Predictors of treatment outcome in children with medically unexplained pain seeking primary care: A prospective cohort study.

Abstract

Medically unexplained pain in children and adolescents is a common and increasing health care problem. Primary care is usually the first point of contact for these patients. It is the overall objective of this study to investigate treatment outcome of medically unexplained pain in paediatric primary care and to identify predictors of treatment failure. In a prospective observational cohort study with three assessments over 6months, N=266 children (6-17years) presenting to paediatric primary care due to medically unexplained pain were included. The primary outcome is treatment failure after 6months defined as disabling chronic pain. Risk factors for treatment failure were identified by means of logistic regression analyses. At the 6-months follow-up, treatment proved unsuccessful in 22.6% of patients. In patients with headaches, high functional impairment and strong emotional pain burden at study inclusion, the risk for treatment failure was increased. However, when also including data on the initial treatment response, pain location and functional impairment were no longer significant. Patients who did not respond to treatment within the first 3months were more likely to experience treatment failure (OR=203.7 ; p<0.001) at 6months, as were children with a higher emotional pain burden at study inclusion (OR=1.3; p=0.007; R2 =0.781). This study indicates that paediatric primary care is not sufficient for nearly one-quarter of the children with medically unexplained pain. Individuals without a positive treatment response after 3months are at increased risk for treatment failure. This study investigates the treatment outcome of medically unexplained pain in paediatric primary care. Individuals with a higher emotional pain burden at the first visit and those without positive treatment response after 3months are at increased risk for treatment failure. Therefore, a stepped-care approach seems warranted. After an insufficient primary care trial of 3months, patients should be transferred to pain specialists for a more intense treatment.