Patterns and Predictors of Health Service Utilization in Adolescents With Pain: Comparison Between a Community and a Clinical Pain Sample

Abstract

There is limited research describing the patterns of healthcare utilization in adolescents with chronic pain. This study describes healthcare utilization in a clinical chronic pain sample, and compares the patterns of service use of this group to a community sample with intermittent pain complaints. We also investigated demographic and clinical factors that predicted healthcare visits and medication use in the clinical sample. Data on 117 adolescents (aged 12-18; n=59 clinical pain sample, n=58 community) were collected. Caregivers and adolescents reported on sociodemographics, medical visits, current medications, pain, activity limitations, and depression. As hypothesized, the clinical pain sample had higher rates of healthcare consultation on all types of medical visits (general, specialty care, complementary medicine, mental health, OT/PT), and higher medication use compared to the community sample. Regression analyses revealed that higher annual income, greater pain frequency, and higher levels of caregiver reported activity limitations were associated with a greater number of healthcare visits for the total sample. Within the clinical pain sample, higher pain frequency and greater activity limitations (caregiver-report) predicted more specialty care visits. Additionally, higher income and greater levels of depressive symptoms predicted a higher number of prescribed medications.Perspective-This study contributes to the limited available data on health service and medication use in a clinical chronic pain sample versus a community sample of adolescents. We also identify clinical factors (pain frequency, parent-reported activity limitations, depressive symptoms) and demographic factors (gender, income) associated with healthcare utilization.

Predictors of health care utilization in young children with recurrent pain – a population-based study

“…Factors associated with physician visits due to recurrent pain may be relevant to better understand children seeking professional help, and shape the health care system. So far, only three studies have systematically investigated pain-and demographic characteristics as predictors of health care utilization in pediatric pain patients (Perquin et al, 2001;Huguet & Miró, 2008;Toliver-Sokol et al, 2011). These studies agree that pain characteristics are associated with pain-related health care utilization.…”

“…Physician consultation in pediatric pain 3 highly relevant predictors of health care utilization in other contexts such as socioeconomic status (SES) or migration background, have rarely been studied, and if have been found to not be related to health care utilization (Perquin et al, 2001;Toliver-Sokol et al, 2011). Reasons for these inconsistencies may be small sample sizes (N) relative to the number of variables studied (K), and use of univariate analysis (Huguet & Miró, 2008).…”

“…Reasons for these inconsistencies may be small sample sizes (N) relative to the number of variables studied (K), and use of univariate analysis (Huguet & Miró, 2008). One study (Perquin et al, 2001) tested K=28 variables in a sample comprising N=254 children with chronic pain from a larger epidemiologic study, the other study used multiple linear regression analysis to test K=6 variables in N=59 patients (Toliver-Sokol et al, 2011). Such small number of cases per variable may result in spurious findings and overall highly variable effect-estimates.…”

“…These studies found conflicting findings concerning demographic characteristics. While one study indicates that girls with chronic pain seek health care more often than boys (Perquin et al, 2001), other studies did not replicate this gender difference (Huguet & Miró, 2008;Toliver-Sokol et al, 2011). Similarly, one populationbased study found that younger children seek a physician more often (Ellert, Neuhauser & RothIsigkeit, 2007), the other studies did not replicate these findings (Perquin et al, 2001;Huguet & Miró, 2008).…”

Chronic Pain Assessment Tools for Cerebral Palsy: A Systematic Review

“…60,61 This discriminative tool has been validated with children with chronic pain conditions ( Table 2). [62][63][64][65][66][67] The working group deemed the Body Diagram to be approaching wellestablished in psychometric properties with strong clinical utility. As a standalone tool, the Body Diagram would not provide as much detailed information related to chronic pain interference and thereby, is recommended by current reviewers to be paired with another tool.…”