Background: Childhood chronic musculoskeletal pain affects the lower limbs more than any other part of the body[1]. Children with chronic lower limb pain may experience delayed diagnosis, misdiagnosis, or insufficient or inappropriate treatment initiation or type[2]. This pain may be primary or secondary to other health conditions.

Our team was funded by the Medical Research Future Fund in Australia to understand how we can better support clinical care through the development of consistent approaches when assessing, diagnosing and treating children who have chronic musculoskeletal lower limb pain.

Objectives: To identify the breadth of conditions reported in peer-reviewed literature that may result in chronic musculoskeletal lower limb pain in children and adolescents and prioritise the top 10 of these conditions that would benefit from the development of clinical practice guidelines.

Methods: Five electronic databases were searched (Medline, EMBASE, PsycINFO, CINAHL, and the Cochrane Library) for articles involving children under 18 years and reporting on chronic musculoskeletal pain of the lower limb. All studies were screened for eligibility by two reviewers. Extracted data items included study characteristics, lower limb location of pain, and specific condition(s) that were reported to be associated with chronic musculoskeletal pain of the lower limb.

Secondly, a modified two round Delphi with a final confirmatory round was conducted. Three separate panels (allied health professionals, medical specialists, and general practitioners) initially rated their agreement on the need for clinical practice guidelines for all conditions found in the scoping review, and then ranked the top 10 conditions requiring guideline development. In the final confirmatory round, parents of children with chronic lower limb musculoskeletal pain rated the appropriateness of the development of guidelines for the top 10 conditions.

Results: From 10,951 records, 384 papers were included. There were 124 unique conditions associated with chronic lower limb pain, the most common being chronic widespread musculoskeletal pain (21 studies) and juvenile idiopathic arthritis (24 studies). For the prioritisation modified Delphi, 42 health professionals (22 allied health, 7 medical specialists, and 13 general practitioners) across Australia participated in Rounds 1 and 2 with a retention rate of 100%. Sixteen parents participated in a confirmatory Round 3. All 124 conditions were presented to the health professional panel for rating in Round 1, with the top 10 ranked in Round 2. The top 10 conditions prioritised for clinical practice guideline development relating to chronic pain were generalised joint hypermobility, growing pains, musculoskeletal pain, juvenile idiopathic arthritis, joint instability, avascular necrosis, Legg-Calve-Perthes disease, flat foot, slipped capital femoral epiphysis, and patellofemoral pain syndrome.

Conclusion: There was a breadth of conditions associated with chronic musculoskeletal lower limb pain in children and adolescents. During this process, the limited guidance for health professionals to consistently provide evidence-based care in the face of chronic pain was clear. While this research was conducted in Australia, expert health professionals and parents prioritised conditions for guideline development which are likely to have international impact.

REFERENCES: [1] King S, Chambers CT, Huguet A, et al. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain 2011;152(12):2729-38. doi: 10.1016/j.pain.2011.07.016 [published Online First: 2011/11/15].

[2] Shebeshi D, Allingham S, Tardif H, et al. Electronic persistent pain outcomes collaboration annual data report 2021. Australian Health Services Research Institute: University of Wollongong, 2022.

Acknowledgements: Kids Leg Pain Steering Group - Dr Emre Ilhan, A/Prof Jane Munro, Prof Craig Munns, A/Prof Elizabeth Sturgiss, A/Prof Nicole Williams, Dr Louise Tofts, Dr Vance Locke, Prof Terry Haines, Dr Sue Brennan, Prof Stephen Maloney, Dr Mitchell Sarkies, Prof Lisa Nissen, Ms Ornella Clavisi and Mr Dan Miles.

Disclosure of Interests: None declared.