Factors associated with physician consultation and medication use in children and adolescents with chronic pain: A scoping review and original data.

Abstract

Although paediatric chronic pain is common, it is not yet clear which individuals with chronic pain are likely to seek health care for their pain. The aims of this study were to summarize the current evidence of the characteristics of children and adolescents with chronic pain who consult a physician or use medication for their pain. Additionally, we aimed to expand knowledge by further investigating key and promising, factors in a large community sample of adolescents. First, using scoping review methodology, studies on health care utilisation in paediatric chronic pain were identified by the systematic literature search. Out of 1,158 articles, 12 were included for data extraction. Second, in a population-based cross-sectional survey, data of N=2,280 adolescents (10-18years) and their parents (N=1,464), were analysed. Univariable logistic and multivariable LASSO regression models were calculated for adolescents with chronic pain (n=749) to identify predictors of physician visits or analgesics intake due to pain, controlling for acute illness and injury. The scoping review identified higher pain intensity, frequency, severity and pain-related disability as significant individual factors associated with physician consultation. Female sex and higher pain intensity were associated with medication consumption. Multivariable analyses with cross-sectional data revealed only pain-related school absence to be associated with physician consultation; analgesic medication use was associated with school absence and higher pain intensity. Original data from this study support prior findings. School absence and pain intensity, plausible surrogates for pain severity, are the most relevant factors in health care utilisation due to chronic pain. A scoping summary of existing research on predictors for physician consultation and medication use in children and adolescents with chronic pain is provided. Furthermore, the role of potential predictors for health care utilisation-sociodemographic, pain, school, psychological and parent-related characteristics-is analysed in a population-based cross-sectional survey. Controlling for illness and injuries, and using a strict chronic pain definition, the cross-sectional survey allows conclusions on healthcare utilisation specific to chronic pain in adolescents.