Management of chronic pain in children.

Overview

Much has been written about the recognition and treatment of acute pain, but the syndrome of chronic pain in the pediatric population has received little attention. A pediatrician faced with a child suffering from recurrent or chronic pain first should exclude an underlying organic illness. However, the clinician also should understand that recurrent painful episodes may lack an organic cause; they may be triggered by a variety of external and internal factors, particularly perceived stress. The consequences of the child's pain and its relief must be evaluated and viewed in the context of rewards, secondary gain, and parental anxiety. Chronic pain may influence self-esteem, socialization, and academic achievement, and these issues must be addressed.