Musculoskeletal pain syndromes that affect adolescents
I. S. Szer
From the Division of Pediatric Rheumatology, Children's Hospital of San Diego (Calif), USA.
Musculoskeletal pain is one of the most common pains of adolescence, along
with headache and abdominal pain, and arthralgia is the single most common
reason for referral to the pediatric rheumatologist. Not surprisingly, the
pediatric rheumatologist is frequently called to distinguish organic from
functional symptoms. During the past decade, the pediatric rheumatology
community has been evaluating increasing numbers of adolescents and
preadolescents who experience musculoskeletal symptoms presumably as a
defense against emotional stress from achievement either in academic work
or in sports. To complicate the challenge further, coexistent organic and
psychologic disturbance is not rare. Clearly, organic illness does not
protect a patient from emotional plan, and it may be most difficult to
differentiate nonorganic pain in a patient with a known organic illness.
Conversely, adolescents with organic illness may use their disease for
secondary gain. Fear of misdiagnosis of physical illness as psychiatric and
the notion that all of the patient's complaints should be explained by a
unifying diagnosis cause diagnostic error in both psychogenic illness with
physical manifestations and physical illness with psychogenic symptoms.
