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Establishing consensus on biopsychosocial factors associated with pediatric chronic pain: A modified Delphi study
Emma Rheel1, Marieke De Craemer2, Tom Deliens3
1Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.
Insights
Experts identified key modifiable factors for pediatric chronic pain, including physical activity and sedentary behavior. These findings guide interventions to prevent and manage chronic pain in children effectively.
Area of Science:
- Pediatric Pain Management
- Child Health Research
- Intervention Science
Background:
- Chronic pain affects many children, necessitating identification of modifiable factors.
- Understanding these factors is crucial for developing effective interventions.
- Targeting modifiable factors can improve prevention and management strategies for pediatric chronic pain.
Purpose of the Study:
- To achieve expert consensus on factors associated with pediatric chronic pain.
- To evaluate the modifiability and population-level effect of these factors.
- To guide the development of targeted interventions for pediatric chronic pain.
Main Methods:
- A two-round modified Delphi method was employed with pediatric pain experts.
- Web-based questionnaires assessed factors' association strength, modifiability, and population-level effect.
- Expert consensus was reached on 47 identified factors associated with pediatric chronic pain.
Main Results:
- Four factors were deemed highly modifiable: physical activity (PA), sedentary behavior (SB), pain-related school absence, and child's pain knowledge.
- Three factors demonstrated a high population-level effect: PA, SB, and child's emotional state (e.g., depression).
- Consensus was achieved on the modifiability and population-level impact of various factors.
Conclusions:
- Expert consensus identified key modifiable factors and those with high population-level effects in pediatric chronic pain.
- Physical activity, sedentary behavior, and emotional well-being are critical targets for intervention.
- These findings provide a foundation for evidence-based interventions to reduce the burden of chronic pain in children.
Abstract:
A variety of factors are associated with the development and maintenance of chronic pain in children. Identifying modifiable factors associated with pediatric chronic pain is important to use them as target outcomes in the development and evaluation of interventions for the prevention and management of chronic pain. This study aimed to reach expert consensus on factors associated with pediatric chronic pain and their modifiability and population-level effect. Pediatric pain experts were questioned using a web-based two-round modified Delphi method. Two rounds of questions with Likert scaling were used to identify influencing factors (Round 1) and to reach consensus on each factor (Round 2) in terms of: 1) strength of association with chronic pain in children; 2) modifiability; and 3) population-level effect. An inductive approach was used to derive categories (ranging from 'very low' to 'very high') and subcategories (ranging from 'low' to 'high'). In total, 48 experts from 14 different countries completed Round 1, and 31 completed Round 2. A list of 47 factors was considered to be associated with pediatric chronic pain. Four factors (physical activity (PA), sedentary behavior (SB), pain-related school absence, and pain concept/knowledge of the child) were considered highly modifiable and three factors having a high population-level effect (PA, SB, and the child's depressive or negative emotional feelings). Expert consensus was established about modifiable and population-level factors associated with pediatric chronic pain through this web-based modified Delphi study, guiding target outcomes for its prevention and management. PERSPECTIVE: This article presents the results of a modified Delphi study with pediatric pain experts to gain consensus on factors associated with pediatric chronic pain. Relationship strength, modifiability, and population-level effect of associated factors were rated to identify areas of research priority and interventions aiming to reduce the development and maintenance of chronic pain in children.
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