Evaluation of pain in pediatric upper extremity conditions.

STUDY DESIGN:Narrative Review. INTRODUCTION:Hand surgeons and therapists play an important role in the early identification of children at risk of developing chronic or recurrent pain after an upper extremity injury. Early identification of children at risk of developing a pain syndrome is critical because their physical, psychological, and/or social functioning may decline quickly without proper management due to the multidimensional nature of pain. PURPOSE OF THE STUDY:This article outlines one approach to evaluating upper extremity pain in children to help identify those with, or at risk of, chronic pain. METHODS:An assessment framework that recognizes the biological, sensory, emotional, and psychosocial components of pain is described. RESULTS:The key components of a screening evaluation include obtaining a detailed history and a thorough physical examination that involves: systematic upper extremity mapping of sensory thresholds, mapping of sensory disturbances, and screening of self-reported pain intensity, location, descriptors, and interference. DISCUSSION AND CONCLUSION:The evaluation approach described will enable hand therapists to identify children with upper extremity pain that are at risk of developing a chronic pain and make an early referral to a multidisciplinary pain team that provides education, pharmacological pain management, physical rehabilitation, and psychological treatments.