Chronic Pain & Growing pains
Non-specific aches and pains are common and the differential is broad.
Key points include:
- Careful clinical assessment and exclusion of red flags are important.
- Hypermobility is common in children and a feature of normal development so it is important not to ascribe all aches and pains to hypermobility - many hypermobile children have no pain at all.
- Inflammatory joint or muscle conditions, metabolic disease (osteomalacia, thyroid disease) can result in aches and pains.
- Growing pains are a diagnosis of exclusion.
- Chronic pain is a feature of idiopathic pain syndromes which are also called Chronic Regional Pain Syndromes (CRPS).
Chronic idiopathic pain syndromes or Chronic Regional Pain Syndromes are mostly seen in older female children and adolescents; the pain can be incapacitating but the patient is otherwise well, and physical examination is usually normal. The widespread type may associate with fatigue and debility. The localised type most commonly affects the foot or hand, may be triggered by trauma (often mild) and can have characteristic features of the affected part being cool, cyanosed and very sensitive to touch. These children are often very debilitated and missing school. Management is multidisciplinary involving physiotherapy, pain management and psychology support. Outcome is variable.
Growing pains have no relation to growth. The cause of growing pains is unknown. Growing pains occur in young children with lower leg aches, often in calves, feet and ankles, after periods of activity, and usually end of the day, or evenings and can wake children from sleep. Care must be taken to not miss serious pathology, including malignancy or arthritis. Management is essentially explanation and reassurance, advice on analgesia, footwear and when to come back and seek health care attention. Advise to use paracetamol before bed time may help to pre-empt and prevent night waking. If the child does wake then massaging limbs may help. Supportive foot wear (such as trainers or sports shoes) may help to reduce episodes of pain.