Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients

Abstract

Background: Prevalence of pain as a recurrent symptom in children is known to be high, but little is known about children with high impairment from chronic pain seeking specialized treatment. The purpose of this study was the precise description of children with high impairment from chronic pain referred to the German Paediatric Pain Centre over a 5-year period.

Methods: Demographic variables, pain characteristics and psychometric measures were assessed at the first evaluation. Subgroup analysis for sex, age and pain location was conducted and multivariate logistic regression applied to identify parameters associated with extremely high impairment.

Results: The retrospective study consisted of 2249 children assessed at the first evaluation. Tension type headache (48%), migraine (43%) and functional abdominal pain (11%) were the most common diagnoses with a high rate of co-occurrence; 18% had some form of musculoskeletal pain disease. Irrespective of pain location, chronic pain disorder with somatic and psychological factors was diagnosed frequently (43%). 55% of the children suffered from more than one distinct pain diagnosis. Clinically significant depression and general anxiety scores were expressed by 24% and 19% of the patients, respectively. Girls over the age of 13 were more likely to seek tertiary treatment compared to boys. Nearly half of children suffered from daily or constant pain with a mean pain value of 6/10. Extremely high pain-related impairment, operationalized as a comprehensive measure of pain duration, frequency, intensity, pain-related school absence and disability, was associated with older age, multiple locations of pain, increased depression and prior hospital stays. 43% of the children taking analgesics had no indication for pharmacological treatment.

Conclusion: Children with chronic pain are a diagnostic and therapeutic challenge as they often have two or more different pain diagnoses, are prone to misuse of analgesics and are severely impaired. They are at increased risk for developmental stagnation. Adequate treatment and referral are essential to interrupt progression of the chronic pain process into adulthood.

Figure 1

Distribution of children with chronic pain by age and gender.Note. Chi²-test: *** p < 0.001; * p < 0.05.

Figure 2

Relationship between age at pain onset and first appointment.

Figure 3

Emotional distress of children by main pain locations.Note. Figure 3a) number of children with clinically relevant values in depression (Chi²(2) = 15.163; p < 001; Cramer’s V = .1) and general anxiety (Chi²(2) = 20.066; p < 001; Cramer’s V = .1); a T-value >60 is clinically relevant. Figure 3b) mean values of depression and anxiety scores; analyzed by ANOVA (Depression: F(2, 1584) = 13.977; p < 0.001; eta² = 0.02; General Anxiety: F(2, 1558) = 7.704; p < 0.001; eta² = 0.01). Results of post-hoc tests are depicted in the figure: * p < 0.05; ***p < 0.001.

Figure 4

Factors associated with “extremely high impairment”.