Chronic primary and secondary pain in children: Case

Framing the case

This thirteen-year-old has the classic shape of chronic primary pain in an adolescent: widespread pain for more than three months, fatigue and unrefreshing sleep, difficulty concentrating, fluctuating and migrating pain, declining school attendance, and a folder of normal tests. The framework that organises the case is the ICD-11 split of chronic pain into primary, where the pain is itself a nociplastic disease of a sensitised nervous system, and secondary, where the pain arises from an identifiable cause. This girl sits firmly in chronic primary pain, ICD-11 code MG30.0, and the priority is not another scan or a stronger analgesic but a biopsychosocial explanation and an interdisciplinary rehabilitation plan. ^[1][2]

The biopsychosocial assessment and the red-flag screen

The assessment is a biopsychosocial history more than a physical hunt. Cover seven domains: the pain itself and its fluctuating, migrating course; the mood and anxiety, which here include low mood and withdrawal; the sleep, which is broken and unrefreshing; the school attendance, now two days a week; the family response, with a parent pressing for more investigation; the prior tests and treatments; and the girl's own understanding and goals. Examine to screen for the serious mimics and to demonstrate a thorough examination: growth and pubertal staging, a full musculoskeletal screen for joint swelling, warmth, range and gait, and a neurological screen. Quantify function with a numeric pain scale, a Functional Disability Inventory, a pain and sleep diary, and a direct count of school days missed. ^[7]