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Children with unexplained chronic pain: do pediatricians agree regarding the diagnostic approach and presumed primary
Antoinette Y Konijnenberg1, Elisabeth R De Graeff-Meeder, Jan L L Kimpen
1Department of General Pediatrics, University Medical Center Utrecht, Utrecht, Netherlands.
Insights
Pediatricians often disagree on the causes and diagnostic methods for children with unexplained chronic pain (UCP). This lack of consensus may lead to suboptimal care for these young patients.
Area of Science:
- Pediatric Medicine
- Child Psychology
- Pain Management
Background:
- Unexplained chronic pain (UCP) is a common challenge in pediatric care.
- Accurate diagnosis and treatment planning for UCP are often complex.
Purpose of the Study:
- To assess general pediatricians' opinions on the causes of UCP in children.
- To evaluate pediatricians' preferred diagnostic approaches for UCP.
Main Methods:
- A diagnostic follow-up study involving 134 children (8-18 years) with chronic pain.
- 17 pediatricians reviewed patient records and assessment data in three panels.
- Consensus was defined as >=80% agreement on the presumed cause and diagnostic approach.
Main Results:
- Consensus on the primary cause of UCP was reached for only 43% of patients.
- Consensus on the diagnostic approach was achieved for 63% of children.
- Over one-third (37%) of children lacked diagnostic consensus among pediatricians.
Conclusions:
- Significant disagreement exists among pediatricians regarding the etiology and diagnosis of UCP.
- These diagnostic challenges highlight potential risks for suboptimal care in children with UCP.
- Improved consensus on diagnostic strategies is needed for this patient population.
Objective:
To investigate the opinions of general pediatricians regarding children with unexplained chronic pain (UCP), with respect to the presumed cause of the pain and the optimal diagnostic approach for these children.
Design:
Diagnostic follow-up study.
Setting:
Outpatient clinic of a university children's hospital.
Participants:
A total of 134 consecutive patients, 8 to 18 years of age, referred for pain of > or =3-month duration without a satisfactory explanation at presentation.
Methods:
A full copy of the patient records from routine medical practice and data from standardized psychiatric assessments, standardized questionnaires, and standardized follow-up assessments were provided to 17 pediatricians assigned to 3 panels.
Main Outcome Measures:
Agreement regarding the presumed primary cause and diagnostic approach for children with UCP, with consensus being defined as > or =80% agreement among the pediatricians.
Results:
The mean age of the children (73% girls) was 11.8 years (SD: 2.6 years). Psychiatric (co)morbidity was present for 60% of the children. Consensus regarding the presumed primary cause was reached for 43% of the patients (58 of 134 patients), ie, 72% (42 of 58 patients) primarily dysfunctional, 17% (10 of 58 patients) primarily psychologic, and 10% (6 of 58 patients) primarily somatic. Consensus regarding the diagnostic approach was reached for 63% of the children (84 of 134 children), leaving more than one-third of the children (37%) without diagnostic consensus.
Conclusions:
The relatively high rates of disagreement regarding the optimal diagnostic approach and presumed primary cause illustrate the difficulties of diagnostic evaluation and subsequent therapeutic strategy design for this patient group. Therefore, children with UCP might be at risk for suboptimal care.
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