{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T14:33:08Z","timestamp":1780929188650,"version":"3.54.1"},"reference-count":59,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Muscles"],"abstract":"<jats:p>Tourette Syndrome (TS) is a neurodevelopmental disorder depicted by the occurrence of tics and accompanying behavioral problems that commonly appear during childhood. Tics, both motor and vocal, may cause musculoskeletal pain. Both acute and chronic muscle pain have been recognized as a common comorbid aspect of TS-related tic disorders in childhood. The pain most reported in children includes cervical, throat, shoulder, ocular, and joint pain, with most children reporting musculoskeletal pain in more than one part of the body. The impact of muscular pain caused by motor and phonic tics can negatively affect a child\u2019s quality of life. This review describes the association and causation of musculoskeletal pain in childhood tics and TS, which are commonly under recognized and diagnosed. An analysis of the presence of musculoskeletal pain, the severity of the pain, the location of the pain and the movement incapacity due to pain in children is reviewed. Pharmacological and non-pharmacological interventions known to improve musculoskeletal pain in children are highlighted with supportive frameworks evaluated. Further research is needed to better understand musculoskeletal pain cause(s) and prevalence along with age-appropriate assessment methods and outcomes measures. Motor- and phonic-related musculoskeletal pain should be recognized as a common comorbid characteristics of TS and tic disorders in childhood. Such recognition may lead to greater therapeutic opportunities for this problematic condition.<\/jats:p>","DOI":"10.3390\/muscles5010012","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T08:15:54Z","timestamp":1770624954000},"page":"12","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Tics, Tourette\u2019s and Related Muscle Pain in Children: A Review"],"prefix":"10.3390","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1545-0704","authenticated-orcid":false,"given":"Stuart","family":"Evans","sequence":"first","affiliation":[{"name":"School of Education, La Trobe University, Melbourne 3086, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1001\/archneur.60.10.1365","article-title":"The Basal Ganglia and involuntary movements: Impaired inhibition of competing motor patterns","volume":"60","author":"Mink","year":"2003","journal-title":"Arch. Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Fahn, S., Jankovic, J., and Hallett, M. (2011). Principles and Practice of Movement Disorders E-Book, Elsevier Health Sciences.","DOI":"10.1016\/B978-1-4377-2369-4.00025-1"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ueda, K., and Black, K.J. (2021). A Comprehensive Review of Tic Disorders in Children. J. Clin. Med., 10.","DOI":"10.3390\/jcm10112479"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1089\/cap.2024.0025","article-title":"Pain in Tourette Syndrome: A Comprehensive Review","volume":"35","author":"Green","year":"2025","journal-title":"J. Child Adolesc. Psych."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5\u00ae), American Psychiatric Publishing.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_6","unstructured":"Greydanus, D.E., Patel, R., Pratt, H.D., Calles, J.L., Nazeer, A., and Merrick, J. (2015). Tic disorders. Behavioral Pediatrics, Nova Biomedical Publishers. [4th ed.]."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1002\/mds.870060309","article-title":"Dystonic tics in patients with Tourette\u2019s syndrome","volume":"6","author":"Jankovic","year":"1991","journal-title":"Mov. Disord."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1176\/ajp.151.5.675","article-title":"Just right: Perceptions associated with compulsive behavior in Tourette\u2019s syndrome","volume":"151","author":"Leckman","year":"1994","journal-title":"Am. J. Psychiatry"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1177\/0145445505279262","article-title":"An investigation of tic suppression and the rebound effect in Tourette\u2019s disorder","volume":"29","author":"Meidinger","year":"2005","journal-title":"Behav. Modif."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1002\/mds.10552","article-title":"Pilot study of effect of emotional stimuli on tic severity in children with Tourette\u2019s syndrome","volume":"18","author":"Wood","year":"2003","journal-title":"Mov. Disord."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1007\/978-1-4614-0653-2_28","article-title":"Tourette syndrome","volume":"724","author":"Cavanna","year":"2012","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_12","unstructured":"Centers for Disease Control and Prevention (CDC) (2009). Prevalence of diagnosed Tourette syndrome in persons aged 6\u201317 years\u2014United States, 2007. MMWR Morb. Mortal. Wkly. Rep., 58, 581\u2013585."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1016\/j.neubiorev.2012.11.013","article-title":"Clinical assessment of Tourette syndrome and tic disorders","volume":"37","author":"Cohen","year":"2013","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1097\/00004583-198907000-00015","article-title":"The Yale Global Tic Severity Scale: Initial testing of a clinician-rated scale of tic severity","volume":"28","author":"Leckman","year":"1989","journal-title":"J. Am. Acad. Child. Adolesc. Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2108","DOI":"10.1212\/WNL.53.9.2108","article-title":"The Tourette syndrome diagnostic confidence index: Development and clinical associations","volume":"53","author":"Robertson","year":"1999","journal-title":"Neurology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1097\/00004583-199205000-00013","article-title":"The validity of instruments measuring tic severity in Tourette\u2019s syndrome","volume":"31","author":"Walkup","year":"1992","journal-title":"J. Am. Acad. Child. Adolesc. Psychiatry"},{"key":"ref_17","first-page":"2591","article-title":"Oromandibular tics associated with Tourette syndrome","volume":"1","author":"Jankovic","year":"2023","journal-title":"J. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1111\/j.1469-7610.2005.01561.x","article-title":"Fine-motor skill deficits in childhood predict adulthood tic severity and global psychosocial functioning in Tourette\u2019s syndrome","volume":"47","author":"Bloch","year":"2006","journal-title":"J. Child Psychol. Psychiatry"},{"key":"ref_19","first-page":"60","article-title":"Fine motor skills in children with Tourette syndrome and their unaffected first-degree siblings","volume":"11","author":"Tygesen","year":"2019","journal-title":"Scand. J. Child Adolesc. Psychiatry Psychol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/BF00419650","article-title":"Motor functions of the basal ganglia","volume":"55","author":"Phillips","year":"1993","journal-title":"Psychol. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1037\/0278-7393.27.2.470","article-title":"Irrelevant response effects improve serial learning in serial reaction time tasks","volume":"27","author":"Hoffmann","year":"2001","journal-title":"J. Exp. Psychol. Learn. Mem. Cogn."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1176\/appi.ajp.2011.09111692","article-title":"The neural circuits that generate tics in Tourette\u2019s syndrome","volume":"168","author":"Wang","year":"2011","journal-title":"Am. J. Psych."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1176\/appi.ajp.2009.08121831","article-title":"An FMRI study of frontostriatal circuits during the inhibition of eye blinking in persons with Tourette syndrome","volume":"167","author":"Mazzone","year":"2010","journal-title":"Am. J. Psychiatry"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"fcaf260","DOI":"10.1093\/braincomms\/fcaf260","article-title":"Motor network organization in healthy development and chronic tic disorders","volume":"7","author":"Heinen","year":"2025","journal-title":"Brain Commun."},{"key":"ref_25","first-page":"386","article-title":"Pediatric Tourette syndrome: Insights from recent neuroimaging studies","volume":"3","author":"Church","year":"2014","journal-title":"J. Obs.-Compuls. Relat. Disord."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/j.psyneuen.2008.03.014","article-title":"Examining cortisol rhythmicity and responsivity to stress in children with Tourette syndrome","volume":"33","author":"Corbett","year":"2008","journal-title":"Psychoneuroendocrinology"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Inoue, T., Iwanami, J., Kuroiwa, C., Mizukoshi, M., Togashi, K., Hatayama, Y., Nagai, A., Tomoda, A., Woods, D.W., and Ozawa, H. (2025). A randomized clinical trial of remote Group-Based comprehensive behavioral intervention for tics. Eur. Child Adolesc. Psychiatry, 1\u20138.","DOI":"10.1007\/s00787-025-02912-5"},{"key":"ref_28","unstructured":"Allowitz, K., and Hawkins, M. (2025). Tourette Syndrome and Musculoskeletal Tic Pain: A Case for Osteopathic Intervention. Int. J. Trans. Med., 23."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1002\/mds.22900","article-title":"Health-related quality of life in patients with Gilles de la Tourette\u2019s syndrome","volume":"25","author":"Dodel","year":"2010","journal-title":"Mov. Disord."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"P3.460","DOI":"10.1212\/WNL.86.16_supplement.P3.267","article-title":"Pain in Childhood Tourette Syndrome-Retrospective Analysis","volume":"86","author":"Lavenstein","year":"2016","journal-title":"Neurology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.jpain.2012.01.381","article-title":"Case report: Reduction in pain related to Tourette associated motor tic following botulinum toxin injection","volume":"13","author":"Cha","year":"2012","journal-title":"J. Pain"},{"key":"ref_32","first-page":"651","article-title":"Tourette\u2019s Syndrome","volume":"77","author":"Kenney","year":"2008","journal-title":"Am. Fam. Phys."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Taylor, S.J.C., Carnes, D., Homer, K., Kahan, B.C., Hounsome, N., Eldridge, S., Spencer, A., Pincus, T., Rahman, A., and Underwood, M. (2016). Novel three-day, community-based, non-pharmacological group intervention for chronic musculoskeletal pain (COPERS): A randomised clinical trial. PLoS Med., 13.","DOI":"10.1371\/journal.pmed.1002040"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1017\/S0317167100029541","article-title":"Pain in Gilles de la Tourette syndrome and related tic disorders","volume":"16","author":"Riley","year":"1989","journal-title":"Can. J. Neurol. Sci."},{"key":"ref_35","unstructured":"National Institute for Health Care Excellence (NICE) (2025, May 06). Chronic Pain (Primary and Secondary) in over 16s: Assessment of All Chronic Pain and Management of Chronic Primary Pain. Available online: https:\/\/www.nice.org.uk\/guidance\/NG193."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Anderson, S., Edwards, M., and Murphy, T. (2019, January 15\u201317). Pain and tics: A daily experience. Proceedings of the 12th European Conference on Tourette Syndrome and Tic Disorders (ESSTS), Hannover, Germany.","DOI":"10.7490\/f1000research.1116802.1"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Ma\u0142ek, A. (2022). Pain in Tourette Syndrome-Children\u2019s and Parents\u2019 Perspectives. J. Clin. Med., 11.","DOI":"10.3390\/jcm11020460"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Taylor, E., Anderson, S., and Davies, E.B. (2022). \u201cI\u2019m in pain and I want help\u201d: An online survey investigating the experiences of tic-related pain and use of pain management techniques in people with tics and tic disorders. Front. Psychiatry, 13.","DOI":"10.3389\/fpsyt.2022.914044"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1007\/s10578-010-0211-4","article-title":"Exploring the impact of chronic tic disorders on youth: Results from the Tourette Syndrome Impact Survey","volume":"42","author":"Conelea","year":"2011","journal-title":"Child Psychiatry Hum. Dev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1002\/mds.870110512","article-title":"Severe motor tics causing cervical myelopathy in Tourette\u2019s syndrome","volume":"11","author":"Krauss","year":"1996","journal-title":"Mov. Disord."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1212\/WNL.0000000000007467","article-title":"Comprehensive systematic review summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders","volume":"92","author":"Pringsheim","year":"2019","journal-title":"Neurology"},{"key":"ref_42","unstructured":"Twycross, A., Dowden, S., and Bruce, E. (2014). Pain: A Bio-Psycho-Social Phenomenon. Managing Pain in Children: A Clinical Guide for Nurses and Healthcare Professionals, Wiley-Blackwell."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Cuenca, J., Glazebrook, C., Kendall, T., Hedderly, T., Heyman, I., and Jackson, G. (2015). Perceptions of treatment for tics among young people with Tourette syndrome and their parents: A mixed methods study. BMC Psychiatry, 15.","DOI":"10.1186\/s12888-015-0430-0"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/S2352-4642(22)00316-9","article-title":"Comparative efficacy, tolerability, and acceptability of pharmacological interventions for the treatment of children, adolescents, and young adults with Tourette\u2019s syndrome: A systematic review and network meta-analysis","volume":"7","author":"Farhat","year":"2023","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1080\/14737175.2019.1643236","article-title":"McGuire, Evidence-based treatment of Tourette\u2019s disorder and chronic tic disorders","volume":"19","author":"Essoe","year":"2019","journal-title":"Expert Rev. Neurother."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Grados, M., Huselid, R., and Duque-Serrano, L. (2018). Transcranial Magnetic Stimulation in Tourette Syndrome: A Historical Perspective, Its Current Use and the Influence of Comorbidities in Treatment Response. Brain Sci., 8.","DOI":"10.3390\/brainsci8070129"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1515\/jom-2025-0037","article-title":"Chronic pain outcomes among patients treated by osteopathic vs. allopathic physicians: A 36-month follow-up study","volume":"126","author":"Licciardone","year":"2025","journal-title":"J. Osteopath. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/S1550-8579(05)80042-7","article-title":"Sex differences in pain perception","volume":"2","year":"2005","journal-title":"Gend. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1111\/dmcn.14204","article-title":"Pain coping strategies in children with cerebral palsy","volume":"61","author":"Roumenoff","year":"2019","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s40474-021-00231-3","article-title":"Course of tic disorders over the lifespan","volume":"8","author":"Black","year":"2021","journal-title":"Curr. Dev. Disord. Rep."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.jpain.2020.04.001","article-title":"Development and Psychometric Evaluation of the PROMIS Pediatric Pain Intensity Measure in Children and Adolescents with Chronic Pain","volume":"22","author":"Mara","year":"2021","journal-title":"J. Pain"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"293","DOI":"10.3109\/03009749609104061","article-title":"Quantitative and Qualitative Assessments of Pain in Children with Juvenile","volume":"25","author":"Benestad","year":"1996","journal-title":"Scand. J. Rheumatol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/0304-3959(87)91056-6","article-title":"The Varni\/Thompson Pediatric Pain Questionnaire. I. Chronic musculoskeletal pain in juvenile rheumatoid arthritis","volume":"28","author":"Varni","year":"1987","journal-title":"Pain"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Ma\u0142ek, A. (2025). Coping with pain among adults with chronic tic disorders. Front. Psychol., 16.","DOI":"10.3389\/fpsyg.2025.1537088"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Nelson, S., Moorman, E., Farrell, M., and Cunningham, N. (2018). Irritability Is Common and Is Related to Poorer Psychosocial Outcomes in Youth with Functional Abdominal Pain Disorders (FAPD). Children, 5.","DOI":"10.3390\/children5040052"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.ejpain.2004.11.001","article-title":"Human brain mechanisms of pain perception and regulation in health and disease","volume":"9","author":"Apkarian","year":"2005","journal-title":"Eur. J. Pain"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Caligiore, D., Mannella, F., Arbib, M.A., and Baldassarre, G. (2017). Dysfunctions of the basal ganglia-cerebellar-thalamo-cortical system produce motor tics in Tourette syndrome. PLoS Comput. Biol., 13.","DOI":"10.1371\/journal.pcbi.1005395"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/j.jpain.2007.05.010","article-title":"The assessment of pain coping and pain-related cognitions in children and adolescents: Current methods and further development","volume":"8","author":"Hermann","year":"2007","journal-title":"J. Pain"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1007\/s10072-019-04207-5","article-title":"Relaxation therapy as a treatment for tics in patients with Tourette syndrome: A systematic literature review","volume":"41","author":"Tilling","year":"2019","journal-title":"Neurol. Sci."}],"container-title":["Muscles"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2813-0413\/5\/1\/12\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T08:55:08Z","timestamp":1770627308000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2813-0413\/5\/1\/12"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,9]]},"references-count":59,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["muscles5010012"],"URL":"https:\/\/doi.org\/10.3390\/muscles5010012","relation":{},"ISSN":["2813-0413"],"issn-type":[{"value":"2813-0413","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,9]]}}}