G132 Co-morbidities in children and young people with chronic idiopathic pain syndrome

Abstract

Background Chronic Idiopathic Pain Syndrome (CIPS) affects a large number of children and young people (CYP) and makes up a large proportion of the patients seen by Paediatric Rheumatologists. Management of CIPS involves a multi-disciplinary pain management and activity programme. Further complexity is added when CYP have comorbidities, in particular Autistic Spectrum Disorders (ASD), which impact on a patients’ understanding of the concepts used to explain chronic pain and their ability to participate in treatment. There is also increasing concern regarding opiate use in CYP, and they are often ineffective in CIPS. Aim To determine the prevalence of (i) comorbid conditions including ASD, (ii) opiate use and (iii) school attendance, in children with CIPS, at presentation to tertiary Paediatric Rheumatology. Method Retrospective review of electronic patient records for CYP seen in a tertiary Paediatric Rheumatology centre and diagnosed with CIPS from January 2014 to May 2018. Data collected included the following, where available: comorbidities, number of medicines, whether on opiate analgesics, school attendance, and family history of chronic pain or fibromyalgia. Results Data was collected from 131 patients with a median age of diagnosis of 13 years and 73% were female. The median number of comorbidities was 1 and the median number of medicines being taken was 2. 23% (n=30) of patients with CIPS were on opiates at presentation and of those whose school attendance was assessed (54%, n=71) the mean school attendance was 64%. 37% of patients had hypermobility, 18% had low mood/anxiety and 8% had an ASD, considerably higher than the national prevalence of 19.2%, 4%, and 2.3% respectively. When grouped into speciality subgroups, 30% of the comorbidities were MSK-related, 13% psychiatric and 10% Gastroenterological. Conclusion CIPS is an important, complex condition that significantly affects CYP’s school attendance and psychological state. There is a higher rate of ASD’s in this population which requires a multifaceted approach to managing their complex needs. Opiates are still prescribed although there is limited evidence for their use in this condition. These patients often have multiple co-morbidities which may complicate the management of their CIPS and further supports the need for effective multidisciplinary management.