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Forum Name: Pediatric Topics

Question: Child back pain: Real or psychogenetic?


 samwarr - Wed Aug 04, 2010 3:06 pm

My 8-year-old daughter has been complaining of back pain for about 3 years. Typically she complains of a dull ache through the middle of her back at the end of the day near bedtime almost everynight. She's had an X-ray and MRI which both have come up normal. Our pediatrician doesn't suspect anything physical and has suggested that this may be psychogenetic. To our daughter her pain is very real and persistent. For us, it's frustrating. Is there anything else we can do to verify this isn't real? What would you suggest?

Thanks,

Richard H
 Faye Lang, RN, MSW - Fri Aug 06, 2010 6:28 pm

Hello samwarr,

Back pain is uncommon before adolescence. Children usually do not use pain symptoms for secondary gain. Chronic pain in children demands further evaluation, and organic diseases must be considered. In a 6-year orthopedic study, it was found that back pain was the cause of referral in less than 2% of referrals in children age 15 or under, but approximately half of those children had serious underlying disease. Back pain has many potential causes; psychogenic pain isn't impossible, but is extremely rare, and should be considered only after extensive evaluation, including orthodpedic, rheumatologic (pediatric rheumatologist, if possible), neurologic and pain specialist evaluations. Nocturnal back pain in particular must be evaluated, as osteoid sarcoma or osteoblastoma must be ruled out; CT scan is the definitive study. When giving the history of the pain, include the onset or precipitating event, if known, the location of the pain, whether it is localized or radiates, and details such as is it continuous, how severe it is, is it present upon awakening, is there fever, what helps or makes it worse, and has the pain altered the child's usual functional ability and activities. Evaluation of social and family factors should also be made. The initial tests are usually comprised of a complete blood count, uric acid, urinalysis and culture, lactate dehydrogenase level, erythrocyte sedimentation rate, and specific imaging, such as X-ray, CT, MRI, bone scan, and single-photon emission computed tomography, as recommended by the various specialists.

Discussion with your daughter's pediatrician is recommended, with requests for further evaluation and referral to the specialists listed above. If you desire, a second opinion can be useful.

Good luck to you and to your daughter. Please advise us if we can provide further information or assistance, and let us know how things turn out.

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