Chronic pain-related consultations to the emergency department of children with complex pain conditions: A retrospective analysis of healthcare utilization and costs

Abstract

Background There is limited information regarding the effects of pediatric chronic pain management on the number and cost of chronic pain–related emergency department (ED) consultations. Aim This retrospective study aimed to evaluate the number and costs of chronic pain–related ED consultations of children and adolescents with chronic pain conditions at the Montreal Children’s Hospital (MCH). Methods Charts of patients followed by the Edwards Family Interdisciplinary Center for Complex Pain (CCP) of the MCH between April 2017 and December 2018 were reviewed. ED consultations, specialist consultations, medication prescriptions, hospital admissions, and outpatient consultation referrals were assessed for the period of 1 year before and after the patients’ first consultation with the CCP. Associated costs were also calculated. Results One-hundred sixty-eight patients were included in the analysis. Fifty-one percent consulted the ED and had 151 chronic pain–related ED consultations within 1 year before their initial CCP consultation. In the year following their first CCP consultation, 52 patients (31%) consulted the ED, of which 24 consultations were chronic pain–related (84% reduction). There was an 81% reduction in the costs associated with chronic pain–related ED consultations within 1 year after CCP management. In addition, there was a significant reduction in ED interventions within 1 year after CCP management, though there was no change in medication prescriptions, hospital admissions, or subspecialist consultations. Conclusion Children and adolescents with chronic pain conditions had fewer chronic pain–related ED consultations within 1 year after the first evaluation by an interdisciplinary center for complex pain, contributing to reduced ED costs.

Overview of the economic burden of musculoskeletal pain in children and adolescents: a systematic review with meta-analysis

“…29 Two multinational studies (5.5%) 32,59 were conducted: 1 study in the United States, France, Germany, the Netherlands, and the United Kingdom; and the other in Germany, Italy, Spain, France, the United Kingdom, Bulgaria, and Sweden. Thirty-eight studies (84.4%) 2,3,9,10,14,15,17,19,20,23,31,32,34,35,37,40–42,44,46,47,52,55–63,66–69,71,79,81 were conducted in high-income countries, 6 (13.3%) 4,5,28,36,72,80 in upper-middle-income countries, and 1 (2.2%) 29 in a lower-middle-income country. Healthcare and societal costs were the most common data reported.…”

“…Fifteen studies 10,17,19,24,34,37,47,56–58,60,61,63,69,81 included children and adolescents with mixed pain conditions, 13 studies 2,9,15,20,29,31,32,42,52,59,66,68,80 with juvenile idiopathic arthritis, 10 studies 3–5,14,28,35,40,46,62,71 with headache/migraine, and 7 studies 36,41,44,55,67,72,79 with adolescent idiopathic scoliosis. Nineteen were cross-sectional studies, 3–5,9,19,28,32,35,41,42,44,46,47,59,62,69,71,72,80 25 were cohort studies 2,10,14,15,17,20,24,29,31,36,37,40,52,55–58,60,61,63,66–68,79,81 of which 11 provided some type of intervention with cost data collected at baseline or before the intervention, 10,17,20,24,37,52,56–58,61,63 and 1 was a randomized controlled trial with cost data collected at baseline.…”

“…Fifteen studies 10,17,19,24,34,37,47,[56][57][58]60,61,63,69,81 included children and adolescents with mixed pain conditions, 13 studies 2,9,15,20,29 ,31,32,42,52,59,66,68,80 with juvenile idiopathic arthritis, 10 studies [3][4][5]14,28,35,40,46,62,71 with headache/migraine, and 7 studies 36,41,44,55,67,72,79 with adolescent idiopathic scoliosis. Nineteen were crosssectional studies, [3][4][5]9,19,28,32,35,41,42,44,46,47,59,62,69,71,…”

“…Nineteen were crosssectional studies, [3][4][5]9,19,28,32,35,41,42,44,46,47,59,62,69,71,72,80 25 were cohort studies 2,10,14,15,17,20,24,29,31,36,37,40,52,[55][56][57][58]60,61,63,[66][67][68]79,81 of which 11 provided some type of intervention with cost data collected at baseline or before the intervention, 10,17,20,24,37,52,[56]…”

“…19,21,45,51,65 We included 15 studies in this systematic review that recruited mixed musculoskeletal pain conditions, of which 11 (73.3%) included children and adolescents with headaches. 10,17,19,24,34,37,[56][57][58]61,63 Because these studies did not separate costs by condition, we felt exclusion of those studies that include participants with headaches would result in an incomplete picture and potentially bias estimates of the economic burden of musculoskeletal pain in children and adolescents.…”