Abstract

PR1-152

Health care utilization among children with isolated and comorbid chronic pain

¹Tumin D, ²Drees D, ¹Miller R, ¹Wrona S, ¹Hayes, Jr. D, ¹Tobias J, ¹Bhalla T
¹Nationwide Children's Hospital, Columbus, OH, USA; ²The Ohio State University, Columbus, OH, USA

Introduction: Epidemiological data suggest that approximately 5% of children experience moderate or severe problems with chronic pain. The challenge of managing pediatric chronic pain has spurred development of specialized interdisciplinary chronic pain services. However, opportunities to refer children to a specialized pain service may be limited if they are not receiving specialty care related to a recent surgery or another chronic condition. In this study, we use data from a nationally representative survey to characterize the prevalence of chronic pain among children in the United States, and compare the use of primary, specialty, and emergency care among children according to the presence of chronic pain and comorbid conditions.

Methods: We used public de-identified data from the 2016 National Survey of Children’s Health to estimate the prevalence of caregiver-reported chronic pain and comorbid physical or mental health conditions among children ≤ 17 years of age. The measure of chronic pain included one question about “difficulty [with] repeated or chronic physical pain,” and another question about “frequent or severe headaches.” Weighted analysis, including tests of proportions and multivariable logistic regression, compared the use of primary, specialty, or emergency care in the past year according to the presence of (1) no pain, (2) physical or mental health conditions without pain, (3) isolated chronic pain, or (4) comorbid chronic pain.

Results: The analysis included 48,285 children, of whom 3,237 had chronic pain (weighted percentages: isolated, 2%; comorbid, 5%). The prevalence of other physical or mental health conditions without comorbid chronic pain was 41%. Study characteristics are compared by presence of chronic pain and comorbidities in the Table. The prevalence of both isolated and comorbid chronic pain increased with age. On multivariable analysis, comorbid chronic pain was associated with higher odds of receiving specialty care (OR=4.7; 95% CI: 3.1, 7.2; p<0.001) and emergency care (OR=2.8; 95% CI: 1.7, 4.5; p<0.001), compared to isolated chronic pain. Children with comorbid chronic pain also had higher utilization of specialty and emergency care compared to children with other physical or mental health conditions.

Discussion: In our analysis of a recent population-based survey, approximately one-fifth of children with chronic pain did not have comorbid conditions, and this group had lower specialty care utilization compared to children with comorbid chronic pain. Among children with isolated chronic pain, opportunities for referral to specialized chronic pain treatment may be limited by low use of specialty care.

Reference:
1. King S, Chambers CT, Huguet A, MacNevin RC, McGrath PJ, Parker L, MacDonald AJ. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain. 2011;152:2729-38.