title: Pediatric Pain Screening Tool: rapid identification of risk in youth with pain complaints.
abstract: Moderate to severe chronic pain is a problem for 1.7 million children, costing $19.5 billion dollars annually in the United States alone. Risk-stratified care is known to improve outcomes in adults with chronic pain. However, no tool exists to stratify youth who present with pain complaints to appropriate interventions. The Pediatric Pain Screening Tool (PPST) presented here assesses prognostic factors associated with adverse outcomes among youth and defines risk groups to inform efficient treatment decision making. Youth (n = 321, ages 8-18, 90.0% Caucasian, 74.8% female) presenting for multidisciplinary pain clinic evaluation at a tertiary care center participated. Of these, 195 (61.1%) participated at 4-month follow-up. Participants completed the 9-item PPST in addition to measures of functional disability, pain catastrophizing, fear of pain, anxiety, and depressive symptoms. Sensitivity and specificity for the PPST ranged from adequate to excellent, with regard to significant disability (78%, 68%) and high emotional distress (81%, 63%). Participants were classified into low- (11%), medium- (32%), and high- (57%) risk groups. Risk groups did not significantly differ by pain diagnosis, location, or duration. Only 2% to 7% of patients who met reference standard case status for disability and emotional distress at 4-month follow-up were classified as low risk at baseline, whereas 71% to 79% of patients who met reference standard case status at follow-up were classified as high risk at baseline. A 9-item screening tool identifying factors associated with adverse outcomes among youth who present with pain complaints seems valid and provides risk stratification that can potentially guide effective pain treatment recommendations in the clinic setting.
authors.affiliation: Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA PAIN Group, Boston Children's Hospital and Center for Pain and the Brain, Boston, MA, USA Arthritis Research UK Primary Care Centre, Keele University, United Kingdom.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Simons
authors.forename: Allison
authors.initials: A
authors.lastname: Smith
authors.forename: Camila
authors.initials: C
authors.lastname: Ibagon
authors.forename: Rachael
authors.initials: R
authors.lastname: Coakley
authors.forename: Deirdre E
authors.initials: DE
authors.lastname: Logan
authors.forename: Neil
authors.initials: N
authors.lastname: Schechter
authors.forename: David
authors.initials: D
authors.lastname: Borsook
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Hill
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000523:psychology; D058443:Catastrophization / Q000523:psychology; D002648:Child; D059350:Chronic Pain / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D003863:Depression / Q000523:psychology; D004185:Disability Evaluation; D042241:Early Diagnosis; D005239:Fear / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010147:Pain Measurement / Q000379:methods*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity