Experience of Chronic (Non-malignant) Musculoskeletal Pain of French Adolescent and Young Adult: a Qualitative Research With Their Physicians and Non-medical Practitioners

Overview

The purpose of this study is to explore the perspectives of health professionals on chronic (non-malignant) musculoskeletal pain in adolescence and young adulthood. The prevalence of this pain symptom is rising for ten years, and most of the time the diagnosis is complex. Health professionals have to differentiate between the continuing activity of a somatic problem, some painful sequelae, a low threshold for the perception of pain, and psychological symptoms with somatic expression. Diagnosis in this case takes time, and is a matter of trained specialists. No protocol exists to assess the sub-clinical symptoms which will be used to help doing this complex task. This qualitative study will elicit the perspectives of trained specialists on this diagnosis: how do they deal with these patients? What signs and symptoms helps them? The results will present their clinical experiences. The overall goal is to construct the first chronic musculoskeletal pain multidimensional scale that will help the practitioners with this complex diagnosis.

Recent research suggests that musculoskeletal pain may be the most common complaint for which children are referred to a pediatric rheumatologist and is present in approximately 50% of all new patients. A small percentage of these patients will be diagnosed with a form of juvenile idiopathic arthritis (JIA), which is marked by clinically significant pain. A larger percentage will be diagnosed with a musculoskeletal pain syndrome, that approximately 25% of them are chronic and defined as \> = 3 months. The chronic pain symptom is a subjective one that professionals have to precise its outlines in term of semiology, nature and efficacity of past treatments, medical and family backgrounds. The professional then will have to pinpoint a diagnosis, while assessing the consequences of the pain and treating it. Most of the time this task is a complex one and professionals have to build their diagnostic on a body of clinical, paraclinical and more social, familial and psychological evidences. No clear protocol exists to help the professionals with differentiating the continuing activity of a somatic problem, some painful sequelae, a low threshold for the perception of pain, and psychological symptoms with somatic expression. This diagnostic process is lying on sub-clinical symptoms that investigators have to elicit in order to help professionals to better support their patients. This qualitative study will explore the daily clinical experience of the health professionals involved in the care of adolescents suffering from chronic musculoskeletal pain. Semi-structured interviews will be analyzed with a phenomenological approach (interpretative phenomenological analysis). The rich phenomenological description will be the first step of a more ambitious project of constructing a multidimensional scale that will help the practitioners with this complex diagnosis.