APPROACH TO MUSCULOSKELETAL PAIN IN CHILDREN
Keywords:Child, musculoskeletal pain, pediatrics
Introduction: Musculoskeletal (MSK) pain in paediatric population is a frequent complaint in clinical practice for general practitioners (GP) and paediatricians, sometimes of difficult characterization. Although the aetiologies are frequently benign, it is essential to make a proper differential diagnosis. Most children with MSK complaints will present initially to their GP and the majority will not need referral to secondary care. However, it is vital that children are triaged and managed appropriately, which relies on careful clinical assessment and judicious use of investigations where indicated. This complaint usually involves high costs in complementary diagnosis means. The MSK pains which tend to be chronic have a negative impact in physical and psychological well-being of children and their families, compromising the quality of life for both.
Objective: To develop an algorithm of logical, multidisciplinary and systematic approach which encompasses anamnesis, the psychosocial environment and physical examination, in order to identify the cause and avoid long term complications.
Development: Any component of the musculoskeletal system may originate pain. Differential diagnosis includes several aetiologies, from rheumatologic, orthopaedic, infectious, degenerative or traumatic to neoplastic, most rarely. Thus, it is crucial to perform a thorough anamnesis, exploring the personal and family backgrounds, and a comprehensive and detailed physical examination. Complementary diagnosis means may be useful in case of suspected inflammatory pathology and may exclude infectious or malignant pathologies. It is essential to distinguish between benign and suspicious features, as well as warning signs for referral.
Conclusion: This kind of complaint, very frequent in clinical practice, requires an approach for a problem that very often presents itself as undifferentiated, demanding a systematic evaluation in order to obtained an accurate diagnosis and a timely intervention.
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