Chronic idiopathic musculoskeletal pain diagnoses stem from pain history, not physical exam
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The key elements that guide the diagnosis of chronic idiopathic musculoskeletal pain do not primarily come from physical exam, but from the patient’s history of pain and the physician’s opinion, according to findings published in Pediatric Rheumatology.
The researchers also concluded that juvenile fibromyalgia does not appear to account for all instances of chronic idiopathic musculoskeletal pain in adolescents.
“Although the physiopathology of chronic pain is better understood today, many consider a diagnosis of chronic idiopathic [musculoskeletal pain (MSP)] to be a diagnosis of exclusion, while others treat it as [juvenile fibromyalgia] with the limitations of its diagnostic criteria,” Hervé Lefèvre, MD, PhD, of Cochin Hospital, Maison de Solenn, Paris, and colleagues wrote. “In this context, the existence of global positive specific criteria for chronic idiopathic MSP remains to be demonstrated.”
To identify the criteria for chronic idiopathic musculoskeletal pain, using the experience of professionals with experience treating children and adolescents, Lefèvre and colleagues conducted a cross-sectional multicenter qualitative study. Researchers interviewed 25 health care professionals at the Rare Auto-immune and Inflammatory Systemic diseases (RAISE) pediatric rheumatology reference center’s three facilities.
The 1-hour, semi-structured interviews were transcribed and anonymized. The researchers used Interpretative Phenomenological Analysis, typically used to determine how individuals perceive particular situations and how they make sense of their personal and social world, to examine the data.
Lefèvre and colleagues developed 10 themes based on their data. According to the researchers, these 10 themes are organized around three superordinate themes representing different stages of the diagnostic process:
- Medical history of pain leading up to the reference center consultation;
- The health care professional’s personal judgement regarding the clinical presentation; and
- From the initial clinical examination to the diagnosis and treatment of chronic idiopathic musculoskeletal pain.
In addition, the key elements guiding this diagnosis do not in fact come from the physical exam but from the medical history and the health care professional’s judgment, the researchers wrote. The professionals’ sense of uneasiness and frustration, prompted by patients and their parents, is also important.
“This exploration of the experience of 25 experts in the management of chronic MSP has made it possible to describe and develop the narrative and clinical symptomatologic elements by which they implicitly orient their diagnosis toward the idiopathic form,” Lefèvre and colleagues wrote. “Their experience allows us to conclude that the principal elements guiding the diagnosis do not come from the physical examination but rather from the healthcare follow-up and the health professionals’ subjective feelings and clinical sense. A constellation of nonorganic criteria can help specialists to reach the diagnosis of chronic idiopathic MSP. Our study thus has potential clinical implications.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
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