Abstract
Background
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 pediatric primary care and to identify predictors of treatment failure.
Method
In a prospective observational cohort study with three assessments over six months, N=266 children (6 to 17 years) presenting to pediatric primary care due to medically unexplained pain were included. The primary outcome is treatment failure after 6 months defined as disabling chronic pain. Risk factors for treatment failure were identified by means of logistic regression analyses.
Results
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 three months were more likely to experience treatment failure (OR=104.3; p<.001) at 6 months, as were children with a higher emotional pain burden at study inclusion (OR=1.2; p=.007; R²=.755).
Conclusions
This study indicates that pediatric primary care is not sufficient for nearly one quarter of children with medically unexplained pain. Individuals without a positive treatment response after three months are at increased risk for treatment failure.
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from Wiley: European Journal of Pain: Table of Contents http://bit.ly/2WW8bQ1
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