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

## TL;DR

This study compares how healthcare professionals assess and manage pain in children with inflammatory and non-inflammatory musculoskeletal conditions, finding similar assessments but differing management approaches.

## Contribution

The study provides new insights into how HCPs prioritize pain management in different pediatric musculoskeletal conditions and identifies barriers to biopsychosocial approaches.

## Key findings

- Similar pain assessments were selected for both inflammatory and non-inflammatory conditions.
- Biomedical approaches were more common for inflammatory conditions, while psychosocial approaches were preferred for non-inflammatory ones.
- Barriers to biopsychosocial care included time, resources, and HCPs' beliefs about pain management.

## Abstract

There is no research evidence about how healthcare professionals (HCPs) 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 HCPs’ pain assessment/management priorities in inflammatory and non-inflammatory chronic musculoskeletal conditions and explored perceived barriers to implementation of prioritised pain assessment/management approaches.

Participants were presented with online vignettes describing a young person with an inflammatory (JIA) 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 from 56 HCPs (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 HCPs’ habits and beliefs about pain care (e.g. limiting access to components of biopsychosocial pain management due to preconceived beliefs about the musculoskeletal condition).

Paediatric rheumatology HCPs generally prioritise similar pain assessments for inflammatory and non-inflammatory chronic musculoskeletal conditions. However, some HCPs perceive psychosocial pain management approaches as less important for managing pain in inflammatory conditions. Importantly, pain is always biopsychosocial in nature and clinical guidelines (that emphasise the biopsychosocial perspective) should ideally be followed regardless of condition type.