Epidemiology

Epidemiological studies provide data crucial to the understanding of the etiology, natural history, impact, aggregation, and transmission of a disease or condition.

Pain is a health care problem that carries severe personal and economic consequences. The Nuprin Pain Report (3), conducted in the United States, estimated that half a billion dollars were lost directly because of pain among those employed full time. Pain in adolescents does not create the same economic hardship as adult pain, thus, to date, motivation to gain a more comprehensive understanding of pain in the adolescent population is lacking. It is, however, widely appreciated that significant numbers of adolescents who report pain go on to suffer pain and pain-associated disability in adulthood. Studies have concluded that since pain reports in childhood and early adolescence seem to be associated with the report of pain in early adulthood, more attention should be given to the way ill health is managed in the vulnerable adolescent group. (4).

It has been estimated that 15% to 25% of all children and adolescents suffer from recurrent or chronic pain conditions (5,6). A study in Germany showed that of 749 school age children, 83% had experienced pain during the preceding three months. A total of 30.8% of the children and adolescents stated that the pains had been present for over six months. Musculoskeletal pains accounted for 64% of all pain reported (7). It is widely recognized to be more common in girls (8-11) but recent studies have shown that the incidence in boys may actually be increasing (7). In a large Scandinavian study the prevalence of childhood pain was slightly higher in low-educated or low-income families compared to those of high status. Children living in low educated, low-income, worker families had approximately a 1.4-fold increased chance of having pain (9). It is generally believed that chronic pain is much more prevalent in developed countries, although there is little current research that shows this. There is, however, recognition that cultural background should certainly be taken into account when planning rehabilitation (12).

There have been some recent epidemiological studies looking at complex regional pain syndrome (CRPS). Prior to the 1970s, CRPS was seldom reported in adolescents. More recently, however, hundreds of pediatric patients have been reported (13-15). CRPS is seen most commonly around puberty although there are a few cases reported below the age of 10. CRPS type 1 is more commonly seen in girls with a ratio of 4:1 (female to male) (15). Unlike adults, the lower extremities are more commonly affected. Like the other pain conditions, CRPS 1 is seen predominantly in Caucasian populations.

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