A developmental perspective of influences on the onset and early trajectory of chronic pain in children attending physiotherapy in primary health care settings: An integrative review

Chronic pain in childhood leads to long-term social, emotional, physical, and financial impacts, with lifelong heightened pain sensitivities. The prevalence of chronic pain in children has increased over the past 20 years. Physiotherapy is often the place of initial intervention for a child in pain, and initial treatment is predictive of chronic pain and can predict outcomes. Children’s pain experiences and responses are thought to be more modifiable than those of adults; therefore, quality physiotherapy interventions have the potential to positively influence the onset and early trajectory of chronic pain. Using a childhood developmental lens, this integrative review aimed to draw together research literature about biopsychosocial factors influencing chronic pain onset and early trajectory in primary-school-aged children. The results of the review contribute novel understandings for physiotherapists in primary healthcare. A range of biopsychosocial concerns including age at onset and pain duration, neuro-biological aspects, psychological influences, parental impacts, sleep quality, trauma history, and stress interact with children’s learning and development. Taken together, these factors have potential to influence chronic pain onset and early trajectory in children. Adopting a holistic understanding of childhood development in the early management of childhood chronic pain would promote positive physiotherapy interventions and may avoid pathologising what is developmentally normal.