Biopsychosocial pain assessment and management in paediatric inflammatory vs non-inflammatory musculoskeletal conditions: a vignette study

Abstract Objectives There is no research evidence about how healthcare professionals prioritise assessment and management of pain in different paediatric chronic musculoskeletal conditions (e.g. inflammatory or non-inflammatory). This study investigated and compared paediatric rheumatology healthcare professionals’ pain assessment/management priorities in inflammatory and non-inflammatory chronic musculoskeletal conditions and explored perceived barriers to implementation of prioritised pain assessment/management approaches. Methods Participants were presented with online vignettes describing a young person with an inflammatory (juvenile idiopathic arthritis) or non-inflammatory (diffuse idiopathic pain) chronic musculoskeletal condition. Participants completed closed questions on pain assessment/management priorities and open questions on perceived barriers to implementation of these priorities in clinical practice. Data were analysed using within-subjects bivariate statistical analysis and content analysis. Results Results from 56 healthcare professionals (11 countries) found that broadly similar pain assessments were selected for both conditions. Biomedical management approaches were more frequently selected for the inflammatory condition whereas psychosocial approaches were primarily selected for the non-inflammatory condition. Barriers to implementation of assessment/management approaches included: limited time, resources, knowledge and skillset, and healthcare professionals’ habits and beliefs about pain care (e.g. limiting access to components of biopsychosocial pain management due to preconceived beliefs about the musculoskeletal condition). Conclusion Paediatric rheumatology healthcare professionals generally prioritise similar pain assessments for inflammatory and non-inflammatory chronic musculoskeletal conditions. However, some healthcare professionals perceive psychosocial pain management approaches as less important for managing pain in inflammatory conditions. Importantly, pain is always biopsychosocial in nature and clinical guidelines (which emphasise the biopsychosocial perspective) should ideally be followed regardless of condition-type.