SHERRY Children with diffuse pain or fibromyalgia may have more long-term pain, depending on the treatment and study (17, 19). However, 11 of 15 school children identified on screening to have fibromyalgia resolved their fibromyalgia after 30 months (20). It is important to realize that these children were not seeking medical help when diagnosed. Cognitive-behavior therapy alone was employed in five girls with fibromyalgia, and four reported no pain 10 months later (21). Children with amplified musculoskeletal pain may develop other bodily pains such as headache and abdominal pain (8). In the children we have followed, unresolved psychological issues contributed to nonpainful poor outcomes such as conversion reactions, eating disorders, school avoidance, suicide attempts, and acting out behaviors. Summary AMPLIFIED MUSCULOSKELETAL PAIN IN CHILDREN may vary from localized CRPS to widespread, total body pain. Children with amplified musculoskeletal pain all suffer significant pain and disability and need compassionate care that should include a timely and accurate diagnosis, explanation of the possible causes of pain, and an effective therapeutic approach (see Table 2). The diagnosis involves excluding conditions that can cause pain and by the typical pattern manifest in most with amplified musculoskeletal pain. The psychological aspects involved should be formally assessed in all children. Intense exercise therapy along with desensitization is the treatment of choice and of great benefit to most. Normal function, at a minimum, should be restored, and reflected in school attendance and social and sports activities. In those in whom the pain continues, cognitive-behavior therapy or more formal psychotherapy should be pursued. Pharmacological agents should be limited to specific indications, not pain. Children with amplified musculoskeletal pain and their families challenge one’s diagnostic and therapeutic skills, but the outcome is rewarding. Rarely can we so significantly alter the course of a condition that renders children completely debilitated as we can in those who suffer with amplified musculoskeletal pain. 6. Malleson, P.N., M.Y. Fung, and A.M. Rosenberg, The incidence of pediatric rheumatic diseases: results from the Canadian Pediatric Rheumatology Association Disease Registry. Journal of Rheumatology, 1996. 23(11): p. 1981-7. 7. Manners, P.J., Epidemiology of the rheumatic diseases of childhood. Current Rheumatology Reports, 2003. 5(6): p. 453-7. 8. Sherry, D.D., Pain Syndromes, in Adolescent Rheumatology, D.A. Isenberg and J.J.I. Miller, Editors. 1998, Martin Dunitz Ltd: London. p. 197-227. 9. Okifuji, A., et al., A standardized manual tender point survey. I. Development and determination of a threshold point for the identification of positive tender points in fibromyalgia syndrome. Journal of Rheumatology, 1997. 24(2): p. 377-83. 10. Rusy, L.M., S.A. Harvey, and D.J. Beste, Pediatric fibromyalgia and dizziness: evaluation of vestibular function. Journal of Developmental & Behavioral Pediatrics, 1999. 20(4): p. 211-5. 11. Laxer, R.M., et al., Technetium 99m-methylene diphosphonate bone scans in children with reflex neurovascular dystrophy. Journal of Pediatrics, 1985. 106(3): p. 437-40. 12. Sherry, D.D., An overview of amplified musculoskeletal pain syndromes. Journal of Rheumatology Supplement, 2000. 58: p. 44-8. 13. Sherry, D.D., et al., Psychosomatic musculoskeletal pain in childhood: clinical and psychological analyses of 100 children. Pediatrics, 1991. 88(6): p. 1093-9. 14. Sherry, D.D., et al., Short- and long-term outcomes of children with complex regional pain syndrome type I treated with exercise therapy. Clinical Journal of Pain, 1999. 15(3): p. 218-23. 15. Sherry DD, executive producer. Amplified Musculoskeletal Pain in Childhood. Diagnosis and Treatment. A Guide for Physical and Occupational Therapists. (Videotape, DVD) MMII, www.childhoodrnd.org 16. Sherry, D.D. and R. Weisman, Psychologic aspects of childhood reflex neurovascular dystrophy. Pediatrics, 1988. 81(4): p. 572-8. 17. Sherry, D.D. and P.N. Malleson, The idiopathic musculoskeletal pain syndromes in childhood. Rheumatic Diseases Clinics of North America, 2002. 28(3): p. 669-85. 18. Wilder, R.T., et al., Reflex sympathetic dystrophy in children. Clinical characteristics and follow-up of seventy patients. Journal of Bone & Joint Surgery American, 1992. 74(6): p. 910-9. 19. Siegel, D.M., D. Janeway, and J. Baum, Fibromyalgia syndrome in children and adolescents: clinical features at presentation and status at follow-up. Pediatrics, 1998. 101(3 Pt 1): p. 377-82. 20. Buskila, D., et al., Fibromyalgia syndrome in children—an outcome study. Journal of Rheumatology, 1995. 22(3): p. 525-8. 21. Walco, G.A. and N.T. Ilowite, Cognitive-behavioral intervention for juvenile primary fibromyalgia syndrome. Journal of Rheumatology, 1992. 19(10): p. 1617-9. REFERENCES 1. Malleson, P.N., M. al-Matar, and R.E. Petty, Idiopathic musculoskeletal pain syndromes in children. Journal of Rheumatology, 1992. 19(11): p. 1786-9. 2. Merskey, D.M. and N. Bogduk, Classification of Chronic Pain. Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. 1994, Seattle: IASP Press. 3. Wolfe, F., et al., The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis & Rheumatism, 1990. 33(2): p. 160-72. 4. Yunus, M.B. and A.T. Masi, Juvenile primary fibromyalgia syndrome. A clinical study of thirty-three patients and matched normal controls. Arthritis & Rheumatism, 1985. 28(2): p. 138-45. 5. Bowyer, S. and P. Roettcher, Pediatric rheumatology clinic populations in the United States: results of a 3-year survey. Pediatric Rheumatology Database Research Group. Journal of Rheumatology, 1996. 23(11): p. 1968-74. DAVID D. SHERRY, MD Director, Clinical Rheumatology, Attending, Pain Management, Professor of Pediatrics at The Children's Hospital of Philadelphia University of Pennsylvania 56 | T H E PA I N P R A C T I T I O N E R | S P R I N G 2 0 0 6
Subscribe to Currents Today! The Academy’s free-of-charge monthly e-newsletter will keep you up-to-date on the latest news and research in pain management. Just go to the Academy’s home page: wwww.aapainmanage.org ~January 2006 T h e n e w e - n e w s l e t t e r o f t h e A m e r i c a n A c a d e m y o f P a i n M a n a g e m e n t MENU Academy Website Become a Member! Subscribe Contact Us About Us Top Stories Policy, Law, Advocacy Studies, Research Industry- Released News Breaking News On this page: Conditions, Treatments Pain Stories Rx Diversion & Abuse Lagniappe Abstracts Product Recalls Academy News The Pain Practitioner: Academy Partners with RSDSA For Spring Issue James W. Broatch, MSW, Executive Director of RSDSA Subscribe to The Pain Practitioner! If you are a member of the Academy, you are entitled to many benefits including The Pain Practitioner, our new quarterly magazine. If you are not an Academy member, you can subscribe for only $35 a year! Subscribe! Top Stories in the News The Big Chill—Inserting the DEA into End-of-Life Care Timothy E. Quill, M.D., and Diane E. Meier, M.D. The New England Journal of Medicine January 5, 2006 On October 5, 2005, the U.S. Supreme Court heard oral arguments in Gonzales v. Oregon. Story Joint Statement on Pain Management January 5, 2006 As part of its ongoing mission to protect the health, safety, and welfare of the public in Florida and to implement the patient safety agenda advocated by the Institute of Medicine and other groups, the Board of Nursing initiated an effort to address the issue of pain management. Story Studies/Research Painkiller Side-Effects, Genes Play A Part January 6, 2006 A study published in the January issue of Gastroenterology found a difference in how people responded to popular painkillers and that up to 30 percent of this variability can be attributed to an individual's genetic make-up. Story Relief of Pain and Suffering a Growing Priority in U.S. Hospitals, Reports a Study in Journal of Palliative Medicine January 6, 2006 The number of palliative care programs that provide expert care to relieve pain and suffering and improve quality of life increased 67% in U.S. hospitals between 2000 and 2003, according to a study published in the December issue of Journal of Palliative Medicine. Story
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Page 10 and 11: COMMENTARY | GIORDANO Comprehending
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Page 22 and 23: FEATURE | PATIENT PROFILE PEOPLE WI
Page 24 and 25: PEOPLE WITH CRPS | THEIR STORIES AN
Page 26 and 27: PEOPLE WITH CRPS | THEIR STORIES AN
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Page 34 and 35: FEATURE | GALER TABLE 1 | IASP Diag
Page 36 and 37: FEATURE | GALER Although there is s
Page 38 and 39: FEATURE | GALER 10. Gammaitoni A, G
Page 40 and 41: INTERVIEW | COVINGTON LIFEBOAT mixe
Page 42 and 43: INTERVIEW | COVINGTON Q. Have any s
Page 45 and 46: Reap the Rewards of Membership Beco
Page 47 and 48: with depression. However, they foun
Page 49 and 50: It is common for patients in pain i
Page 51 and 52: There are multiple forms of amplifi
Page 53 and 54: Okay for Vegas. Not your Practice.
Page 55: especially opioids. Opioids should
Page 59 and 60: FEATURE | COMPLEX REGIONAL PAIN SYN
Page 61 and 62: FEATURE | COMPLEX REGIONAL PAIN SYN
Page 63 and 64: ZICONOTIDE: Promising New Treatment
Page 65 and 66: UNRIVALED INDEPENDENCE COMING SOON
Page 67 and 68: D O YO U G E T I T ? Subscribe to T
Page 69 and 70: SCS as Part of the CRPS Treatment A
Page 72 and 73: OPINION | GETSON The Use of Thermog
Page 74 and 75: IN CONCLUSION | MOSKOVITZ A Theory
Page 76 and 77: IN CONCLUSION | MOSKOVITZ even thin
Page 78 and 79: IN CONCLUSION | MOSKOVITZ Comorbidi
Page 80 and 81: IN CONCLUSION | MOSKOVITZ empathy e
Page 82 and 83: AC ADEMY NEWS | AMERICAN ACADEMY OF
Page 84 and 85: CL ASSIFIED ADS & DIRECTORY | AMERI
Page 86 and 87: RESOURCES | CRPS RESOURCES FOR CRPS
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