Factors associated with physician consultation and medication use in children and adolescents with chronic pain: A scoping review and original data

Abstract

Background: Although paediatric chronic pain is common, it is not yet clear which individuals with chronic pain are likely to seek health care for their pain. The aims of this study were to summarize the current evidence of the characteristics of children and adolescents with chronic pain who consult a physician or use medication for their pain. Additionally, we aimed to expand knowledge by further investigating key and promising, factors in a large community sample of adolescents. Methods: First, using scoping review methodology, studies on health care utilisation in paediatric chronic pain were identified by the systematic literature search. Out of 1,158 articles, 12 were included for data extraction. Second, in a population-based cross-sectional survey, data of N = 2,280 adolescents (10-18 years) and their parents (N = 1,464), were analysed. Univariable logistic and multivariable LASSO regression models were calculated for adolescents with chronic pain (n = 749) to identify predictors of physician visits or analgesics intake due to pain, controlling for acute illness and injury. Results: The scoping review identified higher pain intensity, frequency, severity and pain-related disability as significant individual factors associated with physician consultation. Female sex and higher pain intensity were associated with medication consumption. Multivariable analyses with cross-sectional data revealed only painrelated school absence to be associated with physician consultation; analgesic medication use was associated with school absence and higher pain intensity. Conclusion: Original data from this study support prior findings. School absence and pain intensity, plausible surrogates for pain severity, are the most relevant factors in health care utilisation due to chronic pain. Significance: A scoping summary of existing research on predictors for physician consultation and medication use in children and adolescents with chronic pain is provided. Furthermore, the role of potential predictors for health care utilisationsociodemographic, pain, school, psychological and parent-related characteristics-is analysed in a population-based cross-sectional survey. Controlling for illness and injuries, and using a strict chronic pain definition, the cross-sectional survey allows conclusions on healthcare utilisation specific to chronic pain in adolescents.

Long‐term outcomes of children with severe chronic pain: Comparison of former patients with a community sample

“…From several studies, it is well known that children with chronic pain frequently access a variety of health care services (Groenewald et al, 2014;Könning, Rosenthal, Friese, et al, 2021;Ruhe et al, 2013;Toliver-Sokol et al, 2011).…”

“…From several studies, it is well known that children with chronic pain frequently access a variety of health care services (Groenewald et al., 2014; Könning, Rosenthal, Friese, et al., 2021; Ruhe et al., 2013; Toliver‐Sokol et al., 2011). Following IIPT, health care utilisation decreases (Evans et al., 2016; Zernikow et al., 2018), particularly in patients with an overall improvement in their chronic pain condition (Zernikow et al., 2018).…”

“…they cannot be explained by a defined medical illness (Zernikow et al., 2012). For severely impaired patients, first‐line treatment options, ranging from primary care to specialized care by orthopaedists, neurologists, rheumatologists, gastroenterologists or surgeons are often inefficient (Kaufman et al., 2016; Könning, Rosenthal, Friese, et al., 2021; Wager et al., 2019). In case of treatment failure of single‐disciplinary treatments the preferred therapy is an intensive interdisciplinary approach that addresses the complexity of a chronic pain condition (Simons et al., 2013).…”

Adolescents’ Explanatory Models for Headaches and Associations with Behavioral and Emotional Outcomes

“…This information was transformed into a binary outcome variable by splitting consumption into "<4 days" and "≥4 days" within the last four weeks. In line with a prior study [29], this cut-off was chosen to identify those adolescents with high medication use (at least once a week on average) and differentiate them from students with unique medication intake.…”

The efficacy of an educational movie to improve pain and dysfunctional behavior in school children: A randomized controlled trial

“…Around 30% are affected by chronic pain that occurs at least weekly for 3 months or longer (Wager et al., 2020). Many of these children seek medical treatment and take pain medication (Du et al., 2011; Könning et al., 2021), causing enormous expenses for societies and healthcare systems (Groenewald et al., 2014). Hence, there is a great need for effective prevention and intervention programs.…”