Chronic Pain in Children: A Look at the Referral Process to a Pediatric Pain Clinic

Abstract

We reviewed the referral pattern of children with chronic pain to a specialized pediatric pain clinic. Data were obtained from referring physicians and medical records and during an interview with patients and their parents by physicians and a psychologist. We analyzed the following: referral diagnosis, demographics, duration of symptoms, number of physicians previously consulted, school attendance, sports activities, presence of psychological disorders, final team diagnosis, and outcomes. Children had been experiencing pain for 34 ± 55 months. Patients had consulted on average 3 physicians in addition to their pediatrician. 32% of the patients had missed at least 10 days of school in a calendar year, and 47% had stopped playing sports. 15% had an operation because of pain that had been unsuccessful. The most common missed diagnosis was anxiety (25%) and depression (13%). 69% of the patients were back to school and/or playing sports within 4 months from our initial consultation. 32% of the patients did not make any progress during the follow-up period. The most common reasons for failure to improve were no compliance with the recommended treatments and poorly controlled major mood disorder. The time to refer children with chronic pain for specialized care could be extremely long causing significant social and psychological consequence.

Prevalence of TMD and level of chronic pain in a group of Brazilian adolescents

“…There are two important aspects of chronic pain in children and adolescents: the delay in referring these patients to a pediatric pain specialist, and the failure to recognize psychological disorders as an important comorbid condition in chronic pain [51]. Often, lack of an identifiable etiology along with the complex biopsychosocial nature of this condition leads to a lengthy diagnostic odyssey and delayed treatment that exacerbates the existing problem [52].…”

Interventional procedures in children and adolescents with chronic non‐cancer pain as part of a multidisciplinary pain treatment program

“…Cucchiaro et al assessed the time length of the referral processes to a specialized pediatric pain clinic; and found that children on their series experienced pain for 34 ± 55 months. In pediatric chronic pain programs, interventional procedures are usually introduced when other conservative treatment modalities have failed .…”

Cognitive, emotional, and behavioral profile in children and adolescents with chronic pain associated with rheumatic diseases: A case-control study

“…CPPs had higher scores in the items anxiety/depression of CBCL and anxiety/shyness of CPRS scales with respect to CGPs, with a statistically significant difference. Several previous studies showed that comorbid depression and anxiety were common in chronic pain patients (Cooper et al, 2017; Cucchiaro et al, 2017; Cunningham et al, 2016; Gureje, 2007; Khan et al, 2015; Martínez, Gómez-Restrepo, Ramírez, & Rodríguez, 2016; Simons, Sieberg, & Claar, 2012; Vinall, Pavlova, Asmundson, Rasic, & Noel, 2016; Zis et al, 2017). Neurobiological factors (genes, hormones, and neural networks) shared between chronic pain and symptoms of psychological distress such as anxiety and depression may partly explain their co-occurrence.…”

“…In contrast, in adults, previous studies have found that chronic pain is associated with increased suicide ideation independent of depression (Margari et al, 2013; Miller, Hopkins, & Whorwell, 2004). Anxiety and depression symptoms in turn (Cucchiaro et al, 2017; Cunningham et al, 2016; Khan et al, 2015; Martínez et al, 2016; Simons et al, 2017; Vinall et al, 2016), may play a key role in the maintenance of disability, driving them to avoidant behaviors and perpetuating a vicious cycle, which may further decrease youth quality of life (Cunningham et al, 2016; Simons et al, 2012; Tarantino et al, 2013; Vinall et al, 2016).…”

“…Chronic pain is a complex phenomenon—it involves sensory, physiological, and cognitive–behavioral components—in which psychological factors are closely associated with the development and perpetuation of this condition. Children and adolescents with chronic pain are severely impaired in their daily activities, are unable to attend school regularly, lose social relations, alter family interactions, and suffer from severe emotional distress (Abu-Saad Huijer, 2010; Cucchiaro, Schwartz, Hutchason, & Ornelas, 2017; de Almeida, Braga, Lotufo Neto, & Pimenta, 2013; Moore, Derry, Taylor, Straube, & Phillips, 2014; Zernikow et al, 2012).…”