title: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Marisol
authors.initials: M
authors.lastname: Toliver-Sokol
authors.forename: Caitlin B
authors.initials: CB
authors.lastname: Murray
authors.forename: Anna C
authors.initials: AC
authors.lastname: Wilson
authors.forename: Amy
authors.initials: A
authors.lastname: Lewandowski
authors.forename: Tonya M
authors.initials: TM
authors.lastname: Palermo
mesh_terms: D000293:Adolescent; D017028:Caregivers / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology / Q000628:therapy; D002658:Developmental Disabilities / Q000523:psychology / Q000628:therapy; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010146:Pain / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D018710:Pain Clinics; D059408:Pain Management; D010147:Pain Measurement; D011237:Predictive Value of Tests; D012111:Residence Characteristics