Managing chronic pain in children and adolescents

Editor—Eccleston and Malleson refer to the important and often frustrating topic of managing chronic pain in children and adolescents.¹ I reported a case of a 15 year old schoolgirl with chronic increasing pain (for approximately three years) of the thoracolumbar junction that extended bilaterally into the buttocks and posteriorly to the hip joints, with some intermittent bilateral pain around the lower rib cage laterally and anteriorly with some numbness in the legs and feet.² She had been diagnosed as having growing pains and was having difficulty coping with school work.

The possibility of functional tethered cord syndrome should be considered when adolescent patients present with unexplained lumbar, buttock, and leg symptoms. The diagnosis of functional tethered cord syndrome in this 15 year old patient's case was confirmed at surgery, when an L5 laminectomy was performed to section the filum to release the tethered spinal cord, the tethered filum spontaneously retracting cephalad. The patient did well at school and remained free of symptoms.

Suspicion of functional tethered cord syndrome should be considered in unexplained cases of vague lumbar and lower extremity symptoms and signs in adults³ and adolescents even when repeated lumbar reports after magnetic resonance imaging state there are no features of tethered cord or other dysraphic disorder, laboratory tests are normal, and routine neurological tests for deep reflexes, plantar response, pinprick sensation, and vibration sensation are normal.