Causes
Growing pain is probably a misnomer because the pains are not associated with physiological growth. There appears to be no correlation between the occurrence of growing pains and the rapid phase of growth, epiphyseal closure, or hormonal changes. Perhaps this term is used because the condition occurs in growing people and does not usually occur in adulthood (after cessation of growth). An extension of the syndrome in adults may include restless leg syndrome.
Growing pain is probably a misnomer because the pains are not associated with physiological growth. There appears to be no correlation between the occurrence of growing pains and the rapid phase of growth, epiphyseal closure, or hormonal changes. Perhaps this term is used because the condition occurs in growing people and does not usually occur in adulthood (after cessation of growth). An extension of the syndrome in adults may include restless leg syndrome.
Incidence
It appears that the prevalence of growing pains is between 4.2 and 33.6%; however, this wide range is dependent on the criteria utilized for diagnosis. The low incidence reported by Naish and Apley was indicative of their stricter criteria: recurrent pain lasting at least 3 months and causing disruption of normal daily activities.
Pathogenesis
The pathogenesis of growing pain is unknown. Many etiologies have been suggested, including orthopedic deformities, postural abnormalities, and psychosocial problems. Studies have shown that there is a familial incidence of growing pains and emotional disturbances. Oster reported that 39.2% of the children had multiple symptoms, with headache or abdominal pain in addition to the limb pain. Apley suggested that recurrent limb pains were perhaps an expression of a reaction pattern that might partly reflect an emotional disturbance or might reflect part of a familial pattern of pain reactivity.
It appears that the prevalence of growing pains is between 4.2 and 33.6%; however, this wide range is dependent on the criteria utilized for diagnosis. The low incidence reported by Naish and Apley was indicative of their stricter criteria: recurrent pain lasting at least 3 months and causing disruption of normal daily activities.
Pathogenesis
The pathogenesis of growing pain is unknown. Many etiologies have been suggested, including orthopedic deformities, postural abnormalities, and psychosocial problems. Studies have shown that there is a familial incidence of growing pains and emotional disturbances. Oster reported that 39.2% of the children had multiple symptoms, with headache or abdominal pain in addition to the limb pain. Apley suggested that recurrent limb pains were perhaps an expression of a reaction pattern that might partly reflect an emotional disturbance or might reflect part of a familial pattern of pain reactivity.
Clinical Characterisitics
Growing pains are characterized as deep aching located in nonarticular sites, primarily within the muscle groups. The pain is typically bilateral, usually occurring late in the day or the evening. The pain is not associated with limping or limited mobility. There is no history of trauma or infection, and objective findings are lacking on physical examination. The areas most frequently involved include the thighs, calves, popliteal fossae, and, occasionally, the forearms and trunk. Rarely the pain is located in the periarticular tissues. The complaint of intrinsic joint pain should not be misdiagnosed as growing pains, but rather should herald a thorough investigation for causes of articular pain, such as infection, neoplasm, connective tissue diseases, and orthopedic and endocrine disorders.
Growing pains may occur during the day or evening, and occasionally may awaken the child from sleep. In contrast to patients with JRA, these children are usually asymptomatic in the morning. Occasionally, the child may complain of heaviness in the legs on arising. Naish and Apley divided growing pains into three groups: diurnal, nocturnal, and ill-defined. The diurnal pains usually occur during the day and are aggravated by exertion. The pain may bring the child in from play. Children in this group had a strong family history of “rheumatism†or adult variants of fibromyalgia and an association with psychological problems.
The nocturnal pain group had pain that awakened them from sleep. The discomfort tended to be severe, rapid in onset, and of short duration. These children had fewer psychological problems than those in the diurnal group. The patients with ill-defined pains had no clear distinction between diurnal and nocturnal pains.
The parents report no swelling, color changes, or warmth of the affected limb. The physical examination is likewise unrevealing.
Diagnosis
Roentgenograms and laboratory tests are sometimes necessary to alleviate parental concern. These tests include erythrocyte sedimentation rate, complete blood count, muscle enzyme determination, and serologic tests that are uniformly negative.
Growing pains are characterized as deep aching located in nonarticular sites, primarily within the muscle groups. The pain is typically bilateral, usually occurring late in the day or the evening. The pain is not associated with limping or limited mobility. There is no history of trauma or infection, and objective findings are lacking on physical examination. The areas most frequently involved include the thighs, calves, popliteal fossae, and, occasionally, the forearms and trunk. Rarely the pain is located in the periarticular tissues. The complaint of intrinsic joint pain should not be misdiagnosed as growing pains, but rather should herald a thorough investigation for causes of articular pain, such as infection, neoplasm, connective tissue diseases, and orthopedic and endocrine disorders.
Growing pains may occur during the day or evening, and occasionally may awaken the child from sleep. In contrast to patients with JRA, these children are usually asymptomatic in the morning. Occasionally, the child may complain of heaviness in the legs on arising. Naish and Apley divided growing pains into three groups: diurnal, nocturnal, and ill-defined. The diurnal pains usually occur during the day and are aggravated by exertion. The pain may bring the child in from play. Children in this group had a strong family history of “rheumatism†or adult variants of fibromyalgia and an association with psychological problems.
The nocturnal pain group had pain that awakened them from sleep. The discomfort tended to be severe, rapid in onset, and of short duration. These children had fewer psychological problems than those in the diurnal group. The patients with ill-defined pains had no clear distinction between diurnal and nocturnal pains.
The parents report no swelling, color changes, or warmth of the affected limb. The physical examination is likewise unrevealing.
Diagnosis
Roentgenograms and laboratory tests are sometimes necessary to alleviate parental concern. These tests include erythrocyte sedimentation rate, complete blood count, muscle enzyme determination, and serologic tests that are uniformly negative.
Treatment
The treatment for this condition is empirical. One may prescribe heat, massage, analgesics such as nonsteroidal anti-inflammatory agents or acetaminophen, The parents and the child should be reassured that there is no serious organic disease and that the problem will not progress to arthritis or to other deforming conditions, despite its recurrent nature. It is helpful to explore the family situation in a search for psychosocial stress, which may give the physician insight into the family dynamics and parent child interaction. The consensus of opinion is that growing pains have no long-term sequelae and represent a relatively benign condition.
The treatment for this condition is empirical. One may prescribe heat, massage, analgesics such as nonsteroidal anti-inflammatory agents or acetaminophen, The parents and the child should be reassured that there is no serious organic disease and that the problem will not progress to arthritis or to other deforming conditions, despite its recurrent nature. It is helpful to explore the family situation in a search for psychosocial stress, which may give the physician insight into the family dynamics and parent child interaction. The consensus of opinion is that growing pains have no long-term sequelae and represent a relatively benign condition.
Possibly linked to joint hypermobility
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