Pain Syndromes


Lead Author(s): 

Scott B. Rosenfeld, MD
Brielle Payne Plost, MD

Supporting Author(s): 

Sylvia I. Watkins-Castillo, PhD

Musculoskeletal pain syndromes, including amplified musculoskeletal pain or juvenile fibromyalgia, chronic regional pain syndrome (reflex sympathetic dystrophy), benign hypermobility, and benign limb pains, are common diagnoses in the pediatric population. A systematic review examining the prevalence of chronic musculoskeletal pain found a range of prevalence rates between 4% and 40% in children. Rates were generally higher in girls and increased with age.1 It is estimated that 5% to 8% of new patients presenting to North American pediatric rheumatologists have a musculoskeletal pain syndrome.2

Amplified musculoskeletal pain can be localized or diffuse. Diffuse pain involving at least three major body parts for at least 3 months is seen in the diffuse type. Fibromyalgia is a subset of diffuse amplified musculoskeletal pain. Patients also typically have sleep disturbance and other somatic complaints, such as headaches and abdominal pain. Reflex sympathetic dystrophy (RSD), now called complex regional pain syndrome (CRPS), is a form of amplified pain in which autonomic dysfunction develops in an extremity, often following injury or trauma. The affected limb becomes swollen, discolored, and cold, and the area can be very painful with light touch (allodynia). The recommended treatment for these conditions includes restoring normal sleep patterns, a therapy program with a focus on exercise and desensitization, and cognitive behavioral therapy. Some patients require treatment in an in-patient setting. For further information see Childhood RND Educational Foundation, Inc., available at

Benign limb pains, sometimes referred to as “growing pains,” are most common in children age 2 to 5 years. Children with benign limb pains tend to complain of pain at night, often awaking from sleep due to pain. These symptoms tend to resolve with age.

Benign hypermobility is diagnosed in patients who have hypermobile joints3, without an underlying connective disuse disorder. This condition is common, affecting 8% to 20% of White populations. Anterior knee pain and back pain are more common in hypermobile vs non-hypermobile individuals.2

Healthcare Utilization

Pain syndromes were diagnosed in more than 2.7 million children and adolescent healthcare visits in 2013, of which 63% (1.8 million) had a primary diagnosis of a pain syndrome. Less the 1% of children and adolescents with any pain syndrome diagnoses were hospitalized (20,000), while a tiny fraction (1,700) with a primary diagnosis had a hospital discharge. Two-thirds (65%) of children and adolescents with a pain syndrome diagnosis were seen in physicians’ offices. (Reference Table 7C.1.1 PDF CSV and Table 7C.1.2 PDF CSV)

Females were hospitalized with a pain syndrome diagnosis in slightly higher numbers than males, both for any diagnoses and as a primary diagnosis. Pain syndrome diagnoses increase as a contributing diagnosis in older children, but as a primary diagnosis was greatest between 14 and 17 years old followed by 5 to 13 years old.

Any diagnoses of pain syndrome accounted for just over 4% of hospitalizations for any musculoskeletal condition diagnosis, and 0.3% of all hospitalizations for any healthcare condition. Hospitalizations with a primary diagnosis of pain syndrome were 0.3% of all musculoskeletal diagnoses and a tiny portion of hospitalizations for any health condition diagnosis. (Reference Table 7C.12 PDF CSV)

Hospital Charges

Total charges averaged $48,900 for a mean 6.1-day stay when children and adolescents were hospitalized with any diagnosis of a pain syndrome along with other medical conditions. With a primary pain syndrome diagnosis, the stay was shorter (3.1 days), and mean charges about half that of pain syndrome as a contributing condition ($25,800).

Sex was not a significant factor in length of hospital stay and average charges for a medical problem with a musculoskeletal pain syndrome diagnosis. In patients with a primary diagnosis of a pain syndrome, the average length of hospital stays (4.5 days) and average cost ($40,000) was highest among patients ages 10 to 13. Total hospital charges for primary pain syndrome diagnosis discharges in 2013 were $43.9 million. (Reference Table 7C.12 PDF CSV)


  • 1. King S, Chambers CT, Huquet A, et al. The epidemiology of chronic pain in children and adolescents revisited: A systematic review. Pain 2011;152(12):2729-2738.
  • 2. a. b. Cassidy JT, Petty RE, Laxer RM, Lindsley CB. Textbook of Pediatric Rheumatology, 6th ed. 2010. Elsevier Inc, Philadelphia, PA.
  • 3. Hypermobile joints extend easily and painlessly beyond the normal range of motion. Hypermobility of the joints occurs when the tissues holding a joint together—mainly ligaments—are too loose. Often, weak muscles around the joint also contribute to hypermobility. The joints most often affected are the knees, shoulders, elbows, wrists, and fingers. Hypermobility is a common condition, especially in children, since their connective tissues are not completely developed.


  • Fourth Edition

Chapter Graphs

To save an individual graph, right-click and select Save Image As

Topic Tables

Click on an image to view PDF