title: Managing Chronic Pain in Children and Adolescents: A Clinical Review.
abstract: 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.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
authors.forename: Bradford W
authors.initials: BW
authors.lastname: Landry
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Fischer
authors.affiliation: Department of Physical Medicine and Rehabilitation and Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Sherilyn W
authors.initials: SW
authors.lastname: Driscoll
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN.
authors.forename: Krista M
authors.initials: KM
authors.lastname: Koch
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Harbeck-Weber
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mack
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Wilder
authors.affiliation: Department of General Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Bauer
authors.affiliation: Department of Physical Medicine and Rehabilitation and Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Joline E
authors.initials: JE
authors.lastname: Brandenburg
mesh_terms: D000293:Adolescent; D002648:Child; D059350:Chronic Pain / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D003131:Combined Modality Therapy; D006801:Humans; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement