1. The average child admitted for chronic pain was 13.5 years old, white, and female, and presented with abdominal pain.
2. Chronic pain patients commonly had secondary diagnoses (usually gastrointestinal or psychiatric conditions), with an average of 10 total diagnoses per patient.
Evidence Rating Level: 2 (Good)
Study Rundown: Chronic pain often lacks a clear etiology and is therefore poorly understood and managed, with lifelong consequences for patients. Variation in presenting symptoms, diagnosis, and treatment of chronic pain have resulted in increased resource utilization, healthcare costs, and school absences. Results from this study highlighted the incidence and demographic characteristics of children admitted with chronic pain. Sixteen per 1000 patients admitted were diagnosed with chronic pain, with admissions increasing by 831% over the six-year study period. The average patient was a 13.54-year old, white female presenting with abdominal pain. Each patient had a mean of 10 secondary diagnoses, the most common of which were gastrointestinal or psychiatric conditions. Also, the average length of stay was longer than expected. One limitation of this study was the use of a third-party database, which had few codes for chronic pain states and may not have accurately reflected the population of interest.
Relevant Reading: Recurrent pain, emotional distress, and health service use in childhood
Study Author, Dr. Thomas Coffelt, MD, FAAP, talks to 2 Minute Medicine: Internal Medicine/Pediatrics Hospitalist, Indiana University Health Physicians; Assistant Professor of Clinical Medicine and Pediatrics, Indiana University School of Medicine.
“Our study findings confirm what we are seeing in the hospital – chronic pain complaints are becoming an alarmingly increasing reason for admission to the hospital. These patients frequently undergo invasive procedures to evaluate the cause of their pain and sometimes to treat it (i.e. epidurals). Unfortunately, many of these evaluations do not reveal an underlying pathologic diagnosis. Treatment options frequently include opioids and/or benzodiazepines which establish a vicious cycle of both physical and psychological dependence. We as clinicians need to consider this data carefully and work to develop more targeted diagnostic evaluations and effective treatment options while limiting potential complications and side effects through further research of this growing problem.”
In-Depth [retrospective cohort study]: A total of 3752 patients with chronic pain, ages 0 to 18, were identified from 2004 through 2010. Over these six years, there was an 831% increase in chronic pain patients, who represented 0.16% of the total patients in the database. The average child admitted for chronic pain was found to be 13.54 years old. White patients accounted for 79% of chronic pain patients and females outnumbered males by 2.41 to 1. Furthermore, each patient had a mean of 10 secondary diagnoses, the most common being abdominal pain (39%), mood disorders (28%), constipation (20%), nausea/vomiting/diarrhea (18%), anxiety (18%), and headaches (18%). Overall, 65% of patients had a gastrointestinal diagnosis, 44% had a psychiatric diagnosis, and 9.9% had a coded medication adverse effect, overdose, or substance abuse. The mean length of stay was 7.32 days, while the expected length of stay was 4.24 days; 12.5% of patients were readmitted within one year.
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