Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients

Abstract

BackgroundPrevalence of pain as a recurrent symptom in children is known to be high, but little is known about children with high impairment from chronic pain seeking specialized treatment. The purpose of this study was the precise description of children with high impairment from chronic pain referred to the German Paediatric Pain Centre over a 5-year period.MethodsDemographic variables, pain characteristics and psychometric measures were assessed at the first evaluation. Subgroup analysis for sex, age and pain location was conducted and multivariate logistic regression applied to identify parameters associated with extremely high impairment.ResultsThe retrospective study consisted of 2249 children assessed at the first evaluation. Tension type headache (48%), migraine (43%) and functional abdominal pain (11%) were the most common diagnoses with a high rate of co-occurrence; 18% had some form of musculoskeletal pain disease. Irrespective of pain location, chronic pain disorder with somatic and psychological factors was diagnosed frequently (43%). 55% of the children suffered from more than one distinct pain diagnosis. Clinically significant depression and general anxiety scores were expressed by 24% and 19% of the patients, respectively. Girls over the age of 13 were more likely to seek tertiary treatment compared to boys. Nearly half of children suffered from daily or constant pain with a mean pain value of 6/10. Extremely high pain-related impairment, operationalized as a comprehensive measure of pain duration, frequency, intensity, pain-related school absence and disability, was associated with older age, multiple locations of pain, increased depression and prior hospital stays. 43% of the children taking analgesics had no indication for pharmacological treatment.ConclusionChildren with chronic pain are a diagnostic and therapeutic challenge as they often have two or more different pain diagnoses, are prone to misuse of analgesics and are severely impaired. They are at increased risk for developmental stagnation. Adequate treatment and referral are essential to interrupt progression of the chronic pain process into adulthood.

Systematic Review on Intensive Interdisciplinary Pain Treatment of Children With Chronic Pain

“…This is important given that the affected children suffer for an average of 3 years before initiating IIPT. 4 In this review, IIPT had only small immediate effects in the RCT on reducing pain intensity (d IIPT: RCT = -0.38) and no effect in the NRSs but large effects in both, RCT and NRS, at short-term follow-up (d IIPT: RCT = -1.19; d IIPT: NRS = -1.33). In comparison, there is evidence of moderate beneficial effects of psychological therapies on pain reduction posttreatment (SMD psychological_children = -0.57) and of no beneficial effects at follow-up.…”

“…43 These potentially positive findings of the IIPT on depressive symptoms warrant replication in future welldesigned RCTs. High rates of emotional distress in children with highly disabling chronic pain 4 and high rates of comorbidity with full-blown diagnosis of psychological showing that children who participated in IIPT outperformed children in outpatient treatment in reductions in disability. 36,50 Second, assessment of effectiveness can be made by using benchmarks of expected treatment effects, as recently provided for treatment effects of psychological treatments for adults with chronic pain.…”

“…2,3 Many of these children are severely impaired in their daily activities; they are unable to attend school regularly, and often suffer from severe emotional distress. 1,4 Children and their families exact high costs on the health care system, estimated to be $19.5 billion annually in the United States. 5 Today, there is consensus regarding the complexity of pediatric chronic pain that results in significant distress and disability, and regarding the interaction among biological, social, and psychological factors accounting for and exacerbating pediatric chronic pain.…”

Lėtinis vaikų skausmas biopsichosocialiniu požiūriu: samprata, įvertinimo ir gydymo strategija

“…Vaikai, patiriantys lėtinį skausmą, paprastai būna patyrę daug ir skausmingų procedūrų bei tyrimų [42], tad akcentuojama, jog papildomus medicininius tyrimus reikėtų skirti labai apgalvotai ir sukeliant kiek įmanoma mažiau streso ir žalos vaikui [41].…”

“…Svarbu, jog gydymas būtų pradedamas kuo anksčiau, nes, remiantis tyrimų duomenimis, kuo ilgiau patiriamas lėtinis skausmas, tuo daugiau vaikas patiria nusivylimo dėl nesėkmingo gydymo, skausmingų ir mažai efektyvių procedūrų, tuo daugiau pasitaiko komorbidinių sutrikimų (emocijų, elgesio), tuo pagalba yra sudėtin-gesnė ir mažiau efektyvi [42].…”