COMMENTARY—Chronic Widespread Pain and Small-Fiber Polyneuropathy

The word pain originates from the Latin word poena, meaning punishment, an accurate descriptor of how chronic pain affects the daily lives of millions of afflicted individuals. A 2011 Institute of Medicine report, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research, states that pain costs American society $560 to $635 billion annually, figures based on both health care costs and lost productivity. Pain has an immense impact on quality of life, with high rates of depression, suicidal ideation, and drug abuse in patients with chronic pain. Although most statistics on pain in America are based on individuals age 21 or older, the incidence of pain in children and adolescents may be as high as 20%.¹

In the current issue of Pediatrics, Drs. Oaklander and Klein address a poorly recognized but important national health problem: chronic pain in children and teenagers. In a study of 41 subjects averaging 12 years of age with chronic widespread pain, the researchers report clear functional and pathologic evidence of small-fiber neuropathy in all but one child with objective treatment responses to immunomodulatory therapy. Their findings provide physicians the data required for evidence-based decisions on not only the diagnostic work-up, but also the treatment of children with chronic widespread pain. It is imperative that the medical community listen to Drs. Oaklander and Klein and recognize chronic widespread pain in children as a diagnosable small-fiber neuropathy with clear treatment options.

—Eva L. Feldman, MD, PhD
Russell N. DeJong Professor of Neurology
Director, A. Alfred Taubman Medical Research Institute
Director, Program for Neurology Research and Discovery
University of Michigan, Ann Arbor

Reference
1. Institute of Medicine of the National Academies. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: National Academies Press; 2011.

The word pain originates from the Latin word poena, meaning punishment, an accurate descriptor of how chronic pain affects the daily lives of millions of afflicted individuals. A 2011 Institute of Medicine report, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research, states that pain costs American society $560 to $635 billion annually, figures based on both health care costs and lost productivity. Pain has an immense impact on quality of life, with high rates of depression, suicidal ideation, and drug abuse in patients with chronic pain. Although most statistics on pain in America are based on individuals age 21 or older, the incidence of pain in children and adolescents may be as high as 20%.¹

In the current issue of Pediatrics, Drs. Oaklander and Klein address a poorly recognized but important national health problem: chronic pain in children and teenagers. In a study of 41 subjects averaging 12 years of age with chronic widespread pain, the researchers report clear functional and pathologic evidence of small-fiber neuropathy in all but one child with objective treatment responses to immunomodulatory therapy. Their findings provide physicians the data required for evidence-based decisions on not only the diagnostic work-up, but also the treatment of children with chronic widespread pain. It is imperative that the medical community listen to Drs. Oaklander and Klein and recognize chronic widespread pain in children as a diagnosable small-fiber neuropathy with clear treatment options.

—Eva L. Feldman, MD, PhD
Russell N. DeJong Professor of Neurology
Director, A. Alfred Taubman Medical Research Institute
Director, Program for Neurology Research and Discovery
University of Michigan, Ann Arbor

Reference
1. Institute of Medicine of the National Academies. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: National Academies Press; 2011.

The word pain originates from the Latin word poena, meaning punishment, an accurate descriptor of how chronic pain affects the daily lives of millions of afflicted individuals. A 2011 Institute of Medicine report, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research, states that pain costs American society $560 to $635 billion annually, figures based on both health care costs and lost productivity. Pain has an immense impact on quality of life, with high rates of depression, suicidal ideation, and drug abuse in patients with chronic pain. Although most statistics on pain in America are based on individuals age 21 or older, the incidence of pain in children and adolescents may be as high as 20%.¹

In the current issue of Pediatrics, Drs. Oaklander and Klein address a poorly recognized but important national health problem: chronic pain in children and teenagers. In a study of 41 subjects averaging 12 years of age with chronic widespread pain, the researchers report clear functional and pathologic evidence of small-fiber neuropathy in all but one child with objective treatment responses to immunomodulatory therapy. Their findings provide physicians the data required for evidence-based decisions on not only the diagnostic work-up, but also the treatment of children with chronic widespread pain. It is imperative that the medical community listen to Drs. Oaklander and Klein and recognize chronic widespread pain in children as a diagnosable small-fiber neuropathy with clear treatment options.

—Eva L. Feldman, MD, PhD
Russell N. DeJong Professor of Neurology
Director, A. Alfred Taubman Medical Research Institute
Director, Program for Neurology Research and Discovery
University of Michigan, Ann Arbor

Reference
1. Institute of Medicine of the National Academies. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: National Academies Press; 2011.