Assessment of disability: Assessing fatigue in pediatric chronic pain

Abstract

Pediatric chronic pain is a significant health problem that has implications on school attendance, physical and social activities and psychological distress (Bursch, Walco, & Zeltzer, 1998; McGrath, Dunn-Geier, & Cunningham, 1986; Palermo, 2000). Less understood is the role of fatigue in pediatric chronic pain. The current investigation is a cross-sectional investigation of chronic pain, fatigue and quality of life in children and adolescents who are seeking outpatient pain management services from an urban Childrens Hospital. Twenty-three participants (5 boys and 18 girls) with a mean age of 13.9 (range 8 to 18) were recruited. Participants and their caregivers completed standardized self-report questionnaires and research assistants completed a medical chart review. Participant's diagnostic classifications included headaches, fibromyalgia, sickle cell disease, cancer and others. The sample consisted of mostly Caucasian (47.8%) and Latino/a (34.8%) participants. Quality of life was measured with The Pediatric Quality of Life Inventory (PedsQL) (Varni, 1998). The PedsQL consists of 23 self-report items and yields physical, psychosocial and total summary health scores, ranging from 0-100, with higher scores indicating better quality of life. Fatigue was measured using the PedsQL Multidimensional Fatigue Scale (Varni, 1998), an 18-item self-report instrument with higher scores indicating less fatigue. Pain and qualitative data was gathered using a clinic-developed instrument (Bursch & Zeltzer, 2000). Children, 8-12 years, reported an above average mean quality of life (M=63.8), physical (M=63.4), psychosocial (M=64.0) functioning and fatigue (M=65.1). Adolescents (13-18 years) endorsed lower overall quality of life (M=54.2), physical functioning (M=46.8) and fatigue (M=54.0), with a relative strength in psychosocial functioning (M=59.7). Adolescents appear to report less daily functioning and increased fatigue compared with the younger children. Additional implications of this data will be discussed and recommendations will be made to promote improved quality of life and overall functioning for children, adolescents and families living with chronic pain. Pediatric chronic pain is a significant health problem that has implications on school attendance, physical and social activities and psychological distress (Bursch, Walco, & Zeltzer, 1998; McGrath, Dunn-Geier, & Cunningham, 1986; Palermo, 2000). Less understood is the role of fatigue in pediatric chronic pain. The current investigation is a cross-sectional investigation of chronic pain, fatigue and quality of life in children and adolescents who are seeking outpatient pain management services from an urban Childrens Hospital. Twenty-three participants (5 boys and 18 girls) with a mean age of 13.9 (range 8 to 18) were recruited. Participants and their caregivers completed standardized self-report questionnaires and research assistants completed a medical chart review. Participant's diagnostic classifications included headaches, fibromyalgia, sickle cell disease, cancer and others. The sample consisted of mostly Caucasian (47.8%) and Latino/a (34.8%) participants. Quality of life was measured with The Pediatric Quality of Life Inventory (PedsQL) (Varni, 1998). The PedsQL consists of 23 self-report items and yields physical, psychosocial and total summary health scores, ranging from 0-100, with higher scores indicating better quality of life. Fatigue was measured using the PedsQL Multidimensional Fatigue Scale (Varni, 1998), an 18-item self-report instrument with higher scores indicating less fatigue. Pain and qualitative data was gathered using a clinic-developed instrument (Bursch & Zeltzer, 2000). Children, 8-12 years, reported an above average mean quality of life (M=63.8), physical (M=63.4), psychosocial (M=64.0) functioning and fatigue (M=65.1). Adolescents (13-18 years) endorsed lower overall quality of life (M=54.2), physical functioning (M=46.8) and fatigue (M=54.0), with a relative strength in psychosocial functioning (M=59.7). Adolescents appear to report less daily functioning and increased fatigue compared with the younger children. Additional implications of this data will be discussed and recommendations will be made to promote improved quality of life and overall functioning for children, adolescents and families living with chronic pain.