Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 152 No. 2324 (2022)

Estimating the prevalence of paediatric chronic pain in Switzerland: an online survey among paediatricians

  • Helen Koechlin
  • Cosima Locher
  • Maria Carlander
  • Joe Kossowsky
  • Andreas Woerner
  • Julia Dratva
DOI
https://doi.org/10.4414/SMW.2022.w30194
Cite this as:
Swiss Med Wkly. 2022;152:w30194
Published
06.06.2022

Summary

BACKGROUND: Chronic pain is a frequent complaint in children and adolescents, with great international variation in prevalence. Paediatricians are usually the first-line contact for pain problems in children and might refer patients to other specialists or pain clinics where available. Prevalence estimates of paediatric chronic pain and paediatricians’ care experiences in Switzerland are currently lacking.

OBJECTIVES: The aim of this study was to assess the prevalence of paediatric chronic pain in Swiss paediatrician practices and paediatricians’ professional experience and confidence with, and care provision for patients with paediatric chronic pain.

METHODS: Data were collected in 2019 using a cross-sectional online questionnaire among Swiss paediatricians. Ordinary least square regression analyses and Monte Carlo simulations were applied to estimate the prevalence rate of paediatric chronic pain. Explorative multivariate logistic regression analyses investigated whether sociodemographic and professional factors were associated with paediatricians’ confidence in treating and experience with paediatric chronic pain.

RESULTS: We included 337 paediatricians in our anonymised analyses. The prevalence rate of paediatric chronic pain in our sample was estimated to be between 2.54% and 3.89%. Twenty percent of paediatricians reported feeling confident in treating paediatric chronic pain, 77.2% had referred patients with paediatric chronic pain to another specialist and more than half had at least some experience with paediatric chronic pain. Experience and confidence with treating paediatric chronic pain were associated with male gender.

CONCLUSION: Our study is the first to estimate the prevalence of paediatric chronic pain by means of a sample of Swiss paediatricians. The prevalence rate was considerably lower than other estimates. Given the lack of training and confidence with treating paediatric chronic pain reported by paediatricians, absence of awareness and resulting under-diagnosis is possible.

References

  1. King S, Chambers CT, Huguet A, MacNevin RC, McGrath PJ, Parker L, et al. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain. 2011 Dec;152(12):2729–38. https://doi.org/10.1016/j.pain.2011.07.016
  2. Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. A classification of chronic pain for ICD-11. Pain. 2015 Jun;156(6):1003–7. https://doi.org/10.1097/j.pain.0000000000000160
  3. Palermo TM, Wilson AC, Peters M, Lewandowski A, Somhegyi H. Randomized controlled trial of an Internet-delivered family cognitive-behavioral therapy intervention for children and adolescents with chronic pain. Pain. 2009 Nov;146(1-2):205–13. https://doi.org/10.1016/j.pain.2009.07.034
  4. Friedrichsdorf SJ, Giordano J, Desai Dakoji K, Warmuth A, Daughtry C, Schulz CA. Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints [Internet]. Children (Basel). 2016 Dec;3(4):E42. [cited 2019 Feb 6] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5184817/ https://doi.org/10.3390/children3040042
  5. Nicholas M, Vlaeyen JW, Rief W, Barke A, Aziz Q, Benoliel R, et al.; IASP Taskforce for the Classification of Chronic Pain. The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain. 2019 Jan;160(1):28–37. https://doi.org/10.1097/j.pain.0000000000001390
  6. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007 Jul;133(4):581–624. https://doi.org/10.1037/0033-2909.133.4.581
  7. Liossi C, Howard RF. Pediatric Chronic Pain: Biopsychosocial Assessment and Formulation. Pediatrics. 2016 Nov;138(5):e20160331. https://doi.org/10.1542/peds.2016-0331
  8. Stinson J, Connelly M, Kamper SJ, Herlin T, Toupin April K. Models of Care for addressing chronic musculoskeletal pain and health in children and adolescents. Best Pract Res Clin Rheumatol. 2016 Jun;30(3):468–82. https://doi.org/10.1016/j.berh.2016.08.005
  9. Fisher E, Heathcote LC, Eccleston C, Simons LE, Palermo TM. Assessment of Pain Anxiety, Pain Catastrophizing, and Fear of Pain in Children and Adolescents With Chronic Pain: A Systematic Review and Meta-Analysis. J Pediatr Psychol. 2018 Apr;43(3):314–25. https://doi.org/10.1093/jpepsy/jsx103
  10. Palermo TM, Lewandowski AS, Long AC, Burant CJ. Validation of a self-report questionnaire version of the Child Activity Limitations Interview (CALI): the CALI-21. Pain. 2008 Oct;139(3):644–52. https://doi.org/10.1016/j.pain.2008.06.022
  11. Soltani S, Kopala-Sibley DC, Noel M. The Co-occurrence of Pediatric Chronic Pain and Depression: A Narrative Review and Conceptualization of Mutual Maintenance. Clin J Pain. 2019 Jul;35(7):633–43. https://doi.org/10.1097/AJP.0000000000000723
  12. Gold JI, Mahrer NE, Yee J, Palermo TM. Pain, fatigue, and health-related quality of life in children and adolescents with chronic pain. Clin J Pain. 2009 Jun;25(5):407–12. https://doi.org/10.1097/AJP.0b013e318192bfb1
  13. Kashikar-Zuck S, Zafar M, Barnett KA, Aylward BS, Strotman D, Slater SK, et al. Quality of life and emotional functioning in youth with chronic migraine and juvenile fibromyalgia. Clin J Pain. 2013 Dec;29(12):1066–72. https://doi.org/10.1097/AJP.0b013e3182850544
  14. Varni JW, Seid M, Smith Knight T, Burwinkle T, Brown J, Szer IS. The PedsQLTM in pediatric rheumatology: Reliability, validity, and responsiveness of the Pediatric Quality of Life InventoryTM generic core scales and rheumatology module. Arthritis Rheum. 2002 Mar;46(3):714–25. https://doi.org/10.1002/art.10095
  15. Groenewald CB, Essner BS, Wright D, Fesinmeyer MD, Palermo TM. The economic costs of chronic pain among a cohort of treatment-seeking adolescents in the United States. J Pain. 2014 Sep;15(9):925–33. https://doi.org/10.1016/j.jpain.2014.06.002
  16. Walker LS, Dengler-Crish CM, Rippel S, Bruehl S. Functional abdominal pain in childhood and adolescence increases risk for chronic pain in adulthood. Pain. 2010 Sep;150(3):568–72. https://doi.org/10.1016/j.pain.2010.06.018
  17. Hassett AL, Hilliard PE, Goesling J, Clauw DJ, Harte SE, Brummett CM. Reports of chronic pain in childhood and adolescence among patients at a tertiary care pain clinic. J Pain. 2013 Nov;14(11):1390–7. https://doi.org/10.1016/j.jpain.2013.06.010
  18. Koechlin H, Beeckman M, Meier AH, Locher C, Goubert L, Kossowsky J, et al. Association of parental and adolescent emotion-related factors with adolescent chronic pain behaviors. PAIN [Internet]. 2021 Oct 20 [cited 2021 Oct 28]; Available from: https://journals.lww.com/pain/Abstract/9000/Association_of_parental_and_adolescent.97860.aspx
  19. Ambord S, Eichenberger Y, Delgrande Jordan M. Gesundheit und Wohlbefinden der 11-15-jährigen Jugendlichen in der Schweiz im Jahr 2018 und zeitliche Entwicklung. Lausanne; 2020. (Health Behaviour in School-aged Children (HBSC)). Report No.: 113.
  20. Schneider T, Pfister D, Wörner A, Ruppen W. Characteristics of children and adolescents at the Switzerland-wide first ambulatory interdisciplinary pain clinic at the University Children’s Hospital Basel - a retrospective study. Swiss Med Wkly. 2019 Apr;149:w20073. https://doi.org/10.4414/smw.2019.20073
  21. Questback Gmb H. EFS Survey. Cologne: Questback GmbH; 2019.
  22. Thomopoulos NT. Essentials of Monte Carlo Simulation: Statistical Methods for Building Simulation Models. Springer Science & Business Media; 2012. 184 p.
  23. StataCorp. Stata Statistical Software: Release 15. College Station, TX: StataCorp LLC; 2017.
  24. Eccleston C, Crombez G, Scotford A, Clinch J, Connell H. Adolescent chronic pain: patterns and predictors of emotional distress in adolescents with chronic pain and their parents. Pain. 2004 Apr;108(3):221–9. https://doi.org/10.1016/j.pain.2003.11.008
  25. Palermo TM. Impact of recurrent and chronic pain on child and family daily functioning: a critical review of the literature. J Dev Behav Pediatr. 2000 Feb;21(1):58–69. https://doi.org/10.1097/00004703-200002000-00011
  26. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec;380(9859):2163–96. https://doi.org/10.1016/S0140-6736(12)61729-2
  27. Roth-Isigkeit A, Thyen U, Raspe HH, Stöven H, Schmucker P. Reports of pain among German children and adolescents: an epidemiological study. Acta Paediatr. 2004 Feb;93(2):258–63. https://doi.org/10.1111/j.1651-2227.2004.tb00717.x
  28. Perquin CW, Hazebroek-Kampschreur AA, Hunfeld JA, Bohnen AM, van Suijlekom-Smit LW, Passchier J, et al. Pain in children and adolescents: a common experience. Pain. 2000 Jul;87(1):51–8. https://doi.org/10.1016/S0304-3959(00)00269-4
  29. Gobina I, Villberg J, Välimaa R, Tynjälä J, Whitehead R, Cosma A, et al. Prevalence of self-reported chronic pain among adolescents: evidence from 42 countries and regions. Eur J Pain. 2019 Feb;23(2):316–26. https://doi.org/10.1002/ejp.1306
  30. Stewart WF, Lipton RB, Celentano DD, Reed ML. Prevalence of migraine headache in the United States. Relation to age, income, race, and other sociodemographic factors. JAMA. 1992 Jan;267(1):64–9. https://doi.org/10.1001/jama.1992.03480010072027
  31. Jandial S, Myers A, Wise E, Foster HE. Doctors likely to encounter children with musculoskeletal complaints have low confidence in their clinical skills. J Pediatr. 2009 Feb;154(2):267–71. https://doi.org/10.1016/j.jpeds.2008.08.013
  32. Anderson RS, Levitt DH. Gender Self-Confidence and Social Influence: Impact on Working Alliance. J Couns Dev. 2015;93(3):280–8. https://doi.org/10.1002/jcad.12026
  33. Matthews J, Zoffness R, Becker D. Integrative pediatric pain management: Impact & implications of a novel interdisciplinary curriculum. Complement Ther Med. 2021 Jun;59:102721. https://doi.org/10.1016/j.ctim.2021.102721
  34. Eccleston C, Fisher E, Cooper TE, Grégoire MC, Heathcote LC, Krane E, et al. Pharmacological interventions for chronic pain in children: an overview of systematic reviews. Pain. 2019 Aug;160(8):1698–707. https://doi.org/10.1097/j.pain.0000000000001609
  35. Simons LE, Logan DE, Chastain L, Cerullo M. Engagement in multidisciplinary interventions for pediatric chronic pain: parental expectations, barriers, and child outcomes. Clin J Pain. 2010 May;26(4):291–9. https://doi.org/10.1097/AJP.0b013e3181cf59fb
  36. Schechter NL. Functional pain: time for a new name. JAMA Pediatr. 2014 Aug;168(8):693–4. https://doi.org/10.1001/jamapediatrics.2014.530
  37. Koechlin H, Locher C, Prchal A. Talking to Children and Families about Chronic Pain: The Importance of Pain Education-An Introduction for Pediatricians and Other Health Care Providers. Children (Basel). 2020 Oct;7(10):E179. https://doi.org/10.3390/children7100179
  38. Matthews E, Murray G, McCarthy K. ICD-11 classification of paediatric chronic pain referrals in Ireland with secondary analysis of primary vs. secondary pain conditions. Pain Med. 2021 Nov;22(11):2533–41. https://doi.org/10.1093/pm/pnab116
  39. Bhatia A, Brennan L, Abrahams M, Gilder F. Chronic pain in children in the UK: a survey of pain clinicians and general practitioners. Paediatr Anaesth. 2008 Oct;18(10):957–66. https://doi.org/10.1111/j.1460-9592.2008.02710.x

Most read articles by the same author(s)