title: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: German Paediatric Pain Centre, Datteln, Germany. b.zernikow@kinderklinik-datteln.de
authors.forename: Boris
authors.initials: B
authors.lastname: Zernikow
authors.forename: Julia
authors.initials: J
authors.lastname: Wager
authors.forename: Tanja
authors.initials: T
authors.lastname: Hechler
authors.forename: Carola
authors.initials: C
authors.lastname: Hasan
authors.forename: Uta
authors.initials: U
authors.lastname: Rohr
authors.forename: Michael
authors.initials: M
authors.lastname: Dobe
authors.forename: Adrian
authors.initials: A
authors.lastname: Meyer
authors.forename: Bettina
authors.initials: B
authors.lastname: Hübner-Möhler
authors.forename: Christine
authors.initials: C
authors.lastname: Wamsler
authors.forename: Markus
authors.initials: M
authors.lastname: Blankenburg
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D000041:Absenteeism; D000293:Adolescent; D001007:Anxiety / Q000209:etiology; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data; D002675:Child, Preschool; D059350:Chronic Pain / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D005260:Female; D005858:Germany; D006261:Headache / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D059352:Musculoskeletal Pain / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D010147:Pain Measurement; D011594:Psychometrics; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires