title: Classifying the severity of paediatric chronic pain - an application of the chronic pain grading.
abstract: BACKGROUND
  The chronic pain grading (CPG), a standard approach to classify the severity of pain conditions in adults, combines the characteristics of pain intensity and pain-related disability. However, in children and adolescents, the CPG has only been validated in a school sample, but not in the actual target population, i.e., clinical populations with pain.
  
  
  METHODS
  In the present study, we applied the CPG to a tertiary sample of adolescents with chronic pain (n=1242). Construct validity, sensitivity to change and prognostic utility were examined.
  
  
  RESULTS
  Results indicate that most adolescents were equally classified into the three higher severity grades. Higher CPG classification was associated with more pain locations, higher pain frequency, longer pain duration, extensive use of health care and more depressive symptoms. Adolescents with a high CPG received recommendations for inpatient treatment more often; however, the prognostic utility for therapy recommendation - as operationalized in this study - was low. Sensitivity to change was assessed via reassessment at follow-up for a subsample of 490 adolescents. The majority of adolescents improved to a less severe CPG; changes were more common in the high severity range.
  
  
  CONCLUSIONS
  The CPG may be applied to adolescent tertiary care samples and to assess outcomes in clinical trials. However, in this study it was not appropriate to assign adolescent patients to different treatment options. Future work should focus on developing a comprehensive assessment tool for assigning patients to different treatments.
authors.affiliation: German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany. j.wager@kinderklinik-datteln.de
authors.forename: J
authors.initials: J
authors.lastname: Wager
authors.forename: T
authors.initials: T
authors.lastname: Hechler
authors.forename: A S
authors.initials: AS
authors.lastname: Darlington
authors.forename: G
authors.initials: G
authors.lastname: Hirschfeld
authors.forename: S
authors.initials: S
authors.lastname: Vocks
authors.forename: B
authors.initials: B
authors.lastname: Zernikow
mesh_terms: D000293:Adolescent; D002648:Child; D059350:Chronic Pain / Q000145:classification* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement / Q000379:methods*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires