Children with unexplained chronic pain: do pediatricians agree regarding the diagnostic approach and presumed primary cause?

Abstract

Objective: To investigate the opinions of general pediatricians regarding children with unexplained chronic pain (UCP), with respect to the presumed cause of the pain and the optimal diagnostic approach for these children.

Design: Diagnostic follow-up study.

Setting: Outpatient clinic of a university children's hospital.

Participants: A total of 134 consecutive patients, 8 to 18 years of age, referred for pain of > or =3-month duration without a satisfactory explanation at presentation.

Methods: A full copy of the patient records from routine medical practice and data from standardized psychiatric assessments, standardized questionnaires, and standardized follow-up assessments were provided to 17 pediatricians assigned to 3 panels.

Main outcome measures: Agreement regarding the presumed primary cause and diagnostic approach for children with UCP, with consensus being defined as > or =80% agreement among the pediatricians.

Results: The mean age of the children (73% girls) was 11.8 years (SD: 2.6 years). Psychiatric (co)morbidity was present for 60% of the children. Consensus regarding the presumed primary cause was reached for 43% of the patients (58 of 134 patients), ie, 72% (42 of 58 patients) primarily dysfunctional, 17% (10 of 58 patients) primarily psychologic, and 10% (6 of 58 patients) primarily somatic. Consensus regarding the diagnostic approach was reached for 63% of the children (84 of 134 children), leaving more than one-third of the children (37%) without diagnostic consensus.

Conclusions: The relatively high rates of disagreement regarding the optimal diagnostic approach and presumed primary cause illustrate the difficulties of diagnostic evaluation and subsequent therapeutic strategy design for this patient group. Therefore, children with UCP might be at risk for suboptimal care.