Background:
Prevalence of pain as a recurrent symptom in children is known to be high, but little is knownabout children with high impairment from chronic pain seeking specialized treatment. Thepurpose of this study was the precise description of children with high impairment fromchronic pain referred to the German Paediatric Pain Centre over a 5-year period.
Methods:
Demographic variables, pain characteristics and psychometric measures were assessed at thefirst evaluation. Subgroup analysis for sex, age and pain location was conducted andmultivariate logistic regression applied to identify parameters associated with extremely highimpairment.
Results:
The retrospective study consisted of 2249 children assessed at the first evaluation. Tensiontype headache (48%), migraine (43%) and functional abdominal pain (11%) were the mostcommon diagnoses with a high rate of co-occurrence; 18% had some form of musculoskeletalpain disease. Irrespective of pain location, chronic pain disorder with somatic andpsychological factors was diagnosed frequently (43%). 55% of the children suffered frommore than one distinct pain diagnosis. Clinically significant depression and general anxietyscores were expressed by 24% and 19% of the patients, respectively. Girls over the age of 13were more likely to seek tertiary treatment compared to boys. Nearly half of children sufferedfrom daily or constant pain with a mean pain value of 6/10. Extremely high pain-relatedimpairment, operationalized as a comprehensive measure of pain duration, frequency,intensity, pain-related school absence and disability, was associated with older age, multiplelocations of pain, increased depression and prior hospital stays. 43% of the children takinganalgesics had no indication for pharmacological treatment.
Conclusion:
Children with chronic pain are a diagnostic and therapeutic challenge as they often have twoor 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 areessential to interrupt progression of the chronic pain process into adulthood.