To develop an interdisciplinary guideline for the assessment and management of pain in children (<18 years) with Multiple Sclerosis (MS).

Pain is common in people with MS and assessment and treatment are defined for adult patients; however, there is a dearth of literature pertaining to pain in children and adolescents with MS.

To formulate the guideline, an expert Delphi Panel was convened consisting of pediatric and adult MS physicians, a physiotherapist, a pediatric pain expert, a patient with MS, a nurse practitioner, a social worker, a physiatrist, and an MS researcher (12 panelists). A questionnaire was sent to panelists for anonymous completion from which themes were extracted by the Panel Chair. The Panel met to discuss findings. A second questionnaire proposing guideline contents will be circulated through REDCap. This iterative process will continue until a consensus guideline is reached, at which time, the final guideline will be presented.

Preliminary results indicate that type of pain sensation, severity, and frequency vary greatly in children with MS. Headache was the most common pain type described by the Panel. Experts suggested assessing how pain impacts sleep, mood, and daily activities. The Face Pain Scale and providing a list of vernacular adjectives for describing pain were suggested for assessing pain in children. Simple analgesics were recommended for short-lasting pain. Experts recognized that some patients with more persistent pain require prescription medication for the particular pain type (e.g., neuropathic pain). Discussions regarding specific agents are ongoing. Panelists identified the importance of mental health in managing pain and encouraged counseling when appropriate. Managing pain to promote school and social engagement was emphasized.

Preliminarily, the Panel agrees that pain should be assessed routinely and age-appropriately, and that pain typically requires interdisciplinary management. We expect that the final guideline will inform the interdisciplinary care of children with MS.