Overview of neurodevelopment and pain research, possible treatment targets

Pain is a common presenting and often persistent symptom for children with rheumatological disease. Pain is not clearly related to disease severity in children with inflammatory juvenile idiopathic arthritis, and presentations of non-inflammatory musculoskeletal pain are common but there is limited evidence to guide management. Pain assessment must extend beyond measures of pain severity to more fully evaluate characteristics of pain, functional impact and psychosocial effects and family interactions. Evaluation of mechanisms of joint pain in adults has identified potential treatment targets, but additional studies are required as the acute and long-term impacts of pain and injury change during postnatal development. Genotyping, sensory evaluation and neuroimaging may better characterize chronic musculoskeletal pain, identify high-risk groups and/or provide additional outcome measures to monitor disease and treatment progress. An integrated approach to management is required to effectively select and target interventions, reduce pain and disability and improve long-term outcome.