DISORDERS OF THE PEDIATRIC AND ADOLESCENT SPINE
Back Pain in Children
Howard A. King, MDPage: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11
The evaluation starts with a high index of suspicion. Patients who present with unusual symptoms, left thoracic scoliosis, painful scoliosis, or night pain must be evaluated for a tumor. For spinal cord tumors, MR imaging techniques seem to be the best. When vertebral column lesions are expected, a bone scan followed by CT imaging has generally proven to be useful. On occasion, the early differential diagnosis is unclear, and all three techniques may be necessary. The treatment program depends on the type of lesion and its location.
Throughout this article, it has been stressed that psychosomatic back pain should be a diagnosis of exclusion, in patients in whom a detailed workup has been done without a positive diagnosis and in whom the symptoms seem to exceed the findings. A psychosomatic disorder is often the diagnosis. The complaints may reflect significant changes within the family or school environments. It is not uncommon to find an adult role model and a high level of personal and family stress. When these items are noted or suspected, it is important to help the child and family to find appropriate counseling. The clinician must reevaluate the patient to be sure organic causes for the symptoms are not missed.
CONCLUSION
The evaluation of a child or adolescent complaining of back pain is a challenging endeavor. The current literature suggests that young people have a fairly high incidence of back pain, but they rarely seek medical attention because most of their symptoms are mild and not limiting. In patients who seek medical attention, especially at referral centers, the incidence of organic causes for symptoms is high. Careful clinical, radiographic, and other imaging evaluations establish a diagnosis about 50% of the time. In patients in whom no diagnosis is made, continued monitoring is appropriate because a diagnosis may become apparent with time. Psychosomatic problems can occur in children and should be included in the differential diagnosis but should be a diagnosis only of exclusion. Even with modern technology, nothing replaces the physician with skilled clinical expertise and a high index of suspicion.