ABSTRACT
BACKGROUND: Rheumatic diseases, such as juvenile idiopathic arthritis (JIA), are typically associated with acute pain mainly caused by inflammation. Chronic pain is described as pain lasting at least 3 months. In JIA patients chronic pain may occur despite successful treatment. Chronic pain and pain disorders frequently occur during the course of the disease despite successful control of inflammation. OBJECTIVE: Possible interrelations between JIA and pain disorders are presented. METHOD: Besides a review of the available literature, a retrospective cohort study was conducted, including 906 patients with a chronic pain disorder with somatic and psychological factors (CPD) and/or a complex regional pain syndrome type I (CRPS I). The frequency of pre-existing rheumatic illnesses was analyzed. RESULTS: The JIA is a risk factor for the development of a CPD. Especially polyarticular, extended oligoarticular, enthesitis-associated JIA and psoriatic arthropathy were found to be significantly associated with an increased risk for developing CPD. In contrast, an increased risk for development of CRPS I was not observed. CONCLUSION: Our study demonstrates JIA to be a risk factor for the development of chronic pain not only as a result from malpositioning or arthrosis but also as a chronic pain disorder (CPD). Further studies are necessary to clarify the relevance of disease activity and duration and also of psychological factors for the pathogenesis.
Subject(s)
Arthritis, Juvenile , Chronic Pain , Rheumatic Diseases , Adolescent , Arthritis, Juvenile/diagnosis , Arthritis, Juvenile/epidemiology , Child , Chronic Pain/diagnosis , Chronic Pain/epidemiology , Humans , Retrospective Studies , Rheumatic Diseases/diagnosis , Rheumatic Diseases/epidemiology , Young AdultABSTRACT
Chronic pain syndromes in children and adolescents are defined as continuous or recurrent pain without an underlying causative diagnosis and lasting for more than 3 months. It is estimated that every fourth child in Germany suffers from chronic pain with every twentieth suffering from extreme recurrent pain. The incidence of chronic pain in children and adolescents is increasing with headache, abdominal pain and musculoskeletal pain being the most frequent. The quality of life declines not only due to the pain but to relieving postural and psychological factors, such as fear and sadness. School attendance, social activities and hobbies are mostly affected. This review summarizes the background of chronic pain syndromes and introduces a multimodal therapeutic approach.
Subject(s)
Arthralgia/diagnosis , Arthralgia/therapy , Chronic Pain/diagnosis , Chronic Pain/therapy , Complex Regional Pain Syndromes/diagnosis , Complex Regional Pain Syndromes/therapy , Adolescent , Arthralgia/psychology , Child , Child, Preschool , Chronic Pain/psychology , Complex Regional Pain Syndromes/psychology , Diagnosis, Differential , Evidence-Based Medicine , Female , Humans , Infant , Infant, Newborn , Male , Pain Management/methods , Pain Management/psychology , Pain Measurement/methods , Treatment Outcome , Young AdultABSTRACT
The wish for an attractive appearance is evident in many people. Aesthetic, cosmetic and surgical treatment is willingly made use of in order to fit into the current beauty ideal. A considerable portion of people who decide to follow this path show signs of psychological problems. One has to recognize and evaluate these for the planning or, if necessary, refusal of further treatment. In this article, the most common psychological problems in the cosmetic and aesthetic field of work are presented. A guideline for handling these patients is explained. Thus, a productive and relaxed cooperation will be possible which enables psychological and physical satisfaction for the medical team and the patients.
