New study defines chronic pain in children, suggests better treatment

New research from Montreal shows nociplastic pain can develop in children and adolescents.

Nociplastic pain is pain that patients experience without any evidence of tissue or nervous system damage.

Researchers at the Montreal Children's Hospital and the MUHC's research institute recently published their observations in The Journal of Pain Research and have developed a treatment protocol that significantly reduces patients' use of medications to treat it.

"Nociplastic pain is notably present in people with fibromyalgia, complex regional pain syndrome and irritable bowel syndrome," said study co-lead Dr. Pablo Ingelmo in a news release. "While first identified in adults, it had never been described in children."

Ingelmo said there are around 6,000 children in Montreal and Laval who suffer from chronic pain and that the majority of them wind up in hospital ERs where physicians don't necessarily know how to treat their complex issues aside from prescribing drugs. The patients' families, he said, often have to pay large sums out of pocket, wind up isolated and often miss long stretches of school.

The Edwards Family Interdisciplinary Centre for Complex Pain at the Children's became the first pediatric complex pain facility in Canada to start looking at the nociceptive system in 2016. The nociceptive system is what activates pain and connects it to the central and peripheral nervous systems.

Children suffering these types of pain suffered from panic disorder and social phobia symptoms and weren't able to get quality sleep when compared to patients with other types of pain.

Igelmo said that 75 per cent of patients at the centre reported adverse effects immediately, and researchers at the centre wanted to reduce these while improving treatment options.

"We can now identify children and adolescents with nociplastic pain and treat them accordingly," said Ingelmo. "The result is fewer drugs, fewer side effects, lower costs and, most importantly, happier patients."

According to the hospital, the research team focused on personalized medicine rather than drug treatments used in adults.

The results, the study shows, were positive. 

"Because we can now determine how each of our young patients feels pain, we can personalize treatments and avoid giving them inappropriate and unnecessary medications," said study co-lead Catherine Ferland. "This is the culmination of a long process that we have put in place and that has paid off."

The study involved 414 patients between 2016 and 2021. Around 40 per cent of them were identified as having nociplastic pain that involves the following:

• Persistent or recurrent pain for at least three months.
• Regional (diffuse) pain rather than discrete/distinct in distribution.
• No evidence that other pain mechanisms are entirely responsible for the pain.
• Evoked pain hypersensitivity that can be clinically elicited in the region of pain.

Ingelmo said that a third of those who suffer nociplastic pain will develop chronic pain as adults, making it extra important to identify what pain mechanism is at work and how to treat it.