Growing pains: a noninflammatory pain syndrome of early childhood

Abstract

The term 'growing pains' has been used for almost 200 years to refer to the often severe, generally bilateral lower-extremity nocturnal pains experienced by up to one-third of all children at some time during early childhood. No clear mechanism has yet been identified that explains these pains, but there is an increasing body of evidence indicating that several factors, individually or in combination, might be responsible for this phenomenon. These include mechanical factors, such as joint hypermobility and flat feet, decreased pain thresholds, reduced bone strength, and emotional factors involving the patient's family and other social stressors. Correct diagnosis of growing pains requires a thorough patient history and physical examination. The diagnosis can be safely established without unnecessary laboratory investigations or imaging; however, identification of one or more clinical cautionary signs, such as unilateral pain, morning stiffness, joint swelling and systemic symptoms (e.g. fever, weight loss and malaise), should trigger an extended evaluation to exclude other more serious conditions that might also present with limb pain. Once the diagnosis has been established, conservative management, using symptomatic pain medications, massage and other supportive measures, should be employed until the syndrome self-resolves with time.

The effect of lumbosacral manipulation on growing pains

“…The only objective measurements performed were the algometer measurements which were taken by the researcher on the first, third and fifth visit prior to treatment, and on the seventh visit. The algometry measurements were performed on the tibialis anterior muscle belly as children with GP have demonstrated a decreased pain threshold in this area (Lowe & Hashkes, 2008). Subjective measurements consisted of the Oucher self-report pain scale (OSRPS), the pain diary and the 6-week post-trial follow-up question.…”

“…However, according to Lowe and Hashkes (2008), GP tend to occur in children aged 4e14 years. The prevalence of GP has been reported in nine separate studies since 1928 (Evans & Scutter, 2004b).…”

“…Many authors agree that there is no conclusive aetiology for GP (Al-Khattat & Campbell, 2000;Evans, 2008;Evans & Scutter, 2004aEvans et al, 2006;Lowe & Hashkes, 2008;Uziel & Hashkes, 2007). Furthermore the term "growing pains" is thought to be a contradiction as there is no evidence that the process of growth is painful, the peak incidence of pain does not conincide with peak growth periods and pain does not occur at sites where growth is thought to take place (Lowe & Hashkes, 2008).…”

“…Furthermore the term "growing pains" is thought to be a contradiction as there is no evidence that the process of growth is painful, the peak incidence of pain does not conincide with peak growth periods and pain does not occur at sites where growth is thought to take place (Lowe & Hashkes, 2008). Despite the uncertainty of the aetiology, three main theories dominate the literature e the anatomical, fatigability and psychological models (Evans, 2008).…”

“…However, different treatment options were sought and tried. Non-pharmacological approaches included were comforting and local massage therapy (Uziel & Hashkes, 2007), muscle stretching (Evans, 2008), warmth modalities (Lowe & Hashkes, 2008) or simply no management with general improvement over time (Uziel, Chapnick, Jaber, Nemet, & Hashkes, 2010). Pharmacological approaches typically include analgesics such as paracetamol, chronic medication and various types of over-the-counter medication (Evans, 2008;Evans et al, 2006;Lowe & Hashkes, 2008;Uziel & Hashkes, 2007).…”