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      Factors Influencing the Management of Musculoskeletal Pain among Children with Sickle Cell Disease in Western Kenya

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      African Journal of Empirical Research
      AJER Publishing

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          Abstract

          Musculoskeletal pain (MSK) is a common and often distressing symptom among children diagnosed with sickle cell disease (SCD). Despite the recurrent and often severe pain episodes these children endure, there has been limited research into the factors that influence the management of this pain. This study sought to delve into the various factors that impact the management of MSK pain in children with SCD in Western Kenya. It took a comprehensive approach, considering psychological, economic, sociocultural, individual, nutritional, environmental, and hospital-related factors. To gather insights, caregivers of 176 children with musculoskeletal pain associated with SCD were interviewed using semi-structured questionnaires. Thematic analysis was employed to identify recurring themes, and a codebook was developed based on findings from the literature and emerging themes. The interviews continued until theoretical saturation was achieved, ensuring that all necessary data was collected. The results of the study revealed seven key themes that significantly influenced the management of musculoskeletal pain in these children. These themes included psychological factors, economic constraints, sociocultural beliefs, individual health status, nutritional challenges, environmental triggers, and healthcare system-related factors. Caregivers often grappled with psychological distress, financial strain, and social stigmatization. Individual factors, such as compromised immune status, played a crucial role in the frequency and severity of pain episodes. Furthermore, inadequate access to nutritious food exacerbated musculoskeletal pain. Additionally, changing weather conditions and previous negative experiences with healthcare facilities hindered effective pain management. In light of these findings, the study underscores the urgent need for a holistic approach to address these challenges. This includes providing psychosocial support, financial assistance, community awareness campaigns, improved healthcare services, education on proper nutrition, climate-related support, and healthcare worker training to better manage MSK pain in children with SCD.

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          Musculoskeletal pain in children and adolescents

          ABSTRACT Introduction Musculoskeletal (MSK) pain in children and adolescents is responsible for substantial personal impacts and societal costs, but it has not been intensively or systematically researched. This means our understanding of these conditions is limited, and healthcare professionals have little empirical evidence to underpin their clinical practice. In this article we summarise the state of the evidence concerning MSK pain in children and adolescents, and offer suggestions for future research. Results Rates of self-reported MSK pain in adolescents are similar to those in adult populations and they are typically higher in teenage girls than boys. Epidemiological research has identified conditions such as back and neck pain as major causes of disability in adolescents, and in up to a quarter of cases there are impacts on school or physical activities. A range of physical, psychological and social factors have been shown to be associated with MSK pain report, but the strength and direction of these relationships are unclear. There are few validated instruments available to quantify the nature and severity of MSK pain in children, but some show promise. Several national surveys have shown that adolescents with MSK pain commonly seek care and use medications for their condition. Some studies have revealed a link between MSK pain in adolescents and chronic pain in adults. Conclusion Musculoskeletal pain conditions are often recurrent in nature, occurring throughout the life-course. Attempts to understand these conditions at a time close to their initial onset may offer a better chance of developing effective prevention and treatment strategies.
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            Neuropathic pain in children: Steps towards improved recognition and management

            Neuropathic pain in children can be severe and persistent, difficult to recognise and manage, and associated with significant pain-related disability. Recognition based on clinical history and sensory descriptors is challenging in young children, and screening tools require further validation at older ages. Confirmatory tests can identify the disease or lesion of the somatosensory nervous system resulting in neuropathic pain, but feasibility and interpretation may be influenced by age- and sex-dependent changes throughout development. Quantitative sensory testing identifies specific mechanism-related sensory profiles; brain imaging is a potential biomarker of alterations in central processing and modulation of both sensory and affective components of pain; and genetic analysis can reveal known and new causes of neuropathic pain. Alongside existing patient- and parent-reported outcome measures, somatosensory system research methodologies and validation of mechanism-based standardised end-points may inform individualised therapy and stratification for clinical trials that will improve evidence-based management of neuropathic pain in children.
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              Health related quality of life in children with sickle cell disease: A systematic review and meta-analysis.

              This review had three aims: 1) describe the measures used to assess health-related quality of life (HRQL) in pediatric patients diagnosed with sickle cell disease (SCD); 2) document the biopsychosocial factors related to HRQL in pediatric patients diagnosed with SCD; and 3) complete a meta-analysis comparing HRQL in pediatric patients diagnosed with SCD to healthy controls. Included studies were published in English, quantitatively assessed HRQL as a primary aim, in both SCD and controls, and included participants between 0 and 21 years of age. The final review included 66 articles, with a total of 8642 participants with SCD, 4 months-21 years of age, and 62,458 controls, 5-27 years of age. HRQL was predominately measured using the Pediatric Quality of Life Inventory Generic Core and Sickle Cell Disease Module. Meta-analyses revealed children with SCD had significantly worse HRQL compared to healthy controls (standardized mean difference = -0.93, 95% CI = -1.25, -0.61, p < 0.00001). Worse HRQL was associated with more severe SCD, female sex, and pain. The findings indicate that children with SCD are at risk for worse HRQL compared to their healthy peers and their HRQL may be impacted by several biopsychosocial factors. Future research is needed to examine how sociocultural factors uniquely impact this population and their overall quality of life.
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                Author and article information

                Contributors
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                Journal
                African Journal of Empirical Research
                AJERNET
                AJER Publishing
                2709-2607
                July 05 2023
                October 05 2023
                : 4
                : 2
                : 464-470
                Article
                10.51867/ajernet.4.2.48
                60d92fa1-89cf-4cc1-bd8c-30bdc351a3d8
                © 2023

                https://creativecommons.org/licenses/by-nc/4.0

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