VERTEBRAL PAIN SYNDROMES IN CHILDREN: ALGORITHMS OF THERAPY DEPENDING ON AGE

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Abstract

Background: Publications on the problem of dorsalgia in children are scarce. Inadequate treatment of back pain in children and adolescents promotes the disease progression and contributes to high prevalence of this syndrome in adult population.

Aim: To develop an algorithm of age-dependent treatment of children with dorsalgias based on a multidisciplinary approach and taking into account the stage of the disease.

Materials and methods: One hundred and five (105) patients (54 girls and 51 boys) were assessed after admittance to the in-patient department of neurology with complaints on back pain. Chronic pain syndromes (with duration of more than 12 weeks) were noted in 84 (80%) of children, subacute pain syndromes (with 6 to 12 weeks duration), in 8 (7.6%), and acute pain syndromes (of less than 6 weeks duration), in 13 (12.4%). Pain severity and psycho-emotional status were assessed with a visual analogue scale (VAS) and McGill Pain Questionnaire (MPQ). For their treatment, the methods established in neurology were used with consideration of age specifics. The amount and type of medical care depended on the degree of acuity, symptom severity, results of instrumental assessment methods and patient age.

Results: The use of combined approach to the treatment of vertebral pain syndromes with special emphasis on non-medical techniques significantly expanded treatment opportunities and improved the results of restorative therapy. Before treatment, moderate and severe pain syndrome (from 4 to 10 on VAS) was seen in 74.3% of patients, whereas after the treatment course, in 22.9% (p < 0.05). Minimal pain intensity (VAS 0–3) was noted at admittance to the hospital in 25.7% of patients and after the course of age-adjusted treatment this percentage increased to 77.1% (p < 0.05). In most cases, the effect of the elaborated treatment complex was seen up to 12 months, and if some maintenance treatment courses were performed, up to 2–4 years and more. During the follow- up that lasted from 6 to 48 months, 30.8% of patients was hospitalized again; however, in all of them the pain syndrome was significantly less severe (VAS 1–6) than at primary admittance.

Conclusion: Implementation of treatment algorithms, that are commonly used in adult practice and are adapted to pediatric age, allows for a significant decrease in severity of the pain syndrome or for its complete elimination, for improvement of affective disorders (p < 0.0001) and reduction of relapse risks, as well as for maintenance of social and daily adaptation of patients.

About the authors

A. A. Smirnova

Moscow Regional Psychoneurological Hospital for the Children with Central Nervous System Affliction and Mental Disturbance;

Author for correspondence.
Email: 89035820788@mail.ru

PhD, Head of Department of Psychoneurology II

Россия

M. N. Borisova

Moscow Regional Research and Clinical Institute (MONIKI)

Email: borisovam62@yandex.ru

PhD, Senior Research Fellow, Department of Pediatric Neurology

Россия

M. A. Lobov

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

MD, PhD, Professor, Head of Department of Pediatric Neurology (1997–2015)

Россия

O. L. Lapochkin

Moscow Regional Psychoneurological Hospital for the Children with Central Nervous System Affliction and Mental Disturbance

Email: fake@neicon.ru

Chief Physician

Россия

M. V. Panteleeva

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

PhD, Senior Research Fellow, Department of Pediatric Neurology

Россия

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Copyright (c) 2015 Smirnova A.A., Borisova M.N., Lobov M.A., Lapochkin O.L., Panteleeva M.V.

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