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

Original article

Vol. 149 No. 1516 (2019)

Characteristics of children and adolescents at the Switzerland-wide first ambulatory interdisciplinary pain clinic at the University Children’s Hospital Basel – a retrospective study

  • Tobias Schneider
  • Dominik Pfister
  • Andreas Wörner
  • Wilhelm Ruppen
Cite this as:
Swiss Med Wkly. 2019;149:w20073



Given the long history of underestimating chronic pain in children and adolescents, we lack valid data on its assessment and treatment. The psychological and economic burden for patients, their families and society is substantial. The aim of this study was to assess patient characteristics of the first ambulatory interdisciplinary clinic for children and adolescents with chronic pain in Switzerland and compare them with data from other international centres.


All patients of the ambulatory interdisciplinary pain clinic at the University Children’s Hospital in Basel during the period from 4 January 2012 to 4 July 2016 were included in this retrospective study. Data were collected from the patients’ medical records and from a questionnaire, which the patients and their parents received and completed in advance of their first visit. Demographic information, pain, referral, social environment, therapies and school absences of the patients were statistically analysed with means, percentages, 95% confidence intervals (CIs) and standard deviations (SDs).


Of the 135 patients included in this study, 80% were female and the mean age of all patients was 13.95 years (95% CI 13.5–14.4). The commonest pain presentations were: musculoskeletal (38%, 95% CI 0.30–0.46), back (25%, 95% CI 0.18–0.33), multiple regions (21%, 95% CI 0.15–0.28) and headache (7%, 95% CI 0.03–0.12). Mean duration of pain until the patients came to the clinic was 24.5 months (95% CI 19.82–29.22). Physiotherapy (71%, 95% CI 0.63–0.79) and non-opioids (50%, 95% CI 0.42–0.59) were the most used therapies before the first meeting. Psychotherapy (52%, 95% CI 0.44–0.61), most often using a psychosomatic therapeutic approach (psychosomatic therapy) 34% (95% CI 0.26–0.42), physiotherapy (36%, 95% CI 0.27–0.44) and non-opioids (33%, 95% CI 0.25–0.42) afterwards. The mean number of school absences during the last month before the first visit was 5.1 days per month (95% CI 3.48–6.73). The parents of our study participants suffered more often from psychiatric diseases than the mean Swiss population.


The average of more than 2 years of pain before referral to the clinic seems to be a long time. Assuming that specialised support is mandatory for young patients with complex pain syndromes, the referral time should be reduced. Furthermore, patients with headache were underrepresented in Basel compared with other centres. Interestingly, in our study, patients’ parents suffered more often from psychiatric diseases than the mean Swiss population.


  1. Eccleston C, Malleson P. Managing chronic pain in children and adolescents. We need to address the embarrassing lack of data for this common problem. BMJ. 2003;326(7404):1408–9. doi:.
  2. 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;87(1):51–8. doi:.
  3. Huguet A, Miró J. The severity of chronic pediatric pain: an epidemiological study. J Pain. 2008;9(3):226–36. doi:.
  4. 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;152(12):2729–38. doi:.
  5. Stanford EA, Chambers CT, Biesanz JC, Chen E. The frequency, trajectories and predictors of adolescent recurrent pain: a population-based approach. Pain. 2008;138(1):11–21. doi:.
  6. Anttila P, Metsähonkala L, Sillanpää M. Long-term trends in the incidence of headache in Finnish schoolchildren. Pediatrics. 2006;117(6):e1197–201. doi:.
  7. Luntamo T, Sourander A, Santalahti P, Aromaa M, Helenius H. Prevalence changes of pain, sleep problems and fatigue among 8-year-old children: years 1989, 1999, and 2005. J Pediatr Psychol. 2012;37(3):307–18. doi:.
  8. Zernikow B. Schmerztherapie bei Kindern, Jugendlichen und jungen Erwachsenen. 5th ed. Berlin: Springer Verlag; 2015.
  9. Landry BW, Fischer PR, Driscoll SW, Koch KM, Harbeck-Weber C, Mack KJ, et al. Managing chronic pain in children and adolescents: A clinical review. PM R. 2015;7(11, Suppl):S295–315. doi:.
  10. 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;15(9):925–33. doi:.
  11. Pate JW, Hush JM, Hancock MJ, Moseley GL, Butler DS, Simons LE, et al. A Child’s Concept of Pain: An International Survey of Pediatric Pain Experts. Children (Basel). 2018;5(1):12. doi:.
  12. Konijnenberg AY, Uiterwaal CS, Kimpen JL, van der Hoeven J, Buitelaar JK, de Graeff-Meeder ER. Children with unexplained chronic pain: substantial impairment in everyday life. Arch Dis Child. 2005;90(7):680–6. doi:.
  13. Liossi C, Howard RF. Pediatric chronic pain: Biopsychosocial assessment and formulation. Pediatrics. 2016;138(5):e20160331. doi:.
  14. 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;30(3):468–82. doi:.
  15. Schroeder S, Hechler T, Denecke H, Müller-Busch M, Martin A, Menke A, et al. [German Pain Questionnaire for Children, Adolescents and Parents (DSF-KJ). A multimodal questionnaire for diagnosis and treatment of children and adolescents suffering from chronic pain]. Schmerz. 2010;24(1):23–37. German. doi:.
  16. Egle UT, Egloff N, von Känel R. Stressinduzierte Hyperalgesie (SIH) als Folge von emotionaler Deprivation und psychischer Traumatisierung in der Kindheit [Stress-induced hyperalgesia (SIH) as a consequence of emotional deprivation and psychosocial traumatization in childhood : Implications for the treatment of chronic pain]. Schmerz. 2016;30(6):526–36. German. doi:.
  17. Harreby M, Nygaard B, Jessen T, Larsen E, Storr-Paulsen A, Lindahl A, et al. Risk factors for low back pain in a cohort of 1389 Danish school children: an epidemiologic study. Eur Spine J. 1999;8(6):444–50. doi:.
  18. 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;150(3):568–72. doi:.
  19. Hechler T, Kanstrup M, Holley AL, Simons LE, Wicksell R, Hirschfeld G, et al. Systematic review on intensive interdisciplinary pain treatment of children with chronic pain. Pediatrics. 2015;136(1):115–27. doi:.
  20. Wager J, Hechler T, Darlington AS, Hirschfeld G, Vocks S, Zernikow B. Classifying the severity of paediatric chronic pain - an application of the chronic pain grading. Eur J Pain. 2013;17(9):1393–402. doi:.
  21. Wager J, Zernikow B, Darlington A, Vocks S, Hechler T. Identifying subgroups of paediatric chronic pain patients: a cluster-analytic approach. Eur J Pain. 2014;18(9):1352–62. doi:.
  22. Perquin CW, Hazebroek-Kampschreur AA, Hunfeld JA, van Suijlekom-Smit LW, Passchier J, van der Wouden JC. Chronic pain among children and adolescents: physician consultation and medication use. Clin J Pain. 2000;16(3):229–35. doi:.
  23. Zernikow B, Wager J, Hechler T, Hasan C, Rohr U, Dobe M, et al. Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients. BMC Pediatr. 2012;12(1):54. doi:.
  24. Bundesamt für Statistik. Behandlung aufgrund eines psychischen Problems (12 Monate) nach Alter, Geschlecht, Sprachgebiet, Bildungsniveau. 2014. Available at:
  25. Nickel R, Egle UT. Konfliktbewältigung als pathogenetisches Bindeglied zwischen psychosozialen Belastungen in der Kindheit und psychischen Erkrankungen im Erwachsenenalter [Coping with conflict as pathogenetic link between psychosocial adversities in childhood and psychic disorders in adulthood]. Z Psychosom Med Psychother. 2001;47(4):332–47. German. doi:.
  26. Bundesamt für Statistik. Familien in der Schweiz. Neuchâtel, Switzerland: Bundesamt für Statistik; 2017.
  27. Fisher E, Heathcote L, Palermo TM, de C Williams AC, Lau J, Eccleston C. Systematic review and meta-analysis of psychological therapies for children with chronic pain. J Pediatr Psychol. 2014;39(8):763–82. doi:.
  28. Berna C, Kulich RJ, Rathmell JP. Tapering Long-term Opioid Therapy in Chronic Noncancer Pain: Evidence and Recommendations for Everyday Practice. Mayo Clin Proc. 2015;90(6):828–42. doi:.
  29. Zernikow B, Hechler T. Pain therapy in children and adolescents. Dtsch Arztebl Int. 2008;105(28-29):511–21, quiz 521–2.
  30. Hechler T, Dobe M, Kosfelder J, Damschen U, Hübner B, Blankenburg M, et al. Effectiveness of a 3-week multimodal inpatient pain treatment for adolescents suffering from chronic pain: statistical and clinical significance. Clin J Pain. 2009;25(2):156–66. doi:.
  31. Wager J, Zernikow B. Kinder und Jugendliche mit chronischen Schmerzen: Aktuelle Konzepte der Diagnostik und Therapie. Ther Umsch. 2017;74(5):215–21. German. doi:.