Chronic Pain in Children: Causes and Solutions

The child has previously sprained their ankle, and since then, they have been experiencing intermittent pain in the ankle as well as pain in the lower back?

My boyfriend's daughter, who is in the fifth grade, previously twisted her ankle and only received a few sessions of traditional Chinese medicine massage.
My boyfriend doesn't take this seriously, and when the child complains of foot pain, he just tells her to use over-the-counter pain relief patches.
She is unable to run or participate in sports events and has not been active.
Now in the second year of junior high school, she is 165 cm tall and weighs about 80 kg.
She used to spend a lot of time lying in bed playing on her tablet and phone.
I wonder if her poor posture is causing her back pain.
She frequently takes sick leave and often wakes up in the morning complaining of pain (both foot and back pain).
Last week, she even asked her dad to help her get out of bed because the pain was so severe that she couldn't get up.

Can ankylosing spondylitis cause someone to sit for long periods like she does? If she has classes, she sits during those, and when she gets home, she sits to play on the computer, resulting in prolonged sitting.
I sometimes think she might be exaggerating her pain to avoid going to school, but foot and back pain are not visible to the naked eye.
This situation is also awkward for her school teacher, as she frequently takes leave.
Is it possible that she doesn't feel pain when playing on the computer at home? She has G6PD deficiency, and her biological mother has diabetes.
Initially, I wondered if there could be a hereditary link to diabetes.
She doesn't eat vegetables and doesn't exercise, and during elementary school, her sleep schedule was irregular, often staying up until two or three in the morning.
I feel that her risk of developing diabetes is quite high.
Diabetes can also cause foot pain symptoms; she previously mentioned that her foot hurts when she moves it.
Today, she said that she feels pain every time she gets up.

She takes leave to play on the computer, and I question the difference between sitting online and sitting in class.
She takes leave too often, making it hard to believe she isn't lying.
I have already suggested that her father take her for diabetes testing, but he thinks it's unlikely.
I would like to know how much it costs to test for diabetes and ankylosing spondylitis.
During the first year of junior high school, her school health check revealed issues with her limbs.
Although she says her foot hurts, it doesn't seem to be to the extent that she can't walk.
We need to identify the underlying cause of her symptoms to justify her absences.
She doesn't want to participate in physical education classes, and her father is reluctant to take her for tests.
We need to find out what the problem is so that she can avoid physical activity in PE class.
Thank you!

Ms. Zhang, 30~39 year old female. Ask Date: 2016/09/20

Dr. Li Yongheng reply Orthopedics

Testing for diabetes and ankylosing spondylitis requires only X-rays and blood tests, both of which are covered by health insurance.
It is recommended to take your child to an orthopedic outpatient clinic for a detailed examination to avoid delaying the diagnosis.
Thank you for your inquiry.

Reply Date: 2016/09/20

More Info

Understanding chronic pain in children can be a complex issue, especially when it involves multiple symptoms and potential underlying conditions. In the case of your boyfriend's daughter, several factors need to be considered to determine the cause of her pain and the best course of action.

First, it is essential to understand that children can experience pain for various reasons, including injuries, growth-related issues, and even psychological factors. In this particular case, the history of a previous ankle injury raises the possibility of chronic pain resulting from that injury. Sometimes, injuries can lead to long-term discomfort if not adequately rehabilitated. It is crucial to ensure that any past injuries are thoroughly evaluated by a healthcare professional, preferably a pediatric orthopedic specialist, who can assess whether there are lingering effects from the injury.

The symptoms described, such as pain upon waking and difficulty participating in physical activities, could also suggest other conditions. For instance, conditions like juvenile idiopathic arthritis or even fibromyalgia can manifest as chronic pain in children. Additionally, the mention of her being sedentary and spending long hours sitting while using electronic devices could contribute to musculoskeletal pain. Poor posture and lack of movement can lead to muscle stiffness and discomfort, particularly in the lower back and legs.

Regarding the concern about ankylosing spondylitis (AS), it is a type of inflammatory arthritis that primarily affects the spine and can cause significant discomfort. While AS is more common in adolescents and young adults, it can present in children as well. Symptoms typically include chronic back pain and stiffness, especially in the morning or after prolonged periods of inactivity. If there is a family history of autoimmune diseases or inflammatory conditions, it may warrant further investigation.

The mention of her having favism (G6PD deficiency) and a family history of diabetes adds another layer of complexity. While G6PD deficiency itself does not directly cause chronic pain, it is essential to monitor her overall health, especially considering her lifestyle choices, such as a lack of physical activity and poor dietary habits. These factors can increase the risk of developing metabolic conditions, including diabetes, which can also lead to symptoms like foot pain.

In terms of management, it is crucial to encourage a more active lifestyle. Regular physical activity can help alleviate pain and improve overall health. Engaging in low-impact exercises, such as swimming or cycling, can be beneficial. Additionally, addressing her posture during sedentary activities is vital. Ergonomic adjustments to her workspace, including proper seating and screen height, can help reduce strain on her back and legs.

As for the diagnostic tests, screening for diabetes typically involves a fasting blood glucose test or an HbA1c test, which measures average blood sugar levels over the past few months. The cost of these tests can vary depending on the healthcare provider and insurance coverage. Similarly, if there is a suspicion of ankylosing spondylitis, a referral to a rheumatologist may be necessary, and imaging studies such as X-rays or MRIs may be recommended to assess spinal health.

In conclusion, it is essential to take her symptoms seriously and seek a comprehensive evaluation from a pediatric specialist. A multidisciplinary approach involving a pediatrician, orthopedic specialist, and possibly a rheumatologist can help identify the underlying cause of her pain and develop an appropriate treatment plan. Encouraging a healthier lifestyle, including regular exercise and a balanced diet, will also be crucial in managing her symptoms and improving her overall well-being.

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