Clinical trial NCT03171792: Experience of Chronic (Non-malignant) Musculoskeletal Pain of French Adolescent and Young Adult: a Qualitative Research With Their Physicians and Non-medical Practitioners
Official title: Experience of Chronic (Non-malignant) Musculoskeletal Pain of French Adolescent and Young Adult: a Qualitative Research With Their Physicians and Non-medical Practitioners
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Chronic (Non-malignant) Musculoskeletal Pain
Keywords: Musculoskeletal pain
Adolescent
Qualitative research
Attitude
Health professionals
Lead sponsor: Assistance Publique - Hôpitaux de Paris
Sponsor class: OTHER
First posted: 2017-05-31
Enrollment: 25
Sex: ALL
Minimum age (years): 25
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: CROSS_SECTIONAL
Sampling method: NON_PROBABILITY_SAMPLE
Study population: The study will concern the health professionals who takes care of adolescents suffering from chronic (non-malignant) musculoskeletal pain. In France, the medical specialities concerned are paediatric medicine, rheumatology, pain medicine, adolescent medicine and psychiatry. The investigators also want to include participants from paramedical fields: physiotherapists, ergotherapists and psychologists. The participants will be selected in the large repository of the professionals working with the French National Reference Center in Paediatric Rheumatology and Inflammatory Diseases

Brief summary: The purpose of this study is to explore the perspectives of health professionals on chronic (non-malignant) musculoskeletal pain in adolescence and young adulthood. The prevalence of this pain symptom is rising for ten years, and most of the time the diagnosis is complex. Health professionals have to differentiate between the continuing activity of a somatic problem, some painful sequelae, a low threshold for the perception of pain, and psychological symptoms with somatic expression. Diagnosis in this case takes time, and is a matter of trained specialists. No protocol exists to assess the sub-clinical symptoms which will be used to help doing this complex task.

This qualitative study will elicit the perspectives of trained specialists on this diagnosis: how do they deal with these patients? What signs and symptoms helps them? The results will present their clinical experiences. The overall goal is to construct the first chronic musculoskeletal pain multidimensional scale that will help the practitioners with this complex diagnosis.

Detailed description: Recent research suggests that musculoskeletal pain may be the most common complaint for which children are referred to a pediatric rheumatologist and is present in approximately 50% of all new patients. A small percentage of these patients will be diagnosed with a form of juvenile idiopathic arthritis (JIA), which is marked by clinically significant pain. A larger percentage will be diagnosed with a musculoskeletal pain syndrome, that approximately 25% of them are chronic and defined as \> = 3 months. The chronic pain symptom is a subjective one that professionals have to precise its outlines in term of semiology, nature and efficacity of past treatments, medical and family backgrounds. The professional then will have to pinpoint a diagnosis, while assessing the consequences of the pain and treating it.

Most of the time this task is a complex one and professionals have to build their diagnostic on a body of clinical, paraclinical and more social, familial and psychological evidences. No clear protocol exists to help the professionals with differentiating the continuing activity of a somatic problem, some painful sequelae, a low threshold for the perception of pain, and psychological symptoms with somatic expression. This diagnostic process is lying on sub-clinical symptoms that investigators have to elicit in order to help professionals to better support their patients.

This qualitative study will explore the daily clinical experience of the health professionals involved in the care of adolescents suffering from chronic musculoskeletal pain. Semi-structured interviews will be analyzed with a phenomenological approach (interpretative phenomenological analysis). The rich phenomenological description will be the first step of a more ambitious project of constructing a multidimensional scale that will help the practitioners with this complex diagnosis.

Eligibility criteria: Inclusion Criteria:

* Health care professionals working with the French National Reference in Center Pediatric Rheumatology and Inflammatory Diseases
* Professional experiences on the care of chronic musculoskeletal pain

Exclusion Criteria:

- Refusal to participate in the study

Primary outcomes:
measure: Qualitative description of the experience of health professionals faced to adolescents consulting for chronic (non-malignant) musculoskeletal pain
timeFrame: 1 day
Secondary outcomes:
Other outcomes:
Locations:
city: Paris
country: France
facility: Cochin hospital
city: Paris
country: France
facility: Necker Hospital
Study officials:
affiliation: Assistance Publique - Hôpitaux de Paris
name: Pierre QUARTIER, MD, PhD
role: STUDY_CHAIR
affiliation: Assistance Publique - Hôpitaux de Paris
name: Jonathan LACHAL, MD, PhD
role: STUDY_CHAIR
References:
citation: Goodman JE, McGrath PJ. The epidemiology of pain in children and adolescents: a review. Pain. 1991 Sep;46(3):247-264. doi: 10.1016/0304-3959(91)90108-A. No abstract available.
citation: De Inocencio J. Epidemiology of musculoskeletal pain in primary care. Arch Dis Child. 2004 May;89(5):431-4. doi: 10.1136/adc.2003.028860.
citation: Anthony KK, Schanberg LE. Pediatric pain syndromes and management of pain in children and adolescents with rheumatic disease. Pediatr Clin North Am. 2005 Apr;52(2):611-39, vii. doi: 10.1016/j.pcl.2005.01.003.
citation: Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, He X, Maldonado-Cocco J, Orozco-Alcala J, Prieur AM, Suarez-Almazor ME, Woo P; International League of Associations for Rheumatology. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004 Feb;31(2):390-2. No abstract available.
citation: Jaremko JL, Liu L, Winn NJ, Ellsworth JE, Lambert RG. Diagnostic utility of magnetic resonance imaging and radiography in juvenile spondyloarthritis: evaluation of the sacroiliac joints in controls and affected subjects. J Rheumatol. 2014 May;41(5):963-70. doi: 10.3899/jrheum.131064. Epub 2014 Mar 15.
citation: Bell DS, Bell KM, Cheney PR. Primary juvenile fibromyalgia syndrome and chronic fatigue syndrome in adolescents. Clin Infect Dis. 1994 Jan;18 Suppl 1:S21-3. doi: 10.1093/clinids/18.supplement_1.s21.
citation: McGhee JL, Burks FN, Sheckels JL, Jarvis JN. Identifying children with chronic arthritis based on chief complaints: absence of predictive value for musculoskeletal pain as an indicator of rheumatic disease in children. Pediatrics. 2002 Aug;110(2 Pt 1):354-9. doi: 10.1542/peds.110.2.354.
citation: Sherry DD, McGuire T, Mellins E, Salmonson K, Wallace CA, Nepom B. Psychosomatic musculoskeletal pain in childhood: clinical and psychological analyses of 100 children. Pediatrics. 1991 Dec;88(6):1093-9.
citation: Kashikar-Zuck S, Goldschneider KR, Powers SW, Vaught MH, Hershey AD. Depression and functional disability in chronic pediatric pain. Clin J Pain. 2001 Dec;17(4):341-9. doi: 10.1097/00002508-200112000-00009.
citation: - Lachal J, Speranza M, Schmitt A, Spodenkiewicz M, Falissard B, Moro MR, Revah-Levy A. Depression in adolescent from qualitative research to measurement. Adolescent Psychiatry 2012,2(4):296-308.
citation: - Smith J. Interpretative phenomenological analysis. In: Qualitative Psychology: A Practical Guide to Research Methods. 2e éd. Sage Publications Ltd; 2008.
citation: Taieb O, Bricou O, Baubet T, Gaboulaud V, Gal B, Mouthon L, Dhote R, Guillevin L, Rose Moro M. Patients' beliefs about the causes of systemic lupus erythematosus. Rheumatology (Oxford). 2010 Mar;49(3):592-9. doi: 10.1093/rheumatology/kep430. Epub 2009 Dec 29.
citation: Smith JA, Michie S, Stephenson M, Quarrell O. Risk Perception and Decision-making Processes in Candidates for Genetic Testing for Huntington's Disease: An Interpretative Phenomenological Analysis. J Health Psychol. 2002 Mar;7(2):131-44. doi: 10.1177/1359105302007002398.
citation: Chapman E, Smith JA. Interpretative phenomenological analysis and the new genetics. J Health Psychol. 2002 Mar;7(2):125-30. doi: 10.1177/1359105302007002397.
citation: Lefevre H, Loisel A, Meunier BB, Deslandre C, Lemoine N, Moro MR, Quartier P, Lachal J. Chronic idiopathic musculoskeletal pain in youth: a qualitative study. Pediatr Rheumatol Online J. 2019 Dec 27;17(1):86. doi: 10.1186/s12969-019-0389-3.