Evaluating and managing pediatric musculoskeletal pain in primary care
Musculoskeletal pain is common in pedi-atric populations, reported in up to half of children from community samples, and is a frequent presenting complaint in pediatric primary care. Evaluating pedi-atric musculoskeletal pain is complicated by the extensive differential diagnosis. Some of the diagnoses require immediate treatment decisions at the primary care level to prevent future problems and disability. In this chapter we review general evaluation and treatment approaches to pediatric patients who present to primary care providers with musculoskeletal pain complaints. We begin by providing guidelines for evaluating these children, including the history, physical exam, and appropriate use of imaging and laboratory data, emphasizing that some causes of muscu-loskeletal pain in children are diagnosed entirely on the basis of the history and physical. Subsequently we briefl y discuss two relatively uncommon muscu-loskeletal pain conditions in children (back pain and complex regional pain syndrome), where prompt and accurate diagnosis by the primary care physician improves outcome. Finally, we suggest guidelines for referral to pediatric subspecialists. © 2008 Humana Press.
Connelly, MA; Schanberg, LE
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