Systematic Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2019; 10(4): 192-205
Published online Apr 18, 2019. doi: 10.5312/wjo.v10.i4.192
Growing pains: What do we know about etiology? A systematic review
Vito Pavone, Andrea Vescio, Fabiana Valenti, Marco Sapienza, Giuseppe Sessa, Gianluca Testa
Vito Pavone, Andrea Vescio, Fabiana Valenti, Marco Sapienza, Giuseppe Sessa, Gianluca Testa, Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
Author contributions: Pavone V, Vescio A and Testa G contributed equally to the work; Valenti F conceptualized and designed the review together with Vescio A and Testa G carried out the analysis; Sapienza M and Sessa G drafted the initial manuscript; all authors reviewed and approved the final manuscript as submitted.
Conflict-of-interest statement: All authors declare no conflicts of interest.
PRISMA 2009 Checklist statement: A PRIMA checklist was uploaded.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Vito Pavone, MD, PhD, Associate Professor, Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia, 78, Catania 95123, Italy. vpavone@unict.it
Telephone: +39-95-3782273 Fax: +39-95-3782720
Received: January 2, 2019
Peer-review started: January 4, 2019
First decision: January 29, 2019
Revised: February 15, 2019
Accepted: March 16, 2019
Article in press: March 16, 2019
Published online: April 18, 2019
Abstract
BACKGROUND

Growing pains is the most common cause of musculoskeletal pain in early childhood and was first described in 1823 by French physician Marcel Duchamp. Although it has been researched extensively, the etiology is still unknown. Several theories have been proposed throughout the years.

AIM

Analyze the available scientific literature to provide an update on the latest evidence on the etiology.

METHODS

According to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the scientific literature on the etiology of growing pains was systematically reviewed using the following inclusion criteria: studies of any level of evidence reporting clinical or preclinical results and dealing with the etiology of growing pains. The medical electronic databases PubMed and Web of Science were searched by two independent authors on October 20, 2018. The search string used was “(growing pains OR benign nocturnal limb pains OR musculoskeletal pains) AND (etiology OR pathogenesis) AND (pediatrics)”.

RESULTS

A total of 32 articles were included. The etiology of growing pains still remains poorly understood. Many theories have been proposed, but none of them are decisive. A lower pain threshold has been found among patients suffering from growing pains in comparison to healthy controls. Furthermore, evidence suggests an association between growing pains and reduced bone strength in young patients, although this finding still remains controversial. Changes in the vascular perfusion pattern have also been studied. However, the etiology of growing pains does not seem related to a vascular component. The anatomical/mechanical theory has not been supported, but the role of vitamin D deficiency has been investigated many times. Strong recent evidence indicates a genetic susceptibility in the pathogenesis of growing pains. Furthermore, psychological factors also seem to play a strong role in the onset.

CONCLUSION

The scientific literature about the etiology of growing pains presents heterogeneity and lack of consensus; more studies are needed to understand the genesis of benign musculoskeletal pain syndrome of childhood.

Keywords: Growing pains, Benign nocturnal limb pains of childhood, Recurrent limb pains of childhood, Etiology, Pathogenesis

Core tip: Growing pains are benign nocturnal limb pains and the most common cause of musculoskeletal pain in early childhood. Intermittent non-articular pain during the late afternoon or the night with intervals of pain-free days and no objective signs of inflammation are the main clinical features. Despite the etiology of the disease has been widely researched, it is still not fully understood. Lower pain threshold, vascular perfusion changes, anatomical and genetic abnormalities, vitamin D deficiency and psychological factors have been proposed to explain the pathogenesis of growing pain. More studies are needed to understand the complex genesis of the disease.