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

Russian Federation

M. N. Borisova

Moscow Regional Research and Clinical Institute (MONIKI)

Email: borisovam62@yandex.ru

PhD, Senior Research Fellow, Department of Pediatric Neurology

Russian Federation

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)

Russian Federation

O. L. Lapochkin

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

Email: fake@neicon.ru

Chief Physician

Russian Federation

M. V. Panteleeva

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

PhD, Senior Research Fellow, Department of Pediatric Neurology

Russian Federation

References

  1. ВОЗ. Международная статистическая классификация болезней и проблем, связанных со здоровьем. Десятый пересмотр. Пер. с англ. М.: Медицина; 2003. World Health Organization. International Statistical Classification of Diseases and Related Health Problems. 10th Revision. Transl. from English. Moscow: Meditsina; 2003 (in Russian).
  2. Кочергина ОС. Особенности распростра ненности и структуры вертеброгенных заболеваний нервной системы среди детей и подростков. Вертеброневрология. 2002;(3–4):6–10. Kochergina OS. Osobennosti rasprostranennosti i struktury vertebrogennykh zabolevaniy nervnoy sistemy sredi detey i podrostkov [Specifics of prevalence and structure of vertebral disorders of the nervous system among children and adolescents]. Vertebronevrologiya. 2002;(3–4):6–10 (in Russian).
  3. Анисимова СЮ, Рачин АП. Эпидемиология дорсалгии у детей и подростков. Журнал неврологии и психиатрии им. С.С. Корсакова. 2012;112(11):57–8. Anisimova SYu, Rachin AP. Epidemiologiya
  4. dorsalgii u detey i podrostkov [Epidemiology of dorsalgia in children and adolescents]. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2012;112(11):57–8 (in Russian).
  5. Hakala P, Rimpel A, Salminen JJ, Virtanen SM, Rimpela M. Back, neck, and shoulder pain in Finnish adolescents: national cross sectional surveys. BMJ. 2002;325(7367):743.
  6. Van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, Koes B, Laerum E, Malmivaara A. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15(2): 169–91.
  7. Богачева ЛА, Снеткова ЕП. Боль в спине: клиника, патогенез, принципы ведения (опыт работы амбулаторного отделения боли в спине). Боль. 2005;(4):26–30. Bogacheva LA, Snetkova EP. Bol' v spine: klinika, patogenez, printsipy vedeniya (opyt raboty ambulatornogo otdeleniya boli v spine) [Back pain: clinical manifestations, pathophysiology and management principles (an experience of an out-patient department of back pain)]. Bol’. 2005;(4):26–30 (in Russian).
  8. Подчуфарова ЕВ, Яхно НН. Боль в спине. М.: ГЭОТАР-Медиа; 2013. 372 с. Podchufarova EV, Yakhno NN. Bol' v spine [Back pain]. Moscow: GEOTAR-Media; 2013. 372 p. (in Russian).
  9. Алексеев ВВ. Неврологические аспекты лечения острых скелетно-мышечных болевых синдромов. РМЖ. 2004;(5):266–70. Alekseev VV. Nevrologicheskie aspekty lecheniya ostrykh skeletno-myshechnykh bolevykh sindromov [Neurological aspects of management of acute musculoskeletal pain syndromes]. Russian Medical Journal. 2004;(5):266–70 (in Russian).
  10. Штульман ДР, Левин ОС. Неврология. Справочник практического врача. М.: МЕД-пресс-информ; 2008. 1036 с. Shtul'man DR, Levin OS. Nevrologiya. Spravochnik prakticheskogo vracha [Neurology. Practical guide for physician]. Moscow: MEDpress- inform; 2008. 1036 p. (in Russian).
  11. Balague F, Troussier В, Salminen JJ. Non-specific low back pain in children and adolescents: risk factors. Eur Spine J. 1999;8(6):429–38. Balague F, Troussier В, Salminen JJ. Non-specific low back pain in children and adolescents: risk factors. Eur Spine J. 1999;8(6):429–38.
  12. Bogduk N, McGuirk B. Medical management of acute and chronic low back pain. Amsterdam: Elsevier; 2002. 224 p.
  13. Камчатнов ПР, Чугунов АВ, Трубецкая ЕА. Пациент с болью в спине: возможности терапии. Нервно-мышечные болезни. 2013;(2):20–7. Kamchatnov PR, Chugunov AV, Trubetskaya EA. Patsient s bol'yu v spine: vozmozhnosti terapii [The patient with back pain: treatment opportunities]. Nervno-myshechnye bolezni. 2013;(2):20–7 (in Russian).
  14. Меркулов Ю, Путилина М, Гришин Д, Меркулова Д. Оптимальный алгоритм комбинированной терапии при дорсопатии. Врач. 2012;(9):73–8. Merkulov Yu, Putilina M, Grishin D, Merkulova D. Optimal'nyy algoritm kombinirovannoy terapii pri dorsopatii [The optimal algorithm of combined therapy for dorsopathy]. Vrach. 2012;(9):73–8 (in Russian).
  15. van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, van Tulder MW. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J. 2011;20(1):19–39.
  16. Грачев ЮВ, Шмырев ВИ. Вертебральная поясничная боль: полифакторное происхождение, симптоматология, принципы лечения. Лечащий врач. 2008;(5):6–10. Grachev YuV, Shmyrev VI. Vertebral'naya poyasnichnaya bol': polifaktornoe proiskhozhdenie, simptomatologiya, printsipy lecheniya [Vertebral lumbar pain: multifactorial origin, symptomatology and treatment principles]. Lechashchiy vrach. 2008;(5):6–10 (in Russian).
  17. Дубинина ТВ. Оптимизация обследования и лечения пациентов с болью в спине в поликлинической практике. Consilium Мedicum. 2012;9(14):68–73. Dubinina TV. Optimizatsiya obsledovaniya i lecheniya patsientov s bol'yu v spine v poliklinicheskoy praktike. Consilium Мedicum. 2012;9(14):68–73 (in Russian).
  18. Смирнова АА, Лобов МА, Борисова МН, Лапочкин ОЛ. Вертеброгенные болевые синдромы у детей. Доктор.ру. 2011;(4):17–20. Smirnova AA, Lobov MA, Borisova MN, Lapochkin OL. Vertebrogennye bolevye sindromy u detey [Pain caused by spinal column pathology in children]. Doctor.ru. 2011;(4):17–20 (in Russian).
  19. Blozik E, Laptinskaya D, Hermann-Lingen C, Schaefer H, Kochen MM, Himmel W, Scherer M. Depression and anxiety as major determinants of neck pain: a cross-sectional study in general practice. BMC Musculoskelet Disord. 2009;(10):13. Smirnova AA, Lobov MA, Borisova MN, Lapochkin OL. Vertebrogennye bolevye sindromy u detey [Pain caused by spinal column pathology in children]. Doctor.ru. 2011;(4):17–20 (in Russian).
  20. Staiger TO, Gaster B, Sullivan MD, Deyo RA. Systematic review of antidepressants in the treatment of chronic low back pain. Spine. 2003;28(22):2540–5.
  21. Robinson ME, Dannecker EA, George SZ, Robinson ME, Dannecker EA, George SZ, Otis J, Atchison JW, Fillingim RB. Sex differences in the associations among psychological factors and pain report: a novel psychophysical study of patients with chronic low back pain. J Pain. 2005;6(7):463–70.
  22. Maizels M, McCarberg B. Antidepressants and antiepileptic drugs for chronic non-cancer pain. Am Fam Physician. 2005;71(3):483–90.

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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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