Diffuse musculoskeletal pain syndromes in pediatric practice

Diffuse musculoskeletal pains in children and adolescents are common. Females are affected relatively more often. Whereas growing pains and joint hypermobility as possible causes tend to occur in younger children, fibromyalgia syndrome (FMS) appears to be more frequent in adolescents. In growing pains, typically, a) the pains are localized to the thighs, shins, or calves, b) occur in the evening or at night; and c) are usually relieved by massage. Children are otherwise healthy and have normal growth and development. Children with joint hypermobility manifest pain mainly in the knees, ankles, and hips. Symptoms are aggravated by exercise, and mild effusions in the joints can occur. In patients with FMS, pain is generalized, and discrete anatomic points are specifically tender. As in adults with FMS, headaches, abdominal pain, fatigue, and sleep disturbances are usually common. In contrast to the poor outcome of FMS in adults, some data suggest a better prognosis in children. These three syndromes have much in common and might overlap. The diagnosis of any of these diffuse pain syndromes is one of exclusion, and other conditions must be ruled out, including rheumatic disorders such as juvenile rheumatoid arthritis and systemic lupus erythematosus, psychogenic or somatoform disorders, child abuse, sexual abuse, and malignancies. Management is usually conservative and symptomatic; a multidisciplinary team approach may be helpful.