Pain-related presentations to a general pediatric outpatient clinic and physicians' approaches

Pain is a common reason for pediatric outpatient visits, yet deficiencies in assessment and management remain widespread. This study aimed to determine the proportion of pediatric outpatient visits involving pain, classify pain as acute or chronic, evaluate associations with age and sex, assess physicians' diagnostic approaches, and examine pain management and follow-up.

This ambispective observational study combined a retrospective cross-sectional assessment of pain-related outpatient visits with a prospective follow-up of patients with chronic pain. Children aged 3-18 years attending Ankara Etlik City Hospital between February 1 and 28, 2023, were included. Demographic and pain-related data, clinical findings, laboratory results, diagnoses, and treatments were retrospectively extracted from the hospital information system using a standardized data collection form. Patients with chronic pain were prospectively followed for 6 months; follow-up attendance was assessed through the hospital information system, and those who missed scheduled visits were contacted by telephone. Multivariable logistic regression analyses were performed to identify factors independently associated with chronic pain and analgesic prescribing.

During the study period, 646 of 6,790 outpatient visits (9.5%) involved pain-related complaints; 53.6% of patients were female. Acute pain was reported in 70.1%, chronic pain in 10.8%, and pain duration was undocumented in 19.0%. Adolescents accounted for 64.3% of chronic pain cases (p = 0.001). Each one-year increase in age was associated with an 11% increase in the odds of chronic pain (aOR 1.11, 95% CI 1.05-1.18), and female sex was associated with 1.85-fold higher odds of chronic pain (aOR 1.85, 95% CI 1.07-3.19). Diagnostic testing was performed in 58.2% of patients, and 38.5% of those tested had normal results. Only 26.0% received analgesic treatment. Abnormal physical examination findings were the only independent predictor of analgesic prescribing (aOR 5.10, 95% CI 3.25-7.98; p < 0.001). Among 70 patients with chronic pain, follow-up information was available for 45; 20 (44.4%) reported persistent pain, 11 (24.4%) improvement, and 14 (31.1%) complete resolution.

Standardized pain assessment, structured documentation, and evidence-based management may improve pediatric pain care.