Insights in the use of health care services in chronic benign pain in childhood and adolescence

Abstract

The utilization of health care services in children and adolescents with chronic benign pain was studied in a Dutch population sample of 254 chronic pain sufferers aged 0-18 years. Children and adolescents who had reported chronic pain (continuous or recurrent pain >3 months) in our previous prevalence study were asked to keep a 3-week diary on their pain and to fill out questionnaires on background factors, health care use and the impact of pain. Parent ratings were used for children aged 0-11 years, self-report was used in adolescents (12-18 years). In a 3-month period, in 53.4% of the cases medication was used for pain, and general practitioners and specialists were consulted for pain in 31.1% and 13.9% of subjects, respectively. Physiotherapists, psychologists and alternative health providers were visited by 11.5, 2.8, and 4.0%, respectively. In the preceding year, 6.4% had been hospitalized due to pain. The most important factors linked to utilizing medical services were gender, various pain characteristics, school absenteeism and disability. Although consulters reported to be less physically fit and less satisfied with health, their parents were better adapted to the pain, by talking and sharing, mutual support, normalization of the child and heightened self-esteem, than non-consulters. Prospective studies are needed to test causality of coping on care-seeking behavior.

Functional Somatic Symptoms and Consultation Patterns in 5- to 7-Year-Olds

“…20 Finally, a few studies addressing health care use in relation to chronic benign (ie, medically unexplained) pain in childhood and adolescence have found pain severity and related impairment to be important factors linked to the use of medical services. 30,31 In a previous study, we identified a pattern of FSS associated with significant impairment and distress in children as young as 5 to 7 years. 4 The purposes of the current study were to investigate health care use in these children during their first 4 years of life and to explore factors linked to medical help seeking.…”

“…[38][39][40] Furthermore, the results replicate findings from a study on children and adolescents with chronic benign pain in which various pain characteristics, school absenteeism, and disability were important factors linked to health care use. 30 Third, a higher health care use in general practice early in life predicted consultation for FSS at the age of 5 to 7 years, even after adjustment for other potential explanatory factors such as gender, physical comorbidity, and symptom severity. Symptom severity, assessed in terms of multisymptomatic presentation, also turned out to be a strong predictor for medical consultation, whereas gender and comorbid physical disease did not.…”

“…This percentage corresponds to percentages reported in other population-based studies on children and adolescents with chronic benign (ie, functional) pain. 14,30 Three patterns of factors associated with medical consultations due to FSS in children aged 5 to 7 years were seen. First, consulters more often had parents who both were not native Danish compared with nonconsulters.…”

Long-Term Outcomes of Adolescents With Juvenile-Onset Fibromyalgia in Early Adulthood

“…Pediatrics 2014;133:e592-e600 Dr Kashikar-Zuck (principal investigator) designed and conceptualized the study, drafted the manuscript, supervised all aspects of the implementation of the study, consolidated manuscript revisions from all coauthors, and submitted the final document; Dr Cunningham (postdoctoral fellow) conducted the study assessments, assisted in the interpretation of findings, drafted portions of the initial manuscript, and critically reviewed/revised the manuscript; Dr Sil (postdoctoral fellow) conducted the study assessments, assisted in the interpretation of findings, drafted portions of the initial manuscript, and critically reviewed/revised the manuscript; Dr Bromberg (psychology resident) conducted the literature review for the manuscript, drafted portions of the manuscript, and critically reviewed/revised the manuscript; Dr Lynch-Jordan (coinvestigator) provided clinical supervision for the psychological assessments, monitored safety and risk of study participants, assisted with conceptualizing the focus of the manuscript, and critically reviewed/revised the manuscript; Mr Strotman (clinical research coordinator) managed all aspects of data collection, data entry, data cleaning, initial analysis, and preparation of tables and figures for the manuscript; Dr Peugh (study biostatistician) completed all statistical analyses for the manuscript, wrote the analysis plan and assisted with the interpretation of data for the results section, and critically reviewed/revised the manuscript; Dr Noll (coinvestigator and developmental psychologist) assisted in the conceptualization and design of the study and selection of instruments, provided guidance on retention strategies for this long-term study, and critically reviewed/revised the manuscript; (Continued on last page) Chronic widespread musculoskeletal pain in childhood is common, affecting 6% to 7% of school-aged children, [1][2][3][4] and often encountered in pediatric primary care. [5][6][7] For a subset of patients, usually adolescent females, symptoms initially viewed by physicians and parents as temporary "growing pains" may be persistent (beyond 3 months), accompanied by headaches, fatigue, and sleep difficulties, and be medically unexplained. Furthermore, high levels of physical impairment, school absences, and emotional distress are reported, [8][9][10][11] often prompting families to seek medical attention.…”

Care delivery for the child to grow up despite the pain: the family's experience

“…Studies show that children's chronic pain generally changes family functioning through the new demands it creates, making it possible or not to create abilities for the family to overcome this event (1)(2)6) .…”