Chronic non-cancer pain in adolescents: a narrative review
Dor crônica não oncológica no adolescente: uma revisão narrativa
Carlos Silva; Dora Oliveira; Márcia Pestana-Santos; Francisco Portugal; Paula Capelo
Abstract
Introduction
Chronic pain is defined as a pain lasting more than 3–6 months. It is estimated that 25% of the pediatric population may experience some kind of pain in this context. Adolescence, corresponding to a particular period of development, seems to present the ideal territory for the appearance of maladaptive mechanisms that can trigger episodes of persistent or recurrent pain.
Methods
A narrative review, in the PubMed/Medline database, in order to synthetize the available evidence in the approach to chronic pain in adolescents, highlighting its etiology, pathophysiology, diagnosis, and treatment.
Results
Pain is seen as a result from the interaction of biological, psychological, individual, social, and environmental factors. Headache, abdominal pain, and musculoskeletal pain are frequent causes of chronic pain in adolescents. Pain not only has implications on adolescents, but also on family, society, and how they interact. It has implications on daily activities, physical capacity, school performance, and sleep, and is associated with psychiatric comorbidities, such as anxiety and depression. The therapeutic approach of pain must be multimodal and multidisciplinary, involving adolescents, their families, and environment, using pharmacological and non-pharmacological strategies.
Discussion and conclusion
The acknowledgment, prevention, diagnosis, and treatment of chronic pain in adolescent patients seem not to be ideal. The development of evidence-based forms of treatment, and the training of health professionals at all levels of care are essential for the diagnosis, treatment, and early referral of these patients.
Keywords
Resumo
Introdução: A dor crônica é definida como uma dor que se perpetua por mais de 3–6 meses. Estima-se que 25% da população pediátrica poderá apresentar algum tipo de dor nesse contexto. A adolescência, ao corresponder a um período particular do desenvolvimento, parece apresentar o território ideal para o surgimento de mecanismos mal-adaptativos que podem desencadear fenômenos de dor persistente ou recorrente. Material e métodos: Revisão narrativa, com pesquisa na base de dados PubMed/Medline, a fim de sintetizar a evidência disponível na abordagem da dor crônica no adolescente, destacando a sua etiologia, fisiopatologia, diagnóstico e tratamento. Resultados: A dor é interpretada como resultado da interação de fatores biológicos, psicológicos, individuais, sociais e ambientais. As cefaleias, a dor abdominal e a dor musculoesquelética são causas frequentes de dor crônica no adolescente. A dor condiciona não só o adolescente, mas também a família, a sociedade e a forma como eles interagem. Tem implicações nas atividades de vida diária, capacidade física, desempenho escolar e sono, e associa-se a comorbilidades psiquiátricas, como ansiedade e depressão. A abordagem terapêutica da dor deve ser multimodal e multidisciplinar, envolvendo o adolescente, a família e o seu meio envolvente, usando estratégias farmacológicas e não farmacológicas. Discussão e conclusão: O reconhecimento, a prevenção, o diagnóstico e o tratamento da dor no adolescente parece não ser o ideal. O desenvolvimento de formas de tratamento com base na evidência e a formação de profissionais de saúde, nos diferentes níveis de diferenciação, é fundamental para o diagnóstico, tratamento e referenciação mais precoce desses doentes.
Palavras-chave
References
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