Chronic primary and secondary pain in children: Viva

This is a branching oral built to probe the reasoning that places a biopsychosocial explanation and an interdisciplinary rehabilitation plan at the centre, and to expose the candidate who reaches for analgesia and more scans instead. The questions escalate from the framing to the assessment, the plan, the opioid counselling, and the special scenarios. ^[7]

Opening question: framing the problem

The examiner opens with the eight-month history and the folder of normal tests, and asks how you frame this in a single sentence, and what the diagnosis is. ^[1]

A strong answer names chronic primary pain, defines it by the three-month threshold, and explains that the normal tests are exactly what is expected because the mechanism is nociplastic. ^[2]

Model answer. This is chronic primary pain, ICD-11 code MG30.0: pain in multiple regions for more than three months with significant distress and functional disability that is not better explained by another condition. The mechanism is nociplastic, driven by central sensitisation, which is why the tests are normal and the pain is nonetheless real. The disability, with two days of school a week, is the part that needs urgent attention. ^[1][2]

Probe one: the mechanism

The examiner presses on what central sensitisation actually is, and why the pain moves between sites. ^[1]

A strong answer explains that after prolonged nociceptive input the spinal cord and brain become more responsive, the threshold for pain drops, allodynia and hyperalgesia develop, and descending inhibition weakens. The pain migrates because the sensitised system is not tied to one injured tissue; it generates pain across regions. ^[1]