Pain, Quality of Life and Functional Disability in a Pediatric Pain Clinic
The purpose of this study was to describe functional disability, pain and quality of life in a children being seen at a tertiary pediatric pain specialty clinic in the Pacific Northwest.
Rationale
Children with chronic pain are treated in a variety of settings including primary care and specialty-based clinics. Pain intensity has been shown to be important in understanding pain related functional disability in children. A range of other factors may affect other critical outcomes including functional disability and quality of life. Findings from adult-based studies indicate that contextual factors (e.g. demographics, family history of pain and other patient centered characteristics) may contribute to functional disability above and beyond that of pain intensity but are less documented in pediatric populations.
Methods
Data was collected from a consecutive series of 314 new pediatric pain patients, including: demographics, pain intensity, location, history and frequency, academic status, parental and child optimism, family history for pain, anxiety and depression, and a validated self-report measure Children’s Activity Limitations Interview (CALI) a 21-item measure designed to assess pain-related activity limitations in children and adolescents, Data analysis was conducted using SPSS version 22. Summary statistics were used to describe the characteristics of the sample. Means and standard deviations were used for continuous data, and categorical items were described using frequency statistics.
Results
The mean (±SD) age at presentation was 13.79 ± 2.98. Participants reported high levels of pain with a typical pain intensity of 5.82 ± 1.98 and worst pain intensity of 8.95 ± 1.33. 42.3% of participants reported experiencing pain in three or greater locations, while 65.5% reported pain in greater than 2 locations. The most commonly reported pain location included the head (28.5%), abdomen (23.4%), leg (13.6%) and lower back (11.2%) with 78.5% of participants reported experiencing pain at least daily within the last month. 61.4% of participants reported that over the last month, their pain had increased. 87.6% of participants reported difficulty sleeping related to their pain. Over half (50.4%) reported missing greater than 20 days of school within the last school year. The CALI sum scores had a mean of 43.86 ± 17.89. 67.7% of parents reported a family history of pain problems similar to the child with 57.5% reporting a family history of depression and 45.6% family history of anxiety. Child/adolescent perception of their ability to cope or deal with their pain was a mean of 4.86. Parental optimism of ability to cope or deal with their child’s pain was 6.77.
Implications
A clinical sample of children and adolescents with chronic pain presenting for assessment at a tertiary pediatric pain specialty clinic showed high levels of pain and functional disability. Furthermore, children with pain indicated poor coping and their parents were not optimistic about their ability to deal with their child’s pain. Understanding the variables that contribute to the child and adolescents experience of pain and associated disability is an important step in the groundwork for future research and tailoring specific interventions in children and adolescents with chronic pain.