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A Perspective on Adolescent Chronic Pain Dismissal.

Optimal management of chronic pain is complex and often daunting. In the pediatric and adolescent population, care-givers face additional biases in the face of youth and perceived states of health, which compounds this challenge and frequently leads to dismissal or under-treatment of chronic pain complaints. One study reports that approximately 20%–35% of young adults experienced chronic pain during childhood or adolescence that was ‘dismissed’ by parents, teachers, or physicians.1 This study also draws connections to several patient-reported, negative, long-term effects including self-directed negativity and isolation.1 It is, therefore, important to consider the potential roots of this problem to strive future improvements in care. As young physicians, we suggest that our perceptions of a patient’s chronological age and state of apparent health biases us against acknowledging pain in the absence of an associated diagnosis, and therefore education and training are needed to improve patient care. A brief review of the literature reveals that the challenges of adequately addressing patients with idiopathic chronic pain are not new. In The Art of Handling ‘Diff icult’ Patients, Chesanow confides that chronic pain patients are often perceived as “difficult.”2 They require complicated and time-consuming management and are frequently emotionally distressed.2 He also reports that physician dynamics are another major factor.2 Unfortunately, most physicians have at least one personal experience involving a patient seeking treatment for reasons that are not purely medical. We therefore feel compelled to consider the possibility of patient ulterior motives such as getting out of a test or missing school. Many physicians also feel pressured for time in that face of a full clinic, which may contribute to these patients’ feelings of dismissal.2 Additionally, a survey conducted