Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
Pediatric Drugs
Published in: Pediatric Drugs 6/2014

01-12-2014 | Therapy in Practice

Assessment and Management of Pain in Juvenile Idiopathic Arthritis

Authors: Jennifer E. Weiss, Nadia J. C. Luca, Alexis Boneparth, Jennifer Stinson

Published in: Pediatric Drugs | Issue 6/2014

Login to get access

Abstract

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. Persistent pain is the most common and distressing symptom of JIA, and pain in childhood arthritis is multifactorial. Children and adolescents with persistent pain due to JIA experience significantly more problems with physical, emotional, social, and school functioning than healthy individuals. Assessment of pain at each office visit is the cornerstone of effective pain management and should include an evaluation of pain intensity, interference, and coping. Following the biopsychosocial model of pain management, a multi-modal approach is recommended for pain control in children with arthritis. Pharmacologic strategies for the treatment of pain in JIA include aggressive treatment of the underlying disease as well as the use of acetaminophen and systemic and topical non-steroidal anti-inflammatory drugs for persistent mild pain. Opioids can be considered in the case of moderate to severe persistent pain. Physical therapies and psychological interventions such as cognitive behavioral therapy are also key components of pain management in JIA.
Literature
1.
Oen KG, Cheang M. Epidemiology of chronic arthritis in childhood. Semin Arthritis Rheum. 1996;26(3):575–91.PubMedCrossRef
2.
Petty RE, Southwood TR, Manners P, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31(2):390–2.PubMed
3.
Schanberg LE, Lefebvre JC, Keefe FJ, et al. Pain coping and the pain experience in children with juvenile chronic arthritis. Pain. 1997;73(2):181–9.PubMedCrossRef
4.
Lovell DJ, Walco GA. Pain associated with juvenile rheumatoid arthritis. Pediatr Clin North Am. 1989;36(4):1015–27.PubMed
5.
Hagglund KJ, Schopp LM, Alberts KR, et al. Predicting pain among children with juvenile rheumatoid arthritis. Arthritis Care Res. 1995;8(1):36–42.PubMedCrossRef
6.
Sherry DD, Bohnsack J, Salmonson K, et al. Painless juvenile rheumatoid arthritis. J Pediatr. 1990;116(6):921–3.PubMedCrossRef
7.
Schanberg LE, Anthony KK, Gil KM, et al. Daily pain and symptoms in children with polyarticular arthritis. Arthritis Rheum. 2003;48(5):1390–7.PubMedCrossRef
8.
Bromberg MH, Connelly M, Anthony KK, et al. Self-reported pain and disease symptoms persist in juvenile idiopathic arthritis despite treatment advances: an electronic diary study. Arthritis Rheumatol. 2014;66(2):462–9.PubMedCentralPubMedCrossRef
9.
Kimura Y, Walco GA, Sugarman E, et al. Treatment of pain in juvenile idiopathic arthritis: a survey of pediatric rheumatologists. Arthritis Rheum. 2006;55(1):81–5.PubMedCrossRef
10.
Ilowite NT, O’Reilly ME, Hatam L, et al. Expression of the rheumatoid factor cross-reactive idiotype in JRA: association with disease onset subtype, disease activity and disease severity. Scand J Rheumatol. 1992;21(2):51–4.PubMedCrossRef
11.
Malleson PN, Oen K, Cabral DA, et al. Predictors of pain in children with established juvenile rheumatoid arthritis. Arthritis Rheum. 2004;51(2):222–7.PubMedCrossRef
12.
Weiss PF, Beukelman T, Schanberg LE, et al. Enthesitis-related arthritis is associated with higher pain intensity and poorer health status in comparison with other categories of juvenile idiopathic arthritis: the Childhood Arthritis and Rheumatology Research Alliance Registry. J Rheumatol. 2012;39(12):2341–51.PubMedCentralPubMedCrossRef
13.
Sallfors C, Hallberg LR, Fasth A. Gender and age differences in pain, coping and health status among children with chronic arthritis. Clin Exp Rheumatol. 2003;21(6):785–93.PubMed
14.
15.
Munro J, Singh-Grewal D. Juvenile idiopathic arthritis and pain – more than simple nociception. J Rheumatol. 2013;40(7):1037–9.PubMedCrossRef
16.
Hogeweg JA, Kuis W, Huygen AC, et al. The pain threshold in juvenile chronic arthritis. Br J Rheumatol. 1995;34(1):61–7.PubMedCrossRef
17.
Thastum M, Zachariae R, Herlin T. Pain experience and pain coping strategies in children with juvenile idiopathic arthritis. J Rheumatol. 2001;28(5):1091–8.PubMed
18.
Leegaard A, Lomholt JJ, Thastum M, et al. Decreased pain threshold in juvenile idiopathic arthritis: a cross-sectional study. J Rheumatol. 2013;40(7):1212–7.PubMedCrossRef
19.
Connelly M, Anthony KK, Sarniak R, et al. Parent pain responses as predictors of daily activities and mood in children with juvenile idiopathic arthritis: the utility of electronic diaries. J Pain Symptom Manage. 2010;39(3):579–90.PubMedCentralPubMedCrossRef
20.
Ringold S, Beukelman T, Nigrovic PA, et al. Race, ethnicity, and disease outcomes in juvenile idiopathic arthritis: a cross-sectional analysis of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. J Rheumatol. 2013;40(6):936–42.PubMedCrossRef
21.
Henderson CJ, Specker BL, Sierra RI, et al. Total-body bone mineral content in non-corticosteroid-treated postpubertal females with juvenile rheumatoid arthritis: frequency of osteopenia and contributing factors. Arthritis Rheum. 2000;43(3):531–40.PubMedCrossRef
22.
Zak M, Hassager C, Lovell DJ, et al. Assessment of bone mineral density in adults with a history of juvenile chronic arthritis: a cross-sectional long-term followup study. Arthritis Rheum. 1999;42(4):790–8.PubMedCrossRef
23.
Haugen M, Lien G, Flato B, et al. Young adults with juvenile arthritis in remission attain normal peak bone mass at the lumbar spine and forearm. Arthritis Rheum. 2000;43(7):1504–10.PubMedCrossRef
24.
Sawyer MG, Whitham JN, Roberton DM, et al. The relationship between health-related quality of life, pain and coping strategies in juvenile idiopathic arthritis. Rheumatology. 2004;43(3):325–30.PubMedCrossRef
25.
Haverman L, Grootenhuis MA, van den Berg JM. Predictors of health-related quality of life in children and adolescents with juvenile idiopathic arthritis: results from a Web-based survey. Arthritis Care Res. 2012;64(5):694–703.CrossRef
26.
Dhanani S, Quenneville J, Perron M, et al. Minimal difference in pain associated with change in quality of life in children with rheumatic disease. Arthritis Rheum. 2002;47(5):501–5.PubMedCrossRef
27.
Shaw KL, Southwood TR, Duffy CM, et al. Health-related quality of life in adolescents with juvenile idiopathic arthritis. Arthritis Rheum. 2006;55(2):199–207.PubMedCrossRef
28.
Stinson JN, Stevens BJ, Feldman BM, et al. Construct validity of a multidimensional electronic pain diary for adolescents with arthritis. Pain. 2008;136(3):281–92.PubMedCrossRef
29.
Lovell DJ, Athreya B, Emery HM, et al. School attendence and patter: special services and special needs in pediatric patients with rheumatic diseases. Arthritis Care Res. 1990;3:196.
30.
Aasland A, Flato B, Vandvik IH. Psychosocial outcome in juvenile chronic arthritis: a nine-year follow-up. Clin Exp Rheumatol. 1997;15(5):561–8.PubMed
31.
Ostlie IL, Aasland A, Johansson I, et al. A longitudinal follow-up study of physical and psychosocial health in young adults with chronic childhood arthritis. Clin Exp Rheumatol. 2009;27(6):1039–46.PubMed
32.
Butbul Aviel Y, Stremler R, Benseler SM, et al. Sleep and fatigue and the relationship to pain, disease activity and quality of life in juvenile idiopathic arthritis and juvenile dermatomyositis. Rheumatology. 2011;50(11):2051–60.PubMedCrossRef
33.
Stinson JN, Hayden JA, Ahola Kohut S, et al. Sleep problems and associated factors in children with juvenile idiopathic arthritis: a systematic review. Pediatr Rheumatol Online J. 2014;12:19.PubMedCentralPubMedCrossRef
34.
Bromberg MH, Gil KM, Schanberg LE. Daily sleep quality and mood as predictors of pain in children with juvenile polyarticular arthritis. Health Psychol. 2012;31(2):202–9.PubMedCentralPubMedCrossRef
35.
Packham JC, Hall MA. Long-term follow-up of 246 adults with juvenile idiopathic arthritis: functional outcome. Rheumatology. 2002;41(12):1428–35.PubMedCrossRef
36.
Peterson LS, Mason T, Nelson AM, et al. Psychosocial outcomes and health status of adults who have had juvenile rheumatoid arthritis: a controlled, population-based study. Arthritis Rheum. 1997;40(12):2235–40.PubMedCrossRef
37.
38.
39.
Lovell DJ, Passo MH, Beukelman T, et al. Measuring process of arthritis care: a proposed set of quality measures for the process of care in juvenile idiopathic arthritis. Arthritis Care Res. 2011;63(1):10–6.CrossRef
40.
Melzack R. The McGill pain questionnaire: major properties and scoring methods. Pain. 1975;1:277e99.
41.
Hayes M, Patterson D. Experimental development of the graphic rating method. Psychol Bull. 1921;18:98–9.
42.
43.
Stinson JN, Kavanagh T, Yamada J, et al. Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents. Pain. 2006;125:143–57.PubMedCrossRef
44.
Gonzalez-Fernandez M, Ghosh N, Ellison T, et al. Moving beyond the limitations of the visual analog scale for measuring pain: novel use of the general labeled magnitude scale in a clinical setting. Am J Phys Med Rehabil. 2014;93(1):75–81.PubMedCrossRef
45.
von Baeyer CL. Numerical rating scale for self-report of pain intensity in children and adolescents: recent progress and further questions. Eur J Pain. 2009;13(10):1005–7.CrossRef
46.
Filocamo G, Davi S, Pistorio A, et al. Evaluation of 21-numbered circle and 10-centimeter horizontal line visual analog scales for physician and parent subjective ratings in juvenile idiopathic arthritis. J Rheumatol. 2010;37:1534–41.PubMedCrossRef
47.
Hicks CL, von Baeyer CL, Spafford P, et al. The faces pain scale—revised: toward a common metric in pediatric pain measurement. Pain. 2001;93:173–83.PubMedCrossRef
48.
Goodenough B, Addicoat L, Champion GD, et al. Pain in 4- to 6-year-old children receiving intramuscular injections: a comparison of the faces pain scale with other self-report and behavioral measures. Clin J Pain. 1997;13:60–73.PubMedCrossRef
49.
Hester NK. The preoperational child’s reaction to immunization. Nurs Res. 1979;28:250–5.PubMed
50.
Gharaibeh M, Abu-Saad H. Cultural validation of pediatric pain assessment tools: Jordanian perspective. J Transcult Nurs. 2002;13:12–8.PubMedCrossRef
51.
Suraseranivongse S, Montapaneewat T, Manon J, et al. Cross-validation of a self-report scale for postoperative pain in school-aged children. J Med Assoc Thai. 2005;88:412–8.PubMed
52.
Tomlinson D, von Baeyer CL, Stinson JN, et al. A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics. 2010;126(5):e1168–98.PubMedCrossRef
53.
Merkel SI, Voepel-Lewis T, Shayevitz JR, et al. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nursing. 1997;23:293–7.
54.
Stinson JN, Stevens BJ, Feldman BM, et al. Construct validity of a multidimensional electronic pain diary for adolescents with arthritis. Pain. 2008;136:281–92.PubMedCrossRef
55.
56.
Varni JW, Thompson KL, Hanson V. The Varni/Thompson Pediatric Pain Questionnaire: I. Chronic musculoskeletal pain in juvenile rheumatoid arthritis. Pain. 1987;28:27–38.PubMedCrossRef
57.
Lomholt JJ, Thastum M, Herlin T. Pain experience in children with juvenile idiopathic arthritis treated with anti-TNF agents compared to non-biologic standard treatment. Pediatr Rheumatol Online J. 2013;11(1):21.PubMedCentralPubMedCrossRef
58.
Consolaro A, Ravelli A. Paediatric rheumatology: Juvenile idiopathic arthritis: Are biologic agents effective for pain? Nat Rev Rheumatol. 2013;9(8):447–8.PubMedCrossRef
59.
60.
Stinson JN, Petroz GC, Tait G, et al. e-Ouch: usability testing of an electronic chronic pain diary for adolescents with arthritis. Clin J Pain. 2006;22(3):295–305.PubMedCrossRef
61.
Luca N, Stinson JN, Benseler SM, et al. Reliability and responsivenss of the standardized universal pain evaluations for rheumatology providers for children and youth (SUPER-KIDZ). Arthritis Rheum. 2013;6(10):S1193.
62.
Lalloo C, Stinson JN, Brown SC, Campbell F, Isaac L, Henry JL. Pain-QuILT: assessing clinical feasibility of a web-based tool for the visual self-report of pain in an interdisciplinary pediatric chronic pain clinic. Clin J Pain. 2014;30(11):934–43.
63.
Stinson JN, Stevens BJ, Feldman BM, et al. Construct validity of a multidimensional electronic pain diary for adolescents with arthritis. Pain. 2008;136:128–92.CrossRef
64.
Stinson JN, Connelly M, Jibb LA, et al. Developing a standardized approach to the assessment of pain in children and youth presenting to pediatric rheumatology providers: a Delphi survey and consensus conference process followed by feasibility testing. Pediatr Rheumatol Online J. 2012;10(1):7.PubMedCentralPubMedCrossRef
65.
66.
Nicholls A, Hazleman B, Todd RM, et al. Long-term evaluation of naproxen suspension in juvenile chronic arthritis. Curr Med Res Opin. 1982;8(3):204–7.PubMedCrossRef
67.
68.
69.
Ruperto N, Nikishina I, Pachanov ED, et al. A randomized, double-blind clinical trial of two doses of meloxicam compared with naproxen in children with juvenile idiopathic arthritis: short- and long-term efficacy and safety results. Arthritis Rheum. 2005;52(2):563–72.PubMedCrossRef
70.
Goodman S, Howard P, Haig A, et al. An open label study to establish dosing recommendations for nabumetone in juvenile rheumatoid arthritis. J Rheumatol. 2003;30(4):829–31.PubMed
71.
72.
Riddle R, Ryser CN, Morton AA, et al. The impact on health-related quality of life from non-steroidal anti-inflammatory drugs, methotrexate, or steroids in treatment for juvenile idiopathic arthritis. J Pediatr Psychol. 2006;31(3):262–71.PubMedCrossRef
73.
Kimura Y, Walco GA. Treatment of chronic pain in pediatric rheumatic disease. Nat Clin Pract Rheumatol. 2007;3(4):210–8.PubMedCrossRef
74.
Brostrom E, Hagelberg S, Haglund-Akerlind Y. Effect of joint injections in children with juvenile idiopathic arthritis: evaluation by 3D-gait analysis. Acta Paediatr. 2004;93(7):906–10.PubMedCrossRef
75.
Wallen M, Gillies D. Intra-articular steroids and splints/rest for children with juvenile idiopathic arthritis and adults with rheumatoid arthritis. Cochrane Database Syst Rev. 2006;1:CD002824.PubMed
76.
Mina R, Melson P, Powell S, et al. Effectiveness of dexamethasone iontophoresis for temporomandibular joint involvement in juvenile idiopathic arthritis. Arthritis Care Res. 2011;63(11):1511–6.CrossRef
77.
Beukelman T, Patkar NM, Saag KG, et al. American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res. 2011;63(4):465–82.CrossRef
78.
Giannini EH, Ruperto N, Ravelli A, et al. Preliminary definition of improvement in juvenile idiopathic arthritis. Arthritis Rheum. 1997;40(7):1202–9.PubMedCrossRef
79.
Cespedes-Cruz A, Gutierrez-Suarez R, Pistorio A, et al. Methotrexate improves the health-related quality of life of children with juvenile idiopathic arthritis. Ann Rheum Dis. 2008;67(3):309–14.PubMedCrossRef
80.
Prince FH, Geerdink LM, Borsboom GJ, et al. Major improvements in health-related quality of life during the use of etanercept in patients with previously refractory juvenile idiopathic arthritis. Ann Rheum Dis. 2010;69(1):138–42.PubMedCrossRef
81.
Ruperto N, Lovell DJ, Li T, et al. Abatacept improves health-related quality of life, pain, sleep quality, and daily participation in subjects with juvenile idiopathic arthritis. Arthritis Care Res. 2010;62(11):1542–51.CrossRef
82.
Anthony KK, Schanberg LE. Pediatric pain syndromes and management of pain in children and adolescents with rheumatic disease. Pediatr Clin N Am. 2005;52(2):611–639, vii.
83.
Connelly M, Schanberg L. Opioid therapy for the treatment of refractory pain in children with juvenile rheumatoid arthritis. Nat Clin Pract Rheumatol. 2006;2(12):636–7.PubMedCrossRef
84.
Palermo TM, Eccleston C, Lewandowski AS, et al. Randomized controlled trails of psychological therapies for management of chronic pain in children and adolescents: an updated meta-analytic review. Pain. 2010;148(3):387–97.PubMedCentralPubMedCrossRef
85.
Eccleston C, Palermo TM, Williams AC, Lewandowski Holley A, Morley S, Fisher E, Law E. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev. 2014;5:CD003968.
86.
Anthony KK, Schanberg LE. Pediatric pain syndromes and management of pain in children and adolescents with rheumatic disease. Pediatr Clin North Am. 2005;52:611–39.PubMedCrossRef
87.
Tupper SM, Rosenberg AM, Pahwa P, et al. Pain intensity variability and its relationship with quality of life in youths with juvenile idiopathic arthritis. Arthritis Care Res. 2013;65:563–70.CrossRef
88.
Coda A, Fowlie PW, Davidson JE, et al. Foot orthoses in children with juvenile idiopathic arthritis: a randomised controlled trial. Arch Dis Child. 2014;99:649–51.PubMedCrossRef
89.
Feldman DE, Duffy C, De Civita M, et al. Factors associated with the use of complementary and alternative medicine in juvenile idiopathic arthritis. Arthritis Rheum. 2004;51(4):527–32.PubMedCrossRef
90.
Toupin April K, Walji R. The state of research on complementary and alternative medicine in pediatric rheumatology. Rheum Dis Clin N Am. 2001;37(1):85–94.CrossRef
Metadata
Title
Assessment and Management of Pain in Juvenile Idiopathic Arthritis
Authors
Jennifer E. Weiss
Nadia J. C. Luca
Alexis Boneparth
Jennifer Stinson
Publication date
01-12-2014
Publisher
Springer International Publishing
Published in
Pediatric Drugs / Issue 6/2014
Print ISSN: 1174-5878
Electronic ISSN: 1179-2019
DOI
https://doi.org/10.1007/s40272-014-0094-0

Other articles of this Issue 6/2014

Pediatric Drugs 6/2014 Go to the issue

Acknowledgement to Referees

Acknowledgement to Referees

Original Research Article

Optimized Antimicrobial Dosing Strategies: A Survey of Pediatric Hospitals

Review Article

Omalizumab in Children

Therapy in Practice

Pharmacological Treatment of Chronic Non-Cancer Pain in Pediatric Patients

Review Article

Hidradenitis Suppurativa in Children and Adolescents: A Review of Treatment Options

Systematic Review

The Role of Chemotherapy for Metastatic, Relapsed and Refractory Osteosarcoma