In the outpatient work, parents often lead their children anxiously to the orthopedic department for medical treatment. The children show pain in their limbs at night, which is painful and often wakes up. By the next morning, the symptoms disappear again, and there is usually no positive finding in the clinical examination. This kind of pain bothers children and their parents very much. The most common is the so-called growth pain (the most accurate definition should be: benign idiopathic nocturnal paroxysmal lower limb pain in children).
Wang Shoufeng, deputy chief physician of the orthopaedic bone tumor professional group of Nanjing Gulou Hospital, introduced that the typical growth pain is intermittent, paroxysmal and unfixed pain, which usually occurs 1-2 times a week without fixed time and pattern. The most common location is in front of the knee, lower leg and thigh, occasionally in the groin area, and pain is generally outside the joint. It is mainly muscle pain, not joint or bone pain. The age range is from 4 to 14 years old, and there is no gender difference. Growth pain usually affects 10% to 20% of children.
Deputy Director Wang introduced that growth pain is basically a clinical diagnosis, and the pathogenesis is not very clear at present. Laboratory tests or X-ray films are of little significance for diagnosis, and are mainly used to exclude diagnosis. If other diseases can be excluded and the diagnostic criteria for growth pain are met, growth pain can be basically defined. However, in order to prevent misdiagnosis, it is necessary to exclude related diseases, including 1. Sports injury related diseases: these diseases usually have injury history, and can be diagnosed by carefully asking children about their injury history. 2. Infection related diseases: This kind of disease basically has infection manifestations such as redness, swelling, heat, pain, etc. At the same time, blood routine examination may show increased white blood cells or C-reactive protein. 3. Tumor. 4. Dysplasia or congenital malformation. The most important thing to differentiate is tumor related diseases. If it is a benign tumor, the urgency of diagnosis and treatment is relatively moderate. If it is a malignant tumor, it should be diagnosed and treated in time to avoid delaying the disease.
So, after the diagnosis of growth pain is clear, how to treat it? In this regard, Deputy Director Wang reminded that first, we should correctly understand growth pain. One of the most important treatment methods is to correctly explain the benign characteristics of growth pain. Children and parents must understand that growth pain is a self limiting disease (they will gradually get better) and will not progress to any serious organic disease. A study in Cleveland, the United States, shows that after five years of follow-up observation, about 50% of children with growth pain have lost their pain and returned to normal. Other children have reduced attack frequency, reduced use of pain relievers, and returned to normal school classes. It can be suggested that pain relief drugs should be used to relieve pain during the attack, and non drug treatments such as massage, physical therapy and hot compress can also be used. Because growth pain is intermittent paroxysmal pain, regular or long-term use of pain killers may be harmful to health, so long-term or regular use of drugs is not recommended.
Second, shift your attention. Diverting attention is an effective way for children to ignore pain. Parents can attract children by telling stories, playing games, playing with toys and watching cartoons. Children should be treated more gently and thoughtfully than usual, because parental encouragement and spiritual support are the most important pain relievers for children.
Thirdly, muscle traction training. Based on evidence-based medicine, a randomized controlled trial showed that a muscle traction method can be used to treat growth pain, including quadriceps femoris, hamstring muscles (muscles in front and back of thigh), gastrocnemius and soleus muscles (triceps surae), which can quickly relieve pain. With the help of parents, this training takes 10 minutes every morning and evening.
In addition, orthopedic shoes and other auxiliary measures. Orthopedic shoes and other auxiliary products can be used for growth pain caused by deformed or incomplete bone development.
Finally, other drug treatment research. It has also been reported that most children with growth pain have vitamin D deficiency. However, this study did not report whether children without growth pain also had vitamin D deficiency. Therefore, at present, there is no basis for the treatment of growth pain with vitamin D deficiency. In addition, there is no solid basis for the use of vitamin C, calcium, magnesium, etc. to treat growth pain, so the use of such drugs should not be advocated.
Correspondent Wang Juan Intersection, Nanjing Morning News reporter Qi Zaibing
