Adolescent chronic pain and functional symptoms OSCE — validation, function-first plan and school reintegration

Station objectives

1. Validate chronic pain as real and screen once for red flags, without over-investigating. [1] [8]
2. Explain central sensitisation in validating, understandable language. [2]
3. Co-build a function-first interdisciplinary plan with explicit functional goals. [3]
4. Treat school reintegration as a clinical outcome and address family factors without blame. [4] [5]

Candidate brief

You are the paediatric doctor in adolescent clinic. You have 10 minutes for Station A (widespread pain, school absence, family wants more tests) and 12 minutes for Station B (complex regional pain syndrome, school absence, mother requests stronger painkillers). Examiners score validation, safety, function-first framing and partnership language. [1] [7]

Station A — Widespread pain, school absence, family wants more tests

Setup: A 15-year-old with four months of daily widespread pain, broken sleep and fatigue, now attending school only two days a week. Bloods and a spine MRI are normal. The mother is distressed and convinced something is being missed. No current self-harm. [8] [1]

Expected actions:

• Greet the adolescent first; secure time alone; state conditional confidentiality with its lawful limits. [1]
• Validate the pain as real and not her fault; take a pain history and a HEEADSSS-tailored psychosocial history (mood, sleep, school, peers, family, adversity); screen for suicidality. [1]
• Screen once for red flags (weight loss, failure to grow, systemic features, new neurological deficit, nocturnal pain) and confirm the targeted exclusion is complete; avoid a further test cascade. [7]
• Explain central sensitisation and reframe normal tests as "reassuring because her body is healthy, not because nothing is wrong." [2]
• Co-build a function-first plan: physiotherapy (graded activity), psychology (CBT/ACT), sleep reset, graded return-to-school; set functional goals, not pain-elimination. [3]
• Address the family's expectation without arguing: validate the suffering, confirm the exclusion, bring them into the sensitisation explanation gradually. [1]

Station B — Complex regional pain syndrome, mother requests stronger painkillers

Setup: A 14-year-old with three months of severe right leg pain after a minor ankle sprain; the leg is cool, discoloured and exquisitely tender to light touch; non-weight-bearing on crutches; six weeks of school absence; becoming withdrawn. Fracture and infection excluded. The mother requests "stronger painkillers, maybe opioids." [7]

Expected actions:

• Validate the pain as real; confirm the CRPS / amplified-pain diagnosis and explain the limb changes as altered nervous-system processing, not new injury. [7] [2]
• Outline early mobilisation and graded exposure through physiotherapy as the cornerstone, supported by psychology (CBT/ACT for fear and catastrophising) and a sleep reset. [1]
• Respond to the opioid request directly and empathically: explain that opioids generally have no place in chronic primary adolescent pain because the risks outweigh any long-term benefit, and that movement and desensitisation are the active treatment. [1]
• Treat school absence as a primary treatment target; build a graded, school-led return-to-school plan with education liaison. [4] [5]
• Flag intensive interdisciplinary rehabilitation for refractory or severely disabling presentations. [1]

Marking anchors

Clear pass: validates the pain as real; screens for red flags once; explains central sensitisation without stigmatising language; co-builds a function-first interdisciplinary plan with functional goals; treats school reintegration as a clinical outcome; declines opioids clearly and empathically; addresses family factors without blame. [1] [2] [4] [7] Borderline: validates well but defers school reintegration to "later," offers vague follow-up, or avoids the opioid conversation. Fail: dismisses the pain as "stress"; promises more tests without red flags; prescribes opioids; sets a pain-elimination goal; ignores school absence; uses stigmatising language. [1] [7]

Debrief pearls

• The explanation is itself a treatment — central sensitisation, validated, changes the trajectory. [2]
• Movement is the medicine; opioids are not. [1]
• School absence is a symptom of severity, not a coping strategy. [4]